<p class="BodyA"><b style="mso-bidi-font-weight:normal"><span style="font-size:
14.0pt;mso-bidi-font-size:10.0pt">Climate Change and Health </span></b></p>
<p class="BodyA"><b style="mso-bidi-font-weight:normal"> </b></p>
<p class="BodyA"><b style="mso-bidi-font-weight:normal"><span style="font-size:
11.0pt;mso-bidi-font-size:10.0pt">Louis Reynolds and David Sanders</span></b></p>
<p class="BodyA"> </p>
<p class="BodyA"><span style="font-size:10.0pt">[The second of a 2-part series on
the NHI, based on an article written for the </span><span style="font-size:
10.0pt;color:#16356B;mso-font-kerning:0pt">One Million Cli</span><span style="font-size:10.0pt">mate Jobs Campaign]</span></p>
<p class="BodyA"> </p>
<p class="BodyA"> </p>
<p class="BodyA">Climate change is the largest threat to global health in
history. Health systems, on the other hand, exist to promote, protect and
improve people’s health, and to prevent and treat disease. </p>
<p class="BodyA"> </p>
<p class="BodyA">As large, resource and energy-intensive organizations that
employ many people, health systems produce large amounts of greenhouse gase<span style="mso-ignore:vglayout">
<table cellpadding="0" cellspacing="0">
<tbody><tr>
<td width="83" height="0"><br></td>
</tr>
<tr>
<td><br></td>
<td><img src="file:///C:/Users/Aviva/AppData/Local/Temp/msohtml1/01/clip_image002.gif" width="418" height="288"></td>
</tr>
</tbody></table>
</span><br style="mso-ignore:vglayout" clear="ALL">
s. Therefore, they contribute to climate change, raising the paradox that, on
balance, they may, inadvertently, do people’s health more harm than good in the
long term. </p>
<p class="BodyA"> </p>
<p class="BodyA"><b style="mso-bidi-font-weight:normal"><i style="mso-bidi-font-style:
normal">The impacts of climate change on health</i></b></p>
<p class="BodyA"> </p>
<p class="BodyA">The World Health Organisation estimates that global warming and
trends in rainfall due to human-induced climate change already claim over
150,000 lives annually. Diseases associated with climate change include heart
and lung disease due to heat waves, increased spread of infectious diseases,
and malnutrition due to crop failures. </p>
<p class="BodyA"> </p>
<p class="BodyA">Sub-Saharan Africa is one of
the most vulnerable regions, especially its sprawling cities where the effects
of urbanisation aggravate extreme climatic events. <span style="mso-ansi-language:EN-GB" lang="EN-GB">More people die from the effects of climate
change in Africa than anywhere else. </span></p>
<p class="BodyA"><span style="mso-ansi-language:EN-GB" lang="EN-GB"> </span></p>
<p class="BodyA">The map shows deaths from climate change for 2002 as estimated
by the World Health Organization (WHO). </p>
<p class="BodyA"><span style="mso-ansi-language:EN-GB" lang="EN-GB"> </span></p>
<p class="BodyA"><span style="mso-ansi-language:EN-GB" lang="EN-GB">Humanitarian
disasters like the famine in Somalia,
where the effects of drought are being compounded by corruption, conflict and
political instability, are likely to become more frequent. With refugees
pouring into camps in Kenya
at the rate of 1500 a day – 80 percent of them women and children – and
uncountable deaths, this is emerging as Africa’s
worst humanitarian crisis in decades. </span></p>
<p class="BodyA"> </p>
<p class="BodyA">But the health impacts of climate change extend beyond those
directly due to heat waves, floods and droughts to include those due to
destroyed livelihoods, altered land use, and food insecurity.<span style="mso-spacerun:yes"> </span>These include large-scale migration from
affected areas, leading to squalid urbanization, social disruption, conflict,
and instability; and increasing the burden on already overburdened health
systems. </p>
<p class="BodyA"> </p>
<p class="BodyA"><i style="mso-bidi-font-style:normal"> </i></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><i style="mso-bidi-font-style:
normal"><span style="font-family:Helvetica;mso-font-kerning:.5pt;mso-ansi-language:
EN-US">The impact of health systems on climate change</span></i></b></p>
<p class="MsoNormal"><span class="BodyAChar"> </span></p>
<p class="MsoNormal"><span class="BodyAChar">Given the devastating and growing
impact of climate change on health, it is ironic that health systems themselves
contribute substantially to climate change through their enormous greenhouse
gas (GHG) emissions. </span></p>
<p class="MsoNormal"><span class="BodyAChar"> </span></p>
<p class="MsoNormal"><span class="BodyAChar">While no data exist for South Africa,
it is possible to extrapolate from the United Kingdom (UK), where research by
the Sustainable Development Unit (SDU) – a unit within the National Health
Service (NHS) established recently in recognition of the urgent need to address
the NHS contribution to climate change – shows that in 2004, the carbon
footprint of the NHS was 18.61 million tons (MtCO2) per year, representing 25%
of England’s public sector emissions. It has since grown to 21 MtCO2 per year,
which is larger than some medium-sized countries.</span></p>
<p class="MsoNormal"><span class="BodyAChar"> </span></p>
<p class="MsoNormal" style="margin-bottom:10.0pt;tab-stops:15.3pt 30.6pt 45.9pt 61.25pt 76.55pt 91.85pt 107.15pt 122.45pt 137.75pt 153.05pt 168.4pt 183.7pt 199.0pt 214.3pt 229.6pt 244.9pt 260.2pt 275.55pt 290.85pt 306.15pt 321.45pt 336.75pt 352.05pt 367.35pt 382.7pt 398.0pt 413.3pt 426.0pt">
<span style="font-family:Helvetica;mso-ansi-language:EN-US">This carbon production is
made up of an ‘external’ component (coal burning for energy, food processed and
transported, transport used by staff) and an ‘'internal’ component – calculated
per hospital bed or per outpatient visit.</span></p>
<p class="MsoNormal" style="margin-bottom:10.0pt;tab-stops:15.3pt 30.6pt 45.9pt 61.25pt 76.55pt 91.85pt 107.15pt 122.45pt 137.75pt 153.05pt 168.4pt 183.7pt 199.0pt 214.3pt 229.6pt 244.9pt 260.2pt 275.55pt 290.85pt 306.15pt 321.45pt 336.75pt 352.05pt 367.35pt 382.7pt 398.0pt 413.3pt 426.0pt">
<span style="font-family:Helvetica;mso-ansi-language:EN-US">The table below shows
that the CO2 emissions resulting from a typical hospital admission in the UK are
approximately 7 times greater than an outpatient visit.<a name="Ref301520606"></a><span style="mso-spacerun:yes"> </span></span></p>
<p class="MsoNormal" style="margin-bottom:10.0pt;tab-stops:15.3pt 30.6pt 45.9pt 61.25pt 76.55pt 91.85pt 107.15pt 122.45pt 137.75pt 153.05pt 168.4pt 183.7pt 199.0pt 214.3pt 229.6pt 244.9pt 260.2pt 275.55pt 290.85pt 306.15pt 321.45pt 336.75pt 352.05pt 367.35pt 382.7pt 398.0pt 413.3pt 426.0pt">
<span style="font-family:Helvetica;mso-ansi-language:EN-US"> </span></p>
<p class="MsoNormal"><span lang="EN-GB"><img src="file:///C:/Users/Aviva/AppData/Local/Temp/msohtml1/01/clip_image004.gif" width="376" height="215"></span><span class="BodyAChar"></span></p>
<p class="MsoNormal"><span class="BodyAChar"> </span></p>
<p class="MsoNormal" style="margin-bottom:10.0pt"><span class="BodyAChar">South Africa</span><span class="BodyAChar">’s
total carbon emissions per capita are remarkably similar to those of the UK. In 2008 for
example, the carbon footprint of the UK
was 8.5 metric tons of CO2 per capita, while in South Africa it was 8.8. Moreover,
in South Africa, to a far
greater extent than in the UK,
greenhouse gas emissions are disproportionately produced by industries, a
corporate sector, and conveniences that predominantly cater to the demands of a
small elite.</span></p>
<p class="MsoNormal" style="margin-bottom:10.0pt;tab-stops:15.3pt 30.6pt 45.9pt 61.25pt 76.55pt 91.85pt 107.15pt 122.45pt 137.75pt 153.05pt 168.4pt 183.7pt 199.0pt 214.3pt 229.6pt 244.9pt 260.2pt 275.55pt 290.85pt 306.15pt 321.45pt 336.75pt 352.05pt 367.35pt 382.7pt 398.0pt 413.3pt 426.0pt">
<span style="font-family:Helvetica;mso-ansi-language:EN-US">While South Africa
has 28 hospital beds per 10000 people overall, the public and private sectors
have 22 and 38 beds per 10000 respectively. Our private sector is more
hospital-centered than the public sector, and its bed number is almost
identical to the UK’s
39 per 10000 people.</span></p>
<p class="MsoNormal" style="margin-bottom:10.0pt;tab-stops:15.3pt 30.6pt 45.9pt 61.25pt 76.55pt 91.85pt 107.15pt 122.45pt 137.75pt 153.05pt 168.4pt 183.7pt 199.0pt 214.3pt 229.6pt 244.9pt 260.2pt 275.55pt 290.85pt 306.15pt 321.45pt 336.75pt 352.05pt 367.35pt 382.7pt 398.0pt 413.3pt 426.0pt">
<span style="font-family:Helvetica;mso-ansi-language:EN-US">Thus, we can reasonably
assume that both the ‘external’ and the ‘internal’ components of health system
emissions in South Africa’s
private sector are comparable to those of the UK. </span></p>
<p class="MsoNormal" style="margin-bottom:10.0pt;tab-stops:15.3pt 30.6pt 45.9pt 61.25pt 76.55pt 91.85pt 107.15pt 122.45pt 137.75pt 153.05pt 168.4pt 183.7pt 199.0pt 214.3pt 229.6pt 244.9pt 260.2pt 275.55pt 290.85pt 306.15pt 321.45pt 336.75pt 352.05pt 367.35pt 382.7pt 398.0pt 413.3pt 426.0pt">
<span style="font-family:Helvetica;mso-ansi-language:EN-US">Public sector emissions
are likely to be lower per capita because of the greater proportion of
facilities that serve mainly outpatients (clinics and health centres) with
relatively fewer energy-consuming, GHG-producing inpatient beds and technology.
</span></p>
<p class="MsoNormal"><span class="BodyAChar">Given the above, urgent action is
needed to reduce health sector greenhouse gas emissions on a massive scale.
Health systems exist to promote and protect the health of populations, and they
should not themselves contribute to the causation of disease. Furthermore,
health systems must be sustainable into the future. </span></p>
<p class="MsoNormal"><span class="BodyAChar"> </span></p>
<p class="MsoNormal"><span class="BodyAChar"> </span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span style="font-family:Helvetica;mso-font-kerning:.5pt;mso-ansi-language:EN-US">Climate
change increases the urgency of health system transformation in South Africa</span></b></p>
<p class="MsoNormal"><span style="font-family:Helvetica;mso-font-kerning:.5pt;
mso-ansi-language:EN-US"> </span></p>
<p class="MsoNormal" style="background:white"><span style="font-family:Helvetica;
mso-font-kerning:.5pt;mso-ansi-language:EN-US">The growing awareness of the
interactions between health systems and climate change challenges us to ensure
that our new health system not only provides good health care for all now and
in the future, but that it also minimizes its impact on the planet and is
sustainable. </span></p>
<p class="MsoNormal" style="background:white"><span style="font-family:Helvetica;
mso-font-kerning:.5pt;mso-ansi-language:EN-US"> </span></p>
<p class="MsoNormal" style="background:white"><b style="mso-bidi-font-weight:
normal"><span style="font-family:Helvetica;mso-font-kerning:.5pt;mso-ansi-language:
EN-US">The parallel policy initiatives of the NHI and Re-engineering Primary
Health Care’ could, if thoughtfully implemented, address three crises
simultaneously: the health crisis, the employment crisis, and the carbon
emissions crisis. </span></b></p>
<p class="MsoNormal" style="background:white"><span style="font-family:
Helvetica" lang="EN-GB">.</span><span style="font-family:Helvetica;mso-font-kerning:.5pt;
mso-ansi-language:EN-US"></span></p>
<p class="MsoNormal" style="background:white"><span style="font-family:Helvetica;
mso-font-kerning:.5pt;mso-ansi-language:EN-US">The common core of these
policies would be to move the centre of gravity of the system out of the
hospitals and into the community, closer to where people live. This will entail
new thinking about human resources for health, with a shift in emphasis from
the hospital based, doctor-centered model to a community-based model that
incorporates more community and midlevel health workers. </span></p>
<p class="MsoNormal" style="background:white"><span style="font-family:Helvetica;
mso-font-kerning:.5pt;mso-ansi-language:EN-US"> </span></p>
<p class="MsoNormal" style="background:white"><span style="font-family:Helvetica;
mso-font-kerning:.5pt;mso-ansi-language:EN-US">With the necessary political
will and a participative multi-sectoral approach, massive reductions in GHG
emissions can be achieved and simultaneously large numbers of jobs created. </span></p>
<p class="MsoNormal"><span class="BodyAChar"> </span></p>
<p class="MsoNormal"><span class="BodyAChar">Greening the health system is highly
likely to save money and to create employment both within the health service
itself and in other sectors that are necessary for the process.</span></p>
<p class="MsoNormal"><span class="BodyAChar"> </span></p>
<p class="MsoNormal"><span class="BodyAChar">In the UK the SDU calculates that the NHS
can save at least £180 million per year by reducing its carbon emissions. Some
of the measures being considered and implemented include: reduction of hospital
energy consumption and costs through efficiency and conservation measures;
construction and modification of hospitals and facilities to ensure
responsiveness to local climate conditions with reduced energy and resource
demands; on-site production and consumption of clean, renewable energy; use of
alternative fuels for hospital vehicle fleets; encouraging public transport for
staff and patients; reducing expensive imported processed foods; providing sustainably-grown
local food for staff and patients, ideally procured from small local farmers or
produced in hospital grounds by community members; reduction, re-use, recycling
and composting; employing alternatives to waste incineration; and<span style="mso-spacerun:yes"> </span>conserving water. </span></p>
<p class="MsoNormal"><span class="BodyAChar"> </span></p>
<p class="MsoNormal"><span class="BodyAChar">Implementation of these measures in South Africa
would create jobs and expertise in the health, transport, agricultural and
other sectors and in the fields of recycling, energy conservation and renewable
energy production. </span></p>
<p class="MsoNormal"><span class="BodyAChar"> </span></p>
<p class="MsoNormal"><span class="BodyAChar">In the run-up to COP17 in Durban in late November
South Africa, the host, will be expected to demonstrate its own commitments to
reducing its carbon footprint. To our knowledge plans to address health sector
emissions are at best embryonic. Many of the above measures, researched in the UK, should be
urgently explored here. </span></p>
<p class="MsoNormal"><span class="BodyAChar"> </span></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span style="font-family:Helvetica;mso-ansi-language:EN-US"> </span></b></p>
<p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span style="font-family:Helvetica;mso-ansi-language:EN-US">Conclusion:</span></b></p>
<p class="MsoNormal"><span class="BodyAChar"> </span></p>
<p class="MsoNormal"><span class="BodyAChar">Radical health system transformation
and job creation are two key imperatives for South Africa. It is essential that
this transformation should address not only the health and employment needs of people
in South Africa
today, but also those of future generations. <a name="GoBack"></a></span></p>
<p class="MsoNormal"><span class="BodyAChar"> </span></p>
<p class="BodyA">The advent of the NHI gives us an historic opportunity to build
a sustainable national health system that not only meets the health care needs
of all, but that also addresses and minimizes the growing impacts of climate
change by reducing its own greenhouse gas emissions; playing a leading role in
promoting social justice and equitable socioeconomic development in order to
minimize the impacts on the poor and vulnerable; and finally, being prepared
and ready to deal with the changing disease patterns that emerge in the wake of
climate change.</p>
<p class="BodyA"> </p>
<p class="MsoNormal"><span style="font-family:Helvetica;mso-font-kerning:.5pt;
mso-ansi-language:EN-US">To do all this, we will have to confront powerful
groups with vested interests who will resist transformation at many different
levels. These must be overcome. Such a transformation of South Africa’s
health sector will require strong political will and concerted efforts by all
progressive organs of civil society.</span></p>
<p class="MsoNormal"><span style="font-family:Helvetica;mso-font-kerning:.5pt;
mso-ansi-language:EN-US"> </span></p>
<p class="MsoNormal"><span style="font-family:Helvetica;mso-font-kerning:.5pt;
mso-ansi-language:EN-US"> </span></p>
<p class="BodyA"> </p>
<p class="BodyA">Associate Professor Louis Reynolds,</p>
<p class="BodyA">Health Sciences Faculty</p>
<p class="BodyA">University
of Cape Town.</p>
<p class="BodyA"> </p>
<p class="BodyA">Emeritus Professor David Sanders,</p>
<p class="BodyA">School
of Public Health,</p>
<p class="BodyA">University of the Western
Cape.</p>
<p class="BodyA"> </p>
<p class="BodyA"> </p>
<p class="BodyA">Both authors are paediatricians and members of the Peoples
Health Movement <a href="http://www.phmovement.org">www.phmovement.org</a></p>
<p class="MsoNormal"><span style="font-family:Helvetica;mso-font-kerning:.5pt;
mso-ansi-language:EN-US"> </span></p>
<p class="MsoNormal"><a name="GoBack1"></a><span style="font-family:
Arial;mso-bidi-font-family:"Times New Roman"" lang="EN-GB"> </span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;mso-bidi-font-size:12.0pt;
mso-fareast-font-family:"Times New Roman";color:windowtext;mso-ansi-language:
#0400;mso-fareast-language:#0400;mso-bidi-language:X-NONE"> </span></p>