A presentation on planetary health concerns for the Gloucestershire branch of the British Medical Association, 7th February 2019. 190207 middletonj planetary health or plexit?

1. www.fph.org.uk
Planetary health? or Plexit?
Professor John Middleton
President, UK Faculty of Public Health
Honorary Professor of Public Health, Wolverhampton University

2. Who we are and what we do
• The United Kingdom Faculty of Public Health is a faculty of
the three Royal Colleges of Physicians of London, Edinburgh
and Glasgow (Physicians and Surgeons)
• FPH is a membership organisation for nearly 4,000 public
health professionals across the UK and around the world
• We also have a growing number of student, associate and
international members in more than 80 different countries
To improve and protect the public’s health:
through standards, advocacy, training and
knowledge
www.fph.org.uk

9. 822/02/2019

10. 922/02/2019

11. 1022/02/2019

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13. Rockefeller Lancet
Planetary Health
commission

16. Global environmental change- effects on health
 Climate change
 Biodiversity loss
 Freshwater depletion and
contamination
 Ocean acidification and
overfishing
 Carbon dioxide
fertilization
 Land use change and soil
degradation
 Urbanization
DIRECT EFFECTS ---HEAT AND EXTREME EVENTS
ECOSYSTEM MEDIATED EFFECTS e.g.
EMERGING INFECTIOUS DISEASES
VECTOR-BORNE DISEASES e.g malaria, dengue
WATER-BORNE DISEASES
FOOD SUPPLY and UNDERNUTRITION
SOCIALLY MEDIATED EFFECTS e.g. POVERTY,
MIGRATION AND CONFLICT


17. Increasing exposure to heatwaves
• Headline Finding:
Between 2000 and
2016, the number of
vulnerable people
exposed to heatwave
events has increased
by around 125 million.
16

18. • Heat inequality Guardian
1722/02/2019

19. •
1822/02/2019

20. 1922/02/2019

22. Land use change,
biodiversity loss and
disease risk
Disease control
strategies require
better understanding
of the relative
importance for
health of land use
change, biodiversity
loss, and other
environmental
drivers and their
interactions.
EcoHealth Alliance/Loh et al. in State of
knowledge review, 2015
0 50
Land use change
Food Industry Change
Infection susceptibility
Ag. Industry change
Int. Travel and Commerce
War and Famine
Unspecified
Climate and Weather
Public Health Breakdown
Bushmeat
Drivers of recently-emerging infectious
diseases in humans
from wildlife

23. Aleksandrowicz et al., PLoS ONE 2016
Systematic review on impacts of shifting from current
(Western) diets to more environmentally sustainable
dietary patterns:
Environmental
Impact
Relative differences compared to
current diets
Healthy dietary
guidelines
Vegetarian diets
Greenhouse gas
emissions
12% reduction 31% reduction
Land use 20% reduction 51% reduction
Water Use 6% reduction 37% reduction

24. 2oC Target

25. 2422/02/2019
GW1.5 main findings

26. • In its new evidence-based report, the IPCC contrasts the
impacts of 1.5C and 2C warming. This report predicts a
difference of 10 cm sea level rise and 10.4 million displaced
people by 2100, and a difference of 190 million premature
deaths and hundreds of millions of people forced into poverty
by 2050. Further, the IPCC discusses what is required to limit
warming to 1.5OC. Its conclusion is stark: we must reduce CO2
emissions by at least 45% in the next 12 years compared to
2010 levels; and achieve net zero CO2 production by 2050. This
is a tall order, requiring action on multiple fronts at all levels of
society – from the local to the global.
2522/02/2019
GW1.5 main findings

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28. 22/02/2019 27

29. 2822/02/2019
The UK government has even
imposed a legal obligation upon
itself, under the Infrastructure Act
2015, to “maximise economic
recovery” of the UK’s oil and gas.

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31. 3022/02/2019

32. 3122/02/2019

33. 3222/02/2019

34. 3322/02/2019

35. 3422/02/2019
In the decade between 2001 and 2011, global military
spending increased by an estimated 92 percent, according to
Stockholm International Peace Research, although it fell by
1.9 percent in real terms in 2013 to $1,747 billion. At the same
time, according to the draft of a new study from the
International Peace Bureau (1), almost 10 gigatons of carbon
dioxide equivalent has been released into the atmosphere.
According to the Global Carbon Project, 2014 emissions are
set to reach a record high. Could there be some connection
between rising military expenditures and rising carbon
emissions?

36. Climate change and war, conflict over
scarce resources
Conflict over unfair access to
resources
Destroyed environments causing
conflicts

39. From Alcamo and Heinrichs, 2002. In: Dialogue on Water and Climate, 2003.
Water critical regions
Medium water stress today & future increase in stress plus HDI>0.8
A2 scenario, ECHAM4, 2020s

41. Interconnectness
:
Climate change
refugees

42. 41

43. 4222/02/2019

44. Other lessons (less optimistic)

46. Impact of environmental exposures on vegetable/legume yields (
Scheelbeek et al 2018)
CO2
+250ppm
Water availability
-50%
Temperatur
e +4°C
Ozone
+25%
-25% +25%
Mean yield change & confidence intervals measured in
included studies
+50%-50%
Negative
Effects*
Positive
Effects*
Baseline > 20°C
*All vegetables & legumes
combined

47. Coccolithophore (diatom): Produces 50% of the
world’s oxygen
Algal blooms photosynthesising off
south west coast of Britain

50. • Insectageddon
4922/02/2019

51. Strategic
alliances:
A ‘one
health’
approach

52. A future without antibiotics?
A future with only public health ?

53. Fairer and
more sustainable
global health…

55. Poverty, inequality & violence
Local forces – poverty
Global forces – colonialism & globalisation
Ethnicity
Poverty, inequality & economic development
Political factors – social contracts & democracy
The international dimension
The underlying causes of civil war
The underlying causes of structural violence

56. • All based on an
unsustainable
economic model
• consumerism
• status
• trust
• social cohesion
• Unequal societies are
less sustainable

57. Income to improve health
– what’s the evidence?
L
I
F
E
E
X
P
E
C
T
A
N
C
Y
INCOME

59. The world map reflecting production related to climate change. “Climate
Change presents the biggest threat to health in the 21st Century” The Lancet (373;9697 pp 1659-1734, May 16-22 2009).
Who produces the greenhouse gases?

60. Who bears the burden?
The world map reflecting mortality related to climate change.
“Climate Change presents the biggest threat to health in the 21st Century” The Lancet (373;9697 pp 1659-1734,
May 16-22 2009).

61. Jyväskylä, Finland circular economy P.Melville

62. Thinking Globally,
acting locally
Community led
Active travel, walking
and cycling in
Sandwell, UK

63. Thinking
globally,
acting locally:
Options for
life timber-
frame, self-
built
community
centre
Sandwell, UK

64. Thinking global, acting
local
Urban agriculture in
Sandwell, UK
A beacon for food
growing, jobs and skills
creation and
environmental
protection

65. Thinking globally,
acting locally:
Coventry and
Warwickshire
University
Hospitals Jubilee
Nature Reserve –
managing water
run off from
hospital car parks
- promoting
biodiversity, saving
money

66. Thinking globally, acting locally:
‘Saving lives with Solar’, Royal
North Midlands Hospitals, Stoke

67. Towards an environmentally sustainable health system
• Reduce energy use, GHG emissions and
environmental footprint.
• Increase resilience to floods, heatwaves and
disease outbreaks
• Provide care closer to home
• Reduce health care vehicle emissions and
encourage use of public transportation and bicycles
• Promote healthy low impact diets
66http://sustainability.duke.edu/health_system/
https://www.architects.org/architectureboston/articles/building-health

68. Through policies in several sectors e.g.
• Electricity generation
• Transport
• Housing
• Food and agriculture
• Health care
Adapting to change and capitalising on the health co-
benefits from the ‘low-carbon’ economy

69. Thinking globally, acting nationally:
The UK Faculty of Public Health
Manifesto for Health ‘Start well, live
better’ Active travel and climate
change policy asks
Invest in active transport to
promote good health and reduce our
impact on climate change
Implement a cross national
approach to meet climate change
targets, including a rapid move to a
100% renewables and a zero carbon
energy system

70. • Middleton J, ISIS, crop failure and no anti-biotics: what training will we
need for future public health? European J Public Health 2016;
https://eurpub.oxfordjournals.org/content/26/5/735
• Same skill set:
• But:
• New partnerships : political scientists, international lawyers ,
theologians, climatologists, ecologists
22/02/2019 69

71. ‘Protecting resources
from one generation
to the next’
Thinking globally, acting
nationally- The Welsh
Wellbeing of Future
Generations Act, 2015

72. These 10 Corporations Control Almost Everything We Eat

73. http://www.bmj.com/content/358/bmj.j4443?sso=
MiddletonJ 'Public health low down with the Solent Delta
Blues’

74. An acceptable level of health for all the people of
the world by the year 2000 can be attained through
a fuller and better use of the world’s resources, a
considerable part of which is now spend on
armaments and military conflicts. A genuine policy
of independence, peace, détente, and
disarmament could and should release additional
resources that could well be devoted to peaceful
aims and in particular to the acceleration of social
and economic development of which primary
health care, as an essential part, should be allotted
its proper share’.
Global Health for all by the year 2000
World Health Organisation, 1980

78. The green recovery ?

80. http://www.campaignc
c.org/sites/data/files/D
ocs/one_million_climat
e_jobs_2014.pdf

81. Yevgeny Vuchetich
‘Let us beat swords
into ploughshares ‘
United Nations Art
Collection, 1959
‘The Peace
dividend’

82. www.fph.org.uk
Thank you
John Middleton
president@fph.org.uk

83. www.fph.org.uk
22/02/2019 82

84. References
• Climate and Health Council (www.climateandhealth.org)
Global health, global warming, personal and professional
responsibility, Cambridge Medicine, Pencheon D, Vol 2, No 22, 2008
• Stott R, Healthy response to climate change, BMJ 2006;332;1385-1387
• Gill M, Why should doctors be interested in climate change?
BMJ Jun 2008; 336: 1506
• Griffiths J, Alison Hill, Jackie Spiby and Mike Gill, Robin Stott Ten
practical actions for doctors to combat climate change, BMJ
2008;336;1507
• Sustaining a healthy future: www.fph.org.uk
• Griffiths J et al, The Health Practitioner's Guide to Climate Change,
Earthscan 2009
• Pencheon D, Health services and climate change: what can be done?
J Health Serv Res Policy. Editorial Jan 2009
• UCL Health Commission/Lancet: Managing the Health effects of
Climate Change. May 2009
• The health benefits of tackling climate change, Wellcome/LSHTM, Nov
2009
• Sustainable Development Commission: http://www.sd-
commission.org.uk/pages/health.html

85. References
• Centre for Nonviolent Communication www.cnvc.org
• Galtung J (1996). Peace by peaceful means: peace and conflict, development
and civilisation. London, Prio/Sage.
• Galtung J (2002). What is peace studies? In Johansen J, Vambheim V (eds).
Three papers by Johan Galtung. Tromsø, Centre for Peace Studies, University of
Tromsø, Norway
• Large J (1997). Considering conflict. First consultative meeting on Health as a
Bridge for Peace. Les Pensières, Annecy, WHO.
• Mercy J et al. (1993). Public health policy for preventing violence. Health
Affairs. Winter:7-29.
• Merriam-Webster Online Dictionary www.m-w.com
• Rosenberg M (2003). Nonviolent communication: a language of life. Encinitas,
CA, Puddle Dancer Press.
• Santa Barbara J, MacQueen G (2004). Peace through health: key concepts. The
Lancet 364:384-5.
• WHO (2002). World report on violence and health. Geneva, WHO.
© medicalpeacework.org 2012
Author Klaus Melf, editor Mike Rowson, graphic design Philipp Bornschlegl

86. References and resources
Resources :
REWIND http://www.rewind.org.uk
http://www.quilliamfoundation.org/about/
Institute for Strategic Dialogue
http://www.strategicdialogue.org
WAVES Trust www.wavestrust.org.uk/home.html
Parent Infant Partnership http://www.pipuk.org.uk
ECPAT http://www.ecpat.org.uk
TASC http://tascwheel.com
Centre for Nonviolent Communication www.cnvc.org
Medical peace work. Online course work, course
part Health professionals, conflicts and peace.
Berlin: Medical Peace Work, 2015.
http://www.medicalpeacework.org/teaching-
resources/mpw-presentations.html
References
Bellis, M. A., Hughes, K., Perkins, C., Bennett, A. M., Protecting people,
promoting health: a public health
approach to violence prevention for England. London: NHS. and
Department of Health, 2012.
World Health Organization. (2014). Global status report on violence
prevention 2014.
http://www.who.int/violence_injury_prevention/violence/status_report/2014
/en/ update on WHO (2002). World report on violence and health.
Geneva, WHO
Galtung J (1996). Peace by peaceful means: peace and conflict,
development and civilisation. London, Prio/Sage.
Mercy J et al. (1993). Public health policy for preventing violence.
Health Affairs. Winter:7-29.
Rosenberg M (2003). Nonviolent communication: a language of life.
Encinitas, CA, Puddle Dancer Press.
Santa Barbara J, MacQueen G (2004). Peace through health: key
concepts. The Lancet 364:384-5.

87. • Middleton J, ISIS, crop failure and no anti-biotics:
what training will we need for future public health?
European J Public Health 2016;
https://eurpub.oxfordjournals.org/content/26/5/735
• Middleton J. Public health in England in 2016—the
health of the public and the public health system: a
review Br Med Bull (2017) 1-16. DOI:
https://doi.org/10.1093/bmb/ldw054 and
http://academic.oup.com//bmb/article/doi/10.1093/bmb/l
dw054/2871226/Public-health-in-England-in-2016the-
health-of-the?guestAccessKey=8f7a33a1-bdbf-4db4-
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