The health impacts of climate change have been much discussed internationally, however there is some disagreement about the magnitude of those effects, when they will occur and what the right course of action is. Underpinning those disagreements is a joint uncritical acceptance of the fundamental structure of the political economy of late modern capitalism (neoliberalism), with the differences being around whether climate change requires more immediate public policy intervention or whether capitalism will address the health issues though economic development. In other words, both use the frame of reference of capitalism to argue for more market freedom v statist intervention. This paper seeks to outline the arguments over the health effects of climate change while rooting that discourse within wider often background taken for granted political economy. Two writers, Indur Goklany and Daniel Ben Ami will be used to represent the critical camp in riposte to Costello et al’s 2009 Lancet paper on climate change and health.
Climate change ‘debate’
The Intergovernmental Panel on Climate Change 5th Assessment Report (IPCC 2013) argues that scientists are 95% certain that humans are the ‘dominant cause’ of global warming since the 1950’s (McGrath 2013). Thomas Stocker, IPCC co-chair stated: “…in order to limit climate change, it will require substantial and sustained reduction of greenhouse gas emission…” (BBC 2013). Despite this, there is continuing doubt, denial and a focus on uncertainty in many countries, especially in news media, that Climate Change is human induced and that it requires radical shifts in public policy. See for example Delingpole (2013) in the United Kingdom and particularly in the United States and Australia (Painter 2013). The UK’s Owen Paterson, secretary of state for environment, food and rural affairs, told the 2013 Conservative party conference not to worry about global warming. “I think we should just accept that the climate has been changing for centuries.” (Syal 2013). Previously on BBC television’s ‘Any Questions’, he repeated ten discredited claims about climate change (Mason 2013).
This sits in opposition to many in the medical and public health domain. The World Health Organisation accepts IPCC assessments and considers climate change to be a ‘significant and emerging threat’ to public health (WHO 2013 a,b), while previously ranking it very low down in a table of health threats (WHO 2009). In the United Kingdom, Costello et al (2009) argue that climate change is a major potential public health threat that does require major changes such as action on carbon emissions. In addition, Barton and Grant’s health map (2006) has in its outer ring ‘Climate Change, Biodiversity and Global Ecosystems’ as key determinants of health and supports the WHO view that alongside the social determinants of health, health threats arise from large scale environmental hazards such as climate change, stratospheric ozone depletion, biodiversity losses, changes in water systems, land degradation, urbanisation and pressures on food production. WHO (2013c) argues:
“Appreciation of this scale and type of influence on human health requires a new perspective which focuses on ecosystems and on the recognition that the foundations of long-term good health in populations rely in great part on the continued stability and functioning of the biosphere’s life-supporting systems”.
It is this call for a ‘new perspective on ecosystems’ that indicates why there is a backlash that underpin long standing critiques of the link between climate change, environmental issues and human health. Many of those critical are libertarian, anti state conservatives defending the neoliberal hegemony of free market dogma which ‘new perspectives’ may threaten. For example, Stakaityte (2013) argues:
“Free market proponents are quick to point out that the whole climate change issue has been used to stifle freedom and to expand the nanny state – and they are right. If the climate is changing, and if humans really are responsible, the market will adapt”.
The WHO call for a ‘new perspective’ however is not a radical critique of neoliberal capitalism or a call for its replacement by other political economies. It sits within an overarching acceptance that capitalism is the only economic model, and that only its particular current form requires changing, for example by investments in green technologies.
Critical discourse over such an important issue is crucial. Argument should proceed over matters of empirical facts, within discourses of risk and an understanding of scientific uncertainty (see Painter 2013). Attention also should turn to philosophical positions on political economy in which the dominant neoliberal hegemony (Crouch 2011, Plehwe et al 2006) attempts to build and maintain a sceptical view in the media on climate change and on alternative, including no growth, economic models (Jackson 2009) because it is antithetical to ‘nanny state’ intervention implicit in public health ‘upstream’ analysis.
Health Impacts of climate change and the policy response
Indur Goklany and Daniel Ben Ami respectively are noted writers on the topic and both are in the sceptical camp regarding what to do about climate change. Both however appear to accept the fact of climate change, they just don’t agree with the focus on carbon reduction targets. They are both far more nuanced in their arguments than other commentators such as the UK’s James Delingpole; Andrew Bolt of Australia’s Herald Sun and Steve Molloy of the United States’ Fox News. However, Goklany is associated with the Heartland Institute, but care should be taken not to debunk his thesis merely because he publishes at that anti climate change organisation.
For the health community that makes decisions on what the main threats to health are, there is a need to carefully weigh up the evidence for threats to population health in the short, medium and long term, or what Goklany calls the ‘foreseeable future’. This means addressing Goklany’s argument, especially, on the ranking of health threats and Ben Amis’ argument on progress. For Goklany the health threats are not from climate change, nor will they be for the foreseeable future. For Ben Ami, the answer lies in any case of more progress based on economic growth and development.
Both Goklany and Ben-Ami’s faith in human progress is based on inductive reasoning, ignores the key statistical problem of exponential growth, and may be over confident that limits have been correctly identified or can be overcome. Goklany might turn out to be empirically correct that in the ‘foreseeable future’, defined as 2085-2100, climate change will not be the major threat to public health, however this line of reasoning gives support to the denial of climate change in particular and obscures the requirement of addressing the sustainability of current economic structures. It also sidesteps addressing the language and discourse of risk (Haggett 2010, Painter 2013) which includes considering that human action should not be based on total certainty but on the assessment of the probabilities of high and low impact events. However, the position taken by both writers is that humanity needs more capitalist economic and technological development even if that results in a warmer world.
Goklany (2012) argues that humanity, in developing and using fossil fuels, both freed itself from the vagaries of nature’s provision and also has saved nature from humanity’s need to turn more of it into cropland. The inference from this argument is that we ought to continue to use fossil fuels to further human progress and to save nature from ourselves. Increasing global GDP, i.e. a wealthier world, would also be better equipped to deal with future global warming issues (Goklany 2007). This is inductive in that it assumes that this past pattern of innovation will be repeated in the future.
Daniel Ben-Ami (2010) also forwards this argument in ‘Ferrari’s for all –a defence of economic progress’. He points out that we are living longer and healthier lives than ever before thanks to economic development and growth. Therefore, inductively, we need more growth. The book is also based on the idea that humanity is apart from nature – human exceptualism – and is capable of enormous technical, cultural and progressive ingenuity. Humanity should strive to achieve more in terms of economic development so that everyone should have access to a Ferrari if they want it.
It is a counter to what he terms ‘growth scepticism’, i.e. the “tendency to undermine economic progress by indirect means” (p3). If populations are to be in better health and free from poverty then the only answer is more of the same. Those who suggest climate change is a health threat do not address this economic and development argument head on, there may be implicit acceptance of the current economic models of development. Instead there is a focus on the magnitude of climate change per se as a health threat rather than the economic structures which may drive climate change and other unsustainable practices such as deforestation.
Costello v Goklany
So, Costello et al (2009a) argued that climate change is the biggest global health threat of the 21st century’ (p1693). Goklany in the same year replied and argued that climate change is not the number one threat to humanity and questioned whether it is “the defining challenge of our age” (Goklany 2009a). Costello replied to Goklany’s riposte again in 2009, but Goklany in 2012 further rebutted that claim.
Goklany argued Costello et al made their claim about climate change in 2009 without a comparative analysis of the magnitude, severity and manageability of a range of health threats at that time and therefore ranking it as the No 1 threat is untenable. Goklany (2009c) argued that climate change was ranked 21st out of 24th global health threats. Goklany’s rebuttal data comes from a World Health Organisation World Health Report 2002 and Comparative Quantification of Health Risks 2004 and he uses results from “Fast Track Assessments” (FTAs) of the global impacts of global warming (Arnell et al 2002, Parry 2004). In his 2012 article he also cites Parry (1999) and the World Health Organisation’s 2009 Global Health Risks.
Costello et al (2009b) in reply to Goklany argued that “The ranking of climate change at 21st out of 26 risk factors was made at a time when global temperature rise was only 0·74°C, and when the effects of climate change on the other risk factors was unclear” and they claimed that there has since been substantial changes in our understanding of climate change risks. They cite two papers showing that about 1 trillion tonnes is probably the cumulative limit for all carbon emissions if we wish to stay within the 2°C “safety” limit, and that, without action, we shall exceed this limit before 2050. They also cite a paper by Schneider (2009) who raised the prospect of worst case scenarios: warming at 3°C gives a 90% probability that Greenland will melt, raising sea levels by many metres, and that on present evidence and trends there is a 5—17% chance that temperatures will go up by 6·4°C by 2100, “a risk way above the threshold at which people would usually buy insurance”. Goklany’s position (2012) is that the 2 degree target is irrelevant in any case and he seems happy to accept a 4 degree rise.
The 2013 IPCC report AR5, while accepting a pause in warming over recent years, argues that climate change is a continuing very serious issue and now post dates this difference in Goklany and Costello’s arguments which are based on data from 1999 to 2009. This will need constant revision as more scientific data is published. The IPCC WGII contribution on ‘impacts adaptation and vulnerability’ is due to be reported in March 2014. The report makes it clear that even if greenhouse gas emissions are stopped right now climate change will persists for many centuries, much of it will be irreversible characterised by impacts such as sea level rises. The last time the world was 2 degrees warmer , sea levels were 5 -10 metres higher.
On what to do, Goklany (2009c) argues that ’Societal resources devoted to curb carbon dioxide and other greenhouse gas emissions will be unavailable for other…more urgent tasks including vector control, developing safer water supplies or installing sanitation facilities in developing countries….’ (p69). However this sets up a false dichotomy. The decision to spend on carbon reduction is not an either/or one. There are myriad spending decisions being made, and those choices are made from a raft of competing priorities. One could equally argue that resources devoted to nuclear armaments and other military spending is unavailable also for these other urgent tasks. So to focus on emissions reduction as the spending that diverts funds away from addressing other pressing health issues is a biased view. Goklany could argue for an end to subsidies for the fossil fuel and nuclear industries, reductions in military spending, changing the international tax regimes to access wealth deposited in offshore accounts, or the introduction of a Tobin tax on financial transactions. These are admittedly biased positions and may be seen to be too left wing, and ideologically incompatible with current the neoliberal hegemony (Crouch 2011).
Whether funding spent on carbon reduction actually works in terms of human welfare and is less expensive than alternatives, is a valid question but has to be seen in a wider political discourse about spending decisions. His points regarding the need for poverty reduction via sustainable economic development and advancing our adaptive capacity would possibly bring broad agreement. In any case some consider that it is too late (Peters et al 2013) for mitigation and that adaptation to a warmer world is now needed. Goklany (2009b) uses the term ‘focused adaptation’ meaning taking advantage of the positive benefits of warming. If sea levels are to rise by 5-10 metres this is beyond the foreseeable future and so we should focus on economic growth and development to adapt to those future scenarios rather than wasting time resources and energy on emission curbs. However, this seems somewhat an anthropocentric view taking in little regard for biodiversity loss and ocean acidification. Both of which are also threats to human health
Ben Ami and Goklany put faith instead in ‘secular technological change’. This believes that
1) Existing technologies will become cheaper or more cost effective.
2) New technologies that are even more cost effective will become available.
They may well be correct. They argue the potential health threats may be addressed through human ingenuity based on economic progress and economic progress is best served by accepting the IPCC worse case scenario which would result in greater per capita GDP and thus release capital for adaptation (figure 1).
Figure 1: net GDP per capita, 1990-2200, after accounting for upper bound estimates of losses due to global warming for 4 IPCC scenarios. The warmest is A1FI (4 degrees C) and the coolest is B1 (2.1 degrees C) (source Goklany 2012)
Figure 1, therefore, indicates that if humanity has a choice, it ought to strive for the developmental path corresponding to the richest IPCC scenario (A1FI – 4 degrees C above 1990 by 2085) notwithstanding any associated global warming. Because this increases adaptive capacity and poverty would be eliminated. Other health risks that rank higher than global warming are also associated with poverty and would thus also be eliminated. Poverty related diseases contribute to mortality and morbidity 70-80% more than warming. Mitigative capacity would be increased, therefore health improves with economic and technological development, and development encourages the ‘environmental transition’.
This is a very risky strategy which future generations will have to judge the merits of. There is gathering evidence beyond climate change suggesting that humanity is already transgressing other environmental limits, transgressions which will not support a ‘safe operating space’ as we enter a new era, the ‘anthropocene’. (Rockstrom et al 2009).
Goklany (2012) further argued “This paper does not address hypothesized low-probability but potentially high consequence outcomes such as a shutdown of the thermohaline circulation or the melting of the Greenland and Antarctica Ice Sheets, which have been deemed unlikely to occur in the foreseeable future by both the IPCC and the US Global Change Research Program, among others”, although the IPCC has since (2013) stated that it is “very unlikely that the Atlantic Meridional Overturning Circulation (part of the global thermohaline) will undergo abrupt transition or collapse…however, a collapse beyond the 21st century…cannot be excluded” (IPCC 2013 SPM-17).
Goklany, in not addressing these risks, appears to dismiss the need for ‘risk discourse’ to frame public debate relying on ‘kicking into the long grass’ serious consequences of climate change.
‘Risk’ is already an essential part of everyone’s experience, including in the world of insurance, health and investment. It is not uncommon for people to insure against low probability but high impact events such as house fire, or critical illness. People also invest for the long term, for example in a pension that might take over 40 years to pay off. It is thus arguable that the thermohaline shutdown and ice sheets melts may well be just the sort of low probability but high impact events that humanity ought to be insuring against and taking measures to prevent through carbon emissions reductions. Painter (2013) suggests therefore that elements of risk discourse would provide a better frame for debate than disaster and uncertainty frames, which are both more prevalent in news media.
Space precludes an examination of the concept of exponential growth and the requirement to produce resources to meet the needs of potentially 9-10 billion people by 2050. Costello et al’s position seems to be that climate change will stress ecosystems before we have time to adapt and that both direct and indirect affects will adversely impact on global health. They are not so sanguine about our ability to live within our limits.
Goklany is correct to point out that currently that health threats arise from poverty and underdevelopment. In this assessment he is in accord with the WHO social determinants of health approach. Costello et al have not dismissed this and as public health experts would probably accept a similar position. A focus on the social determinants of health to address poverty needs to run alongside carbon reductions or else the good work could be undone by a low probability but high impact event such as the melting of the Arctic Ice. They differ on when climate change will be a health threat and importantly on how to address it. Goklany and Ben Ami appear to be on the market driven economic development model as the answer whereas Costello et al argue for more immediate state and public intervention in addressing climate change. All however do not critique the fundamental neoliberal economic model or call for alternative economic ‘no growth’ models (Jackson 2009). There is little doubt that we are running an experiment with the climate, there is agreement that this will impact on global health but the answer seems to be either more or less tweaking with capitalist growth models rather than a sustained examination of alternatives.
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