Argument

How to Make Climate Change Doubters Pay a Political Price

Leaders who refuse to acknowledge the public health consequences of air pollution, disease outbreaks, and drought will soon feel the wrath of voters at the polls.

A woman wears an air-filtration mask while crossing a street in San Francisco, California, October 13, 2017. (Smith Collection/Gado/Getty Images)
A woman wears an air-filtration mask while crossing a street in San Francisco, California, October 13, 2017. (Smith Collection/Gado/Getty Images)

More than any past report, the U.S. government’s National Climate Assessment in November made clear the devastating effects of climate change on global public health. As it and other analyses have described, these aftershocks will be generational and wide-reaching but particularly crushing for vulnerable health systems in developing countries. In response, multinational organizations and elected officials must reprioritize how they delegate scarce health resources to ensure that recent progress in combating both communicable and noncommunicable diseases is not reversed. And even the status quo is too little; current efforts are insufficient and poorly funded.

In purely economic terms, health consequences dwarf the other effects of climate change in sheer cost to the United States, estimated at $141 billion due to heat-related deaths alone by 2100, vastly outpacing infrastructure damage to coastal cities from sea-level rise (estimated at $118 billion).

The upshot for policymakers is simple, especially for those who refuse to acknowledge the existence of climate change: anything short of a well-funded and multifaceted approach to the climate crisis will have consequences that can now be easily measured in attributable deaths and rising health care costs.

Climate change doubters should no longer feel comfortable equivocating on the pros and cons of mitigation, where carbon neutrality, emissions cuts, and green energy are easily politicized policy platforms. Now more than ever, solutions to the climate crisis should focus on the devastating effects of rising air pollution, warmer temperatures, droughts, and water insecurity on human health. Doing otherwise would have an outsized effect on citizens with chronic diseases, who tend to vote in significant numbers, particularly in developed nations. Before long, this demographic group will be voting with these issues in mind, a cautionary warning to any elected doubter.

Two of the most climate-progressive U.S. cities, Seattle and San Francisco, had the worst air quality in the world for stretches throughout this year.

 Ambient air pollution, whether from coal-fired plants or persistent wildfires, is unhealthy and its effects frighteningly broad, with clear impacts on overall health. Anyone living on the West Coast of the United States has experienced an array of air quality warnings over just the past six months due to regional wildfires. In fact, two of the most climate-progressive U.S. cities, Seattle and San Francisco, had the worst air quality in the world for stretches throughout this year. As the national climate assessment concluded back in 2014, massive wildfires are here to stay, meaning these poor rankings will, too, a tragic irony for the states of Washington and California, which have exercised outsized leadership in helping the United States meet its Paris climate targets.

This is to say nothing of the chronic scourge that air pollution is for countries like India and China, where a combined more than 3 million of their citizens die prematurely every year from household or outdoor pollutants. Globally, air pollution from manufacturing, vehicle exhaust, and coal burning represents the fourth leading risk factor for all deaths annually. Further, these analyses predict that future deaths from air pollution will rise substantially, even when accounting for currently agreed-upon emissions targets. The link between climate and health, while important in the United States, is even more critical in some of the world’s most geopolitically important and populous nations, where the threat of air pollution is more readily apparent and has already become politically salient.

If the above evidence isn’t enough to build political consensus on climate, the effects of air pollution on voters with pre-existing medical conditions may help move the needle. This demographic, so often appealed to by campaigns in the recent U.S. midterm elections, is disproportionately affected by air pollution, with significantly worsened health outcomes among those exposed. For example, if you’re a smoker with asthma or chronic obstructive pulmonary disease living near wildfire-prone regions, your quality of life will likely be much worse, with more frequent symptoms and hospitalizations. Patients with heart disease are more likely to suffer heart attacks or congestive heart failure in highly polluted environments. If you have a family history of dementia, living in regions suffocated by smoke or industrial exhaust heightens risk of degenerative brain disease.

All of the above should serve as a cautionary tale to U.S. politicians who play fast and loose with the health coverage of individuals with pre-existing conditions between election cycles.

All of the above should serve as a cautionary tale to U.S. politicians who play fast and loose with the health coverage of individuals with pre-existing conditions between election cycles. If you are an elected official in the United States, you cannot support such coverage guarantees while arguing against the existence of climate change and, as a result, its effects on health. Doing so is akin to tacit acceptance of widespread hospital readmissions for the country’s most vulnerable citizens, the cost of which—outside of climate-associated risk factors—is already estimated at over $40 billion annually. Rather, investments in strong primary health care systems, where everyone has access to high-quality care, is a key cog of any cost-effective climate adaptation strategy focused on health, both locally and globally. Adequately addressing chronic disease provides a buffer against climate-related exacerbation of pre-existing conditions.

 Over the next 50 years, climate change is expected to significantly worsen demographic and social pressures on fragile nations with limited health systems throughout South and East Asia and across sub-Saharan Africa. Deteriorating health outcomes globally are expected at an estimated economic cost of $2 billion to 4 billion annually, by 2030, with spillover effects on state and regional security inevitable. Former U.S. Secretary of Defense Chuck Hagel referred to these cascading events as evidence that climate change is a “threat multiplier,” further straining already stressed health systems that are less capable of combating shifting tropical disease patterns, such as outbreaks of zoonotic diseases such as the Ebola virus. The World Economic Forum recently identified climate change as the single greatest threat to global stability because of its manifold consequences for the health and stability of developing nations.

Examples abound. One of the primary antecedents of the Syrian civil war was the nation’s most severe drought on record, which led to widespread food and water insecurity and deteriorating health outcomes, such as malnourishment and widespread communicable diseases. The drought, which has been directly linked to the effects of climate change, helped fuel massive internal displacement which contributed to social unrest, demonstrations against the incumbent regime, and ultimately, prolonged regional conflict and instability.

Further, climate change has and will continue to increase the incidence and geographic distribution of emerging zoonotic and other neglected tropical diseases. By straining already overburdened health systems in developing countries, pathogens such as the Ebola and Zika viruses have already illustrated the widespread morbidity, mortality, and global chaos such illnesses can pose and the necessity of a prompt international response to contain them. Such outbreaks will become more frequent as local health systems in climate-stressed countries become overstretched in their capacity to provide primary care services.

The raging outbreak of Ebola in the Democratic Republic of the Congo provides a case study of this phenomenon.

The raging outbreak of Ebola in the Democratic Republic of the Congo provides a case study of this phenomenon. Congo has one of the most climate-vulnerable health systems worldwide, experiences intense heat nearly year-round, and has suffered through chronic civil war for decades. These ingredients help explain why Ebola has smoldered there for years in a perpetuating cycle of conflict, unpredictable climatic extremes, and eroding public-health capacity. Similarly, Yemen’s ongoing battle with cholera has only been exacerbated by climate-related floods and more intense rainfall patterns, which have become even more common as higher temperatures last longer. These health miseries have compounded the suffering from the country’s brutal civil war, which in turn has only further eroded whatever was left of the country’s now-defunct health system.

The cases described above all point to the existence of a nexus between climate, health, and security, in which the primary impacts of climate change on vulnerable countries are seen through its corrosive effects on a society’s health and the very health systems on which it is reliant. This dual effect results in social unrest and the weakening of state institutions, increasing the threat of collapse. The resulting ripple effects are only likely to increase as climate change become more pronounced.

 All of these stark realities on climate and health were known to us well before the recent U.S. national report became public. Air pollution has long been known to lower life expectancy among those with chronic disease, just as warmer temperatures are known to extend the life cycle of diseases with pandemic potential.

Injecting the consequences of air pollution and climate’s effects on fragile health systems into the climate change debate is a strategy that has not yet been tried but should be. To gain political acceptance on the importance of mitigation strategies, and of the Paris climate agreement more broadly, U.S. politicians should first focus on adaptation for health, an issue that should appeal to everyone’s self-interest and shared humanity—even the climate change doubters.

 

Vin Gupta, an assistant professor at the Institute for Health Metrics and Evaluation at the University of Washington and a fellow at the Center for Global Development, also serves as a physician and officer in the U.S. Air Force Medical Corps, where he focuses on the Pentagon’s global health engagement activities. @VinGuptaMD

Juliette Kayyem served as homeland security
advisor to Gov. Deval Patrick of Massachusetts and, most recently, as assistant
secretary for intergovernmental affairs in the Obama administration. She is now a columnist
for the Boston Globe and teaches at Harvard University's Kennedy School of
Government. You can follow her: @juliettekayyem. @juliettekayyem

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