Presented to Australia China Dialogue January 2022

1. “Tertiary” health
effects of climate and
other forms of
adverse
environmental and
social change
Australia-China
Dialogue
National Centre for Epidemiology and Population Health
Hon Prof Colin Butler, BMed, MSc, PhD
colin.butler@anu.edu.au January 24, 2022
Ahmad Masood/Reuters
https://www.cfr.org/modern-
slavery#!/section1/item-1

2. https://theconversation.com/
profiles/tony-mcmichael-56

3. This lecture may be hard to
understand .. and not only
because of my accent
However, some people do understand!
Especially if you think “ecologically”. But, what
does that mean??

4. Ecos (oikos) – our
home
Millennium Ecosystem
Assessment (2002-05)
https://www.millenniumassessment.o
rg/en/GraphicResources.html
Ernst Haeckel
(1834-1919)

5. 1: Primary, secondary and tertiary effects
-
History (since 1993)
2: Causation
3: Eco-climatic change
4. Tertiary effects
5. Conclusion

6. “Tertiary effects will be experienced as a result of the effects of
changes in the availability of food and water, shelter and
changing patterns of disease on population movements,
including refugees, on the probability of conflict and on
political and economic systems.”
1993

7. The Lancet
1993

8. Direct effects of a rise in temperature (particularly ..
heatwaves) may include deaths from cardiovascular and
cerebrovascular disease among the elderly. Indirect effects
are secondary, such as changes in vector-borne diseases or
crop production, and tertiary, such as the social and
economic impacts of environmental refugees and conflict
over fresh water supplies.
The Lancet
1993

9. 1996

10. 2005

11. Butler et al., 2005
Primary
Secondary
Tertiary
Even worse

12. 12
Confaloneri et al, IPCC, 2007
2007
Primary
Secondary
Tertiary

13. Famine (hinted)
Conflict
Migration not mentioned
2010

14. Secondary
Tertiary
Primary
2014

15. secondary
primary
tertiary
“Tertiary” Health effects
famine, war, population
displacement, refugees,
development failure
15

16. 16
1: Primary, secondary and tertiary effects
2: Causation
3: Eco-climatic change
4. Tertiary effects
5. Conclusion

17. “downstream”
upstream downstream
determinants of health
We should think of the “causes of the causes” – Geoffrey Rose

18. “downstream”
upstream downstream
determinants of health
Smoking causes
cancer
Social disadvantage
causes smoking
A shooter causes
homicide
Deprivation causes a
a shooter
We should think of the “causes of the causes” – Geoffrey Rose

19. 19
causation either “proximate” or
more complex, distal, “risk multiplying”

20. environmental factor effect
“environmental determinism” (alleged )
climate change conflict

21. One effect to rule them all? A comment on climate and conflict
Buhaug, H. et al. (2014) Climatic Change

22. “contradict assertions that eco-scarcity or climate change
alone provoked the outbreak of conflict” (Brown, I.A.
(2010) Assessing eco-scarcity as a cause of the outbreak of
conflict in Darfur: A remote sensing approach. Int J Remote
Sensing)

23. A “strawman” argument!

24. “There are many factors that contribute to conflict in Sudan
that have little or no link to the environment or natural
resources. These include political, religious, ethnic, tribal and
clan divisions, economic factors, land tenure deficiencies and
historical feuds. In addition, where environment and natural
resource management issues are important, they are
generally contributing factors only, not the sole cause for
tension” (UNEP, 2007).

25. internal migration
rival groups
(including religious) poor governance
climate change/
drought
aquifer depletion
high fertility, youth bulges, high unemployment
“eco-social”
determinism
economic liberalisation
Butler, C.D.; Kefford, B.J. Climate and conflict: magnifying risks. Nature 2018, 555, 587.
Butler, C.D. Regional overload” as an indicator of profound risk: a plea for the public health community to awaken. In Medicines for the
Anthropocene: Health on a Finite Planet, Quilley, S.; Zywert, K., Eds. University of Toronto Press: Toronto, Canada (2020).
Syrian
war

26. 26
1: Primary, secondary and tertiary effects
2: Causation
3: Eco-climatic change
4. Tertiary effects
5. Conclusion

27. 27
Part 3: Environmental determinants are
worsening

28. Safe space for
humanity
Steffen et al.,
2015
“Planetary
Boundaries”

29. https://www.carbonbrief.org/analysis-why-scientists-think-100-of-global-warming-is-due-to-humans

30. Stefan Rahmstorf

31. 31
1: Primary, secondary and tertiary effects
2: Causation
3: Eco-climatic change
4. Tertiary effects
5. Conclusion

32. 32
Part 4: Tertiary effects
Conflict
Migration

33. 33
Thomas Robert (Bob) Malthus
(1766-1834)
World’s first
professor of
political economy
Six editions
1798 –1826

34. THE MOST
FUNDAMENTAL
PRINCIPLE?

35. THE MOST
FUNDAMENTAL
PRINCIPLE?
all nature is "at war, one organism with another” .. The war, however, is
not constant, … and hence its effects are easily overlooked.
“It is the doctrine of Malthus applied in most cases with tenfold force.”

36. “Hung cannot have known of Malthus for the simple reason that he
published his essays in the same year (1798)” .. Closer to China was a
“Japanese Malthus ” a contemporary with Hung; the notion that only
Western Europe could produce the views associated with the name of
Malthus is certainly fallacious.”

37. “Of all things in the world, people are the most precious. We believe that revolution can
change everything, and that before long there will arise a new China with a big population
and a great wealth of products, where life will be abundant and culture will flourish. All
pessimistic views are utterly groundless.” Chairman Mao (1949)
Reviewed Work(s): China's Population Struggle: Demographic
Decisions of the People’s Republic, 1949-1969. by H. Yuan Tien
Review by: W. D. Borrie
Demography, Vol. 11, No. 4 (Nov., 1974), pp. 702-705
https://www.jstor.org/stable/2060481

39. Ban Ki-Moon (UN Secretary General) on climate &
conflict
•"In coming decades, changes in our environment and
the resulting upheavals from droughts to inundated
coastal areas to loss of arable land are likely to
become a major driver of war and conflict"
March 1, 2007

40. Climate change will 'lead to battles for food',
says head of World Bank (April 2014)
Jim Yong Kim
“With the increasing impacts of
climate change evident in all
regions, the risks are only going
to grow” - UN chief António
Guterres October 2018
https://news.un.org/en/story/2018/10/1023332
Climate change is exacerbating world
conflicts, says Red Cross president
(Oct 21, 2018)
Many other senior politicians, e.g. U.S.
President Obama in his Nobel Peace Prize
acceptance speech

41. 41
(2012)

42. 42
Components needed for climate conflict

43. 43
Climate change
related?
conflict
extreme
event
Psychological willingness (ie
to accept the link)

44. 44
Climate change
related?
conflict
extreme
event
Darfur, Sudan
Syria Case studies
Psychological willingness (ie
to accept the link)

45. 45
case study 1.
Darfur, Sudan, 2003
Sahel – extending to Yemen

46. 46
UNEP .. Crop yields could fall up to 70% in most vulnerable areas of
Sahel (Senegal – Sudan). "It illustrates and demonstrates what is
increasingly becoming a global concern," said Achim Steiner, UNEP's
executive director. "It doesn't take a genius to work out that as the
desert moves southwards there is a physical limit to what [ecological]
systems can sustain, and so you get one group displacing another."
Over 2 million people displaced,
2-500,000 “casualties”: UNEP;
excess deaths: c300,000 (Lancet)

47. 47
Kevane & Gray. 2008. Darfur: rainfall and conflict. Environmental Research Letters

48. 48
Alex De Waal (1980s).. In a herders’ camp near the desert’s border, met bedridden, nearly
blind Arab sheikh .. who said he was noticing things he had never seen before: Sand blew
into fertile land .. rare rain washed away alluvial soil. Farmers who had once
hosted his tribe and his camels were now blocking their migration; the land
could no longer support both herder and farmer. Many tribesmen had lost their
stock and scratched at millet farming on marginal plots.
The God-given order was broken, the sheikh said, and he feared the future. “The
way the world was set up since time immemorial was being disturbed,” recalled de Waal. “And
it was bewildering, depressing. And the consequences were terrible.”
Environmental degradation “creates very dry tinder,” says de Waal. “So if anyone wants to put
a match to it, they can light it up.”
Faris, Stephan. 2007. "The Real Roots of Darfur." The Atlantic Monthly
http://www.facstaff.bucknell.edu/sdjordan/berc/The%20Real%20Roots%20of%20Darfur.pdf

49. 49
“true culprit” .. National Islamic Front, which came to power in
Khartoum in a military coup (1989) .. intent on expanding political
base though ethnic cleansing, using terror as a tactic.. This is not
about competition over resources.” Eric Reeves
Butler, Declan. 2007. "Darfur's climate roots challenged." Nature 447:1038

50. 50
Darfur: conclusions
Complicated
Rain declined in about 1970 (possibly related to CO2 rise)
Massive population increase (all of Sudan)
Lots of “low level” violence (documented since 1930s)
Major shift 2003 initiating mass violence; a leader in that was son of the
blind sheik that de Waal met
Would this have happened as soon without the decline in rain?
Not possible to rule out a connection

51. 51
https://www.flickr.com/photos/syriana2011/6089225897/
case study 2: Syria

52. 52
Kelley et al, 20015
“drought’s devastating
impact on vegetation
is clear”
Normalized Difference Vegetative Index
2008 minus 2001-07 mean
liquid water equivalent

53. 53
Kelley et al, 20015
PDSI =Palmer Drought Severity Index
When a severe drought began
in 2006/2007, the agricultural
system in the northeastern
“breadbasket” region, which
typically produced over two-
thirds of the country’s crop
yields, collapsed
In 2008, after the driest winter in
Syria’s observed record, wheat
production failed and the agricultural
share fell to 17% (from average

54. internal migration
rival groups
(including religious) poor governance
climate change/
drought
aquifer depletion
high fertility, youth bulges, high unemployment
“eco-social”
determinism
economic liberalisation
Butler, C.D.; Kefford, B.J. Climate and conflict: magnifying risks. Nature 2018, 555, 587.
Butler, C.D. Regional overload” as an indicator of profound risk: a plea for the public health community to awaken. In Medicines for the
Anthropocene: Health on a Finite Planet, Quilley, S.; Zywert, K., Eds. University of Toronto Press: Toronto, Canada (2020).
Syrian
war

55. OTHER
Afghanistan – drought
Lake Chad region (northern Nigeria, Niger, Chad) drought
55
FUTURE:
Bangladesh (sea level rise)
India/Pakistan (damming of Indus tributaries)
Some Pacific islands (local violence)

56. Mass migration

58. https://openknowledge.worldbank.org/handle/10986/29461

59. https://openknowledge.worldbank.org/handle/10986/29461

60. https://www1.wfp.org/publications/2017-
food-security-emigration-why-people-flee-
salvador-guatemala-honduras

61. Central American immigrants take part in a caravan heading to the United States on the road linking Ciudad Hidalgo and Tapachula,
Mexico, on October 21, 2018. # Pedro Pardo / AFP / Getty
https://www.theatlantic.com/photo/2018/10/photos-migrant-caravan/573604/?utm_source=feed
c10% pop’n Guatemala, El Salvador and Honduras fled
danger, forced gang recruitment and dismal economic
opportunities .. one of world’s highest murder rates ..
caravan not "seeking American dream" but "fleeing the
Honduras nightmare" https://www.bbc.com/news/world-us-canada-45920624

62. 62
“continuation of the current pattern of global emissions may limit habitability
in the most populous region, of the most populous country on Earth.”
Kang & Eltahir. 2018. North China Plain threatened by
deadly heatwaves due to climate change and
irrigation. Nature Communications 9:2894.

63. 1: Primary, secondary and tertiary effects
-
History (since 1993)
2: Causation
3: Ecological change
4. Tertiary effects
5. Conclusion

64. 64
Part 5: Conclusion
Civilization at risk?
Securitisation?
Technology: necessary, not sufficient
Hope

65. Carbon pools vulnerable to global warming and land-use
change Canadell et al, 2007
Runaway warming

66. “Tipping points” in the physical system
Lenton et al, 2008

67. “Tipping points” in the eco-social system?
refugees? misery?
conflict?
sea level rise
migration path?
migration path?

68. "North Africa is already hot and is strongly increasing in temperature. At some
point in this century, part of the region will become uninhabitable," Jos Lelieveld,
a climate scientist from the Max Planck Institute for Chemistry, told CNN.
Lelieveld et al. (2016) Strongly increasing heat extremes in the Middle East and North Africa
(MENA) in the 21st century. Climatic Change:1-16
Lin & Emanuel (2015) Grey swan tropical cyclones Nature Climate Change
cyclone originates .. makes landfall north of Dubai with extremely high intensity
(115 m/s), generating a storm surge of 7.4m in Dubai; far beyond highest observed
intensity worldwide so far seen (Typhoon Haiyan 87 m/second).

69. “The dangerous impacts of
climate change can only be
discussed in terms of
nonlinear behavior.’’
Hans Joachim Schellnhuber
“The difference between 2 and
4 degrees of warming ..
is civilisation’’

70. Lancaster House
“securitisation”

72. Crisis = opportunity

73. Ingenuity in the Year without a summer (1816)