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Rapid Responses: Rapid Responses published:
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Global warming and France
- Joseph E Morales, MD (28 May 2004)
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Carbon charges may benefit public health now
- Nick A Wilson (30 May 2004)
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Climate Surprise: Weather Related Mortality Trends Are Down
- Indur M. Goklany* (2 June 2004)
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Holding our breath?
- james whiting (2 June 2004)
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Deaths don't have to add up
- James D Woodcock (3 June 2004)
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Whatever happened to global cooling?
- Robert A. Da Prato (3 June 2004)
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Global warming, health and Bangladesh: Stopping the dam with a finger!
- Md. Anwarul Azim Majumder, Sayeeda Rahman (3 June 2004)
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Specifics of Global Warming
- Mark A. Sircus O.M.D. (4 June 2004)
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focus on prevention
- venkoba R srinivas (4 June 2004)
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Joseph E Morales, MD, Occupational Medicine Sacramento CA
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While this editorial raises many issues that are debatable, the most egregious inclusion is the apparent attribution of the 15,000 French heat wave deaths to global warming. Most of what I have read about the heat wave and the causes for the deaths attributed those deaths to issues such as lack of air conditioning, elder neglect, poor governmental response, etc.
I hope that future articles about mortality from global warming will not include these deaths in any sort of cause and effect relationship.
Competing interests: None declared |
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Nick A Wilson, Senior Lecturer, Public Health Wellington School of Medicine, Otago University, Wellington 6002
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The BMJ editorial by Patz appropriately highlights the potentially major health impacts of global warming [1]. There appears to be a critical need for international collective action through the Kyoto Protocol and even stronger frameworks to prevent such climate change. But one immediate action that countries can take is to introduce carbon taxes on fossil fuels. Such charges can also potentially benefit public health in a number of ways: 1) Reduced harm from air pollution: Air pollution persists as a major health problem in many countries [2]. Carbon charges could potentially reduce air pollution levels in cities by promoting greater use of public transport. Another benefit could be increased interest by the public in energy efficient vehicles and in keeping vehicles properly tuned. Carbon charges could also result in a reduction in the use of coal for home heating and in electricity production (ie, toward a greater reliance on renewable energy instead). 2) Benefits from walking and cycling: A situation where fewer people use their cars and where there is less air pollution in cities, may encourage more commuters to walk or cycle to work. This would benefit health as there is now good evidence for physical activity preventing breast and colon cancer according to the International Agency for Research on Cancer (IARC) [3]. IARC has also stated that weight control and regular physical activity will lead to substantial decreases in the risk of cardiovascular disease, type II diabetes, and other chronic diseases. 3) Reduced harm from injury: Greater use of buses and trains would reduce overall road traffic injury rates as these forms of public transport are much safer (per kilometre travelled) than car and motorbike travel. Reduced traffic volumes would also make cycling and walking relatively safer and more acceptable for commuters. The Intergovernmental Panel on Climate Change (IPCC) has reported that controlling road traffic would benefit health through reductions in road traffic crashes [4]. United States data also indicates that higher fuel taxes reduce motor vehicle crash fatalities [5]. 4) Reduced harm from traffic congestion: Any increased use of public transport could lower traffic congestion levels and improve traffic flows. This could reduce both air pollution levels and psychological stress among commuters. In addition to these health benefits, lowering congestion can save time and money in gridlocked cities. 5) Potential health benefits of tax reform: When Germany introduced various green taxes it lowered income taxes at the same time. So introducing carbon charges can provide governments with an opportunity to lower income tax for low and middle-income citizens. If this helped reduced poverty levels then it would have substantial public health benefits, particularly for child health. In summary, these reasons suggest that health professionals should strongly support the use of carbon charges to protect the planet from global warming and to improve public health now. References 1) Patz J. Global warming: Health impacts may be abrupt as well as long-term. BMJ 2004;328:1269-70. 2) Kjellstrom TE, Neller A, Simpson RW. Air pollution and its health impacts: the changing panorama. Med J Aust 2002;177:604-608. 3) International Agency for Research on Cancer (IARC). Weight control and physical activity (IARC Handbooks of Cancer Prevention). Lyon: IARC Press, 2002. 4) Intergovernmental Panel on Climate Change (IPCC). Secondary health benefits of mitigation policies (section 9.12). Climate Change 2001: Impacts, Adaptation, and Vulnerability. Geneva: IPCC, 2001. 5) Leigh JP, Frank AL. Gas taxes and motor vehicle fatalities. J Health Politics Policy Law 1988;13:723-34. Competing interests: None declared |
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Indur M. Goklany*, Asst. Director, Science & Technology Policy US Department of the Interior, Washington, DC 20240, USA
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The randomly selected anecdotal mortality data provided in Mr. Patz's editorial for various extreme weather events are, at best, red herrings or, at worst, misleading. For instance, it notes that events such as severe storms, floods, and drought claimed millions of lives during the past 20 years. Similarly it informs us that between 1972 and 1996 weather disasters claimed 123,000 lives annually. While these numbers are interesting in their own right, unless one provides a reasonable (and defensible) partition of the mortality into the portions attributable to natural climatic variability, and to human-induced climate change, it is unclear how they relate to global warming. Without such a partitioning, global warming can, at best, only be found guilty by association. Given the editorial's title, a reader may be misled into concluding that because of global warming, aggregate fatalities due to weather related disasters have increased in recent decades [1]. But global annual mortality due to such disasters have, in fact, declined from 73,700 in 1970-79 to 42,200 in 1995-2004 despite both a 50 percent increase in population and increased warming of the world [2]. This translates into a decline in the global death rate of about 60 percent over that period. Similar declines have been recorded in the past few decades in U.S. deaths and death rates due to hurricanes, tornados, lightning and floods [3]. These suggest that no matter how important a factor global warming might be in exacerbating extreme weather events, its effect is secondary to other factors (such as technological advances that make societies less vulnerable and more adaptable through, for instance, improved building standards, early warning systems and disaster management) [4,5]. Contributing to the above reduction in deaths and death rates may be that extreme events are not necessarily getting more extreme everywhere [6], despite highly publicized anecdotes such as the recent heat and flood related deaths in Europe. For instance, both the observed number and wind speeds of violent Atlantic hurricanes have apparently declined since the 1940s [7], consistent with the long term decline in mortality for such events [3]. In addition, because of warming, there are probably fewer cases of cold-related deaths, which can overshadow mortality from warmer weathers in the northern latitudes [8]. Whatever the reasons for the decline, so far trends in aggregate mortality and mortality rates belie commonly-held expectations about the consequences of global warming (now immortalized in the movie, "The Day After Tomorrow"). This, of course, evinces some skepticism regarding many of the projected health impacts of climate change. NOTES & REFERENCES 1) Weather related disasters (WRD) here are defined to include drought, extreme temperatures, famine, flood, insect infestation, wildfire, wind storm, wave/surge, and slides. I have assumed that all deaths ascribed in the data base to such disasters [in note 2] are necessarily related to climate. The declining trends in deaths and death rates in the last few decades also hold true if a less expansive definition is used for WRD or, for that matter, if epidemics are also added to the definition. 2) EM-DAT: The OFDA/CRED International Disaster Database, available at www.em-dat.net, Université Catholique de Louvain, Brussels, Belgium. 3) Goklany IM. Potential consequences of increasing atmospheric CO2 concentration compared to other environmental problem. Technology 2000; 7S: 189-213. 4) Landsea CN, Pielke, Jr., RA, Mestas-Nunez AM, Knaff JA. Atlantic Basin hurricanes: Indices of climatic changes. Clim Change 1999; 42: 89- 129. 5) Goklany IM, Straja SR. U.S. death rates due to extreme heat and cold ascribed to weather, 1979-1997. Technology 2000; 7S: 165-173. 6) Easterling DR, Evans JL, Groisman PY, Karl TR, Kunkel KE, Ambenje P. Observed Variability and Trends in Extreme Climate Events: A Brief Review. Bull Am Met Soc 2000; 81: 417-425. 7) Henderson-Sellers A, Zhang H, Berz G, Emanuel K, Gray W, Landsea C, Holland G, Lighthill J, Shieh S.-L, Webster P, McGuffie K. Tropical cyclones and global climate change: A post-IPCC assessment. Bull Am Met Soc 1998; 79: 19-38. 8) Keatinge WR, Donaldson GC, Cordioli E, Martinelli M, Kunst AE, Mackenbach JP, Nayha S, Vuori I. Heat related mortality in warm and cold regions of Europe: observational study. BMJ. 2000; 321: 670-3. DISCLAIMER Views expressed here are the author's and not necessarily those of any unit of the US government. Competing interests: None declared |
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james whiting, Asst Prof PVAMC 97207
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The guest editorial on global warming reprises a cinematic horror show for our titillation, with the advice that we must do something. The somethings are: "interdisciplinary analyses" and "integrated prevention planning." Thankfully, the Kyoto proposals are not put forward as a potential solution in this editorial. In it, two billion people are exempted from any strictures at all as they move from the bicycle to the motorbike to the automobile. As for the human effects on global warming, most of the greenhouse gas is water vapor. And records of CO2 levels in the atmosphere do not correlate particularly well with global tempertures, which seem to be related more to solar cycles. Rather than prevention planning, we are well advised to begin planning how to cope. This should spur the people in Netherlands and Venice, not to mention the Big Easy (New Orleans), to move forward at a brisker pace. They have engineering tasks ahead of them which are comprehensible and can be tackled, albeit expensively. Perhaps I'm not being fair, but "interdisciplinary analyses and integrated prevention planning" sound like items on a committee's agenda, likely to produce little more than dithering. What's required is some battening down of some of the hatches and the editorialist has gracefully made room for the need for that. Competing interests: None declared |
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James D Woodcock, Quality Assurance Editor, Clinical Evidence BMA House, WC1H 9JR
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In the first response Joseph Morales gives the impression that causes in epidemiology are necessarily mutually exclusive. Even if the deaths in France last year were caused by neglect and poor government response this does not mean they were not also caused by extreme temperatures due to climate change. In the same way a hurricane may cause many more deathes in Central America than the United States due to differences in resources and infrastructure but if the typhoon was part of climate change then climate change also caused the deaths. Competing interests: None declared |
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Robert A. Da Prato, Medical Officer Military Entrance Processing Station, 7545 NE Ambassador Place, Portland OR 97229
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About 30 years ago I recall being vaguely worried about the then current bugaboo of global cooling. The reasoning seemed plausible: human caused air pollution was increasing the earth's albedo (percentage of light from the sun reflected back into space) promising a catastrophic cooling, high and dry port cities, an ice shield down to the tropics, etc. Amazingly, the special interests then were the same as now:the anti internal combustion engine/technology ideologues, university "scientists" in their never ending search for funding, and just the average Joe, eager to be somewhat scared and desperate for passion in life. What a difference 30 years makes, not in the players, but in the bugaboo. I find it interesting that the principle reasoned arguments against human caused global warming come from emeritus professors in relevant fields. My supposition is that they can afford to put "science" above money and ideology. Is global warming occurring? Well, certainly from the last mini-ice age it has, and I'm grateful. How about recently? This is difficult to say since there is evidence which supports this and evidence which doesn't. When you think about it, taking the actual "temperature of the earth" and comparing it to the temperature of the earth 100 years ago is fraught with procedural difficulties: where were the thermometers placed, over how many years were measurements taken, what about city effects, and the list goes on. Global heat measurement by satellite telemetry, which seems to me to be one of the best ways to measure the temperature of the entire earth has shown no changes in the past 18 years, a time frame one would expect to show substantial increases in temperature due to human activity. I see in the (left leaning) mass media in the US that certain glaciers are receding. What they don't say is that the antarctic ice cap (over land) is increasing, and this ice cap is the major determinant of sea level. Last year here was a major media hoo-hah over a chunk of the (floating) antarctic ice cap ("the size of Rhode Island!)breaking off ("due to global warming". Reaching for the World Book encyclopedia when I heard this I read that in the 50's a chuck broke off four times larger! Perhaps this just happens every now and then without human caused climate change. I notice in the same media that even cold spells are attributed to global warming. Any dramatic weather event is now attributed to global warming...in fact, global warming cannot be falsified (a hallmark of religious belief.) Yes, human activity puts CO2 in the atmosphere, but is that necessarily bad? Since the carbon atoms in every organic compound synthesized by plants, and by extension what we eventually eat comes from carbon dioxide, the more carbon in the air as CO2, the more plant life. Since most of the warming alleged is occurring in the winter, this allows for a longer growing season, less need for supplemental heating, etc. Carbon dioxide enrichment in greenhouses despite its expense has been practiced for years because of the substantial increase of biomass even a modest increase in CO2 allows. Ultimately, what places global warming on a religious or ideologic rather than a scientific plane is the lack of matched controls: there is no absolutely identical but uninhabited by humans parallel universe to see climate change without human activity. What we do have are mathematical models of climate change. We have a lot of them because none accurately predicts all prior climate changes, CO2 levels, etc., (a polite way of saying they are all wrong). One who is absolutely definite that global warming is occurring AND due to human activity will be absolutely definite that any remedy when applied will cure the common cold in 7 to 10 days. What is obvious to me is that in a primarily urban population such as the United States and Europe health and longevity are dependent primarily not on the medical community but on the availability of abundant and nutritious food, protection from the extremes of weather, and removal of waste ..all requiring tremendous amounts of energy. American journalist H.L. Mencken described modern life as an endless promulgation of bugaboos, all of them bogus, their express purpose being scaring the ignorant citizenry into changing their behaviors or opening their wallets to the benefit of the bugaboo promoters. Global warming, formerly global cooling, seems to be yet another confirmation of his wisdom. Competing interests: None declared |
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Md. Anwarul Azim Majumder, Lecturer Department of Medical Education, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia, Sayeeda Rahman
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Sir: We read the cover story and editorial publish in your journal titled: “Global warming: health impacts may be abrupt as well as long term”1 with great interest. BMJ has again proven that it is the leading and dedicated journal, relentlessly working for the well being of inhabitants of our beloved planet. However, as health professionals, we expect more in-depth discussion in this article regarding specific public health issues related to global warming in Bangladesh and other islands countries. Bangladesh is the most vulnerable country of the world (http://news.bbc.co.uk/1/hi/world/americas/1220036.stm.) which likely to bear most of the serious health consequences of global warming than any other countries. Bangladesh has already the worst health statistics – mortality and morbidity indicators are very high. This situation is now worsening day by day due to various effects of the global warming. The health effects in relation to global warming can be grouped into two categories: (i) health effects due to climate change, and (ii) health effects due to sea level change. Scientists already predict that by 2050 AD the temperature in Bangladesh is expected to rise by 1.5°-2.0°C and the country will experience an increase in rainfall. As a result, there will be an increase in the frequency and intensity of tropical storms, floods and other natural disasters. Every year the country is experiencing such catastrophes. The health impacts Bangladesh will face in coming years include: increased mortality and illness due to heat stress (specially elderly, children and low-income people) and worsened air pollution (respiratory and cardiovascular diseases, childhood asthma due to increase in ground-level ozone pollution) and increased incidence of vector-borne emerging and re- emerging diseases (SARS, malaria, Kala-azar, and dengue), diseases related to water supply and sanitation (cholera), and food-borne illnesses (food poisoning due to toxic algae – 'red tides'). Expanding populations of pest species, impaired food production and nutrition, and extreme weather events such as floods, droughts, and windstorms will pose serious risks to human health. Changing climate will also affect the productivity of certain crops, adverse alteration in agricultural production, supply and distribution. As a result, malnutrition and starvation may lead to a number of serious public health consequences. It is also forecasted that the increased surface temperature of the earth will cause a thermal expansion of the seawater. This can inundate heavily populated coastal and deltaic areas of Bangladesh and people will move to cities and other areas (environmental refugees. Such pattern of distribution and density of population will create a number of public health hazards. This forecasts an alarming situation, not only for Bangladesh, but also for other island nations. In Bangladesh, the planners, policymakers and politicians, and even NGOs and donors, have little thinking about the seriousness and long-term implications of the consequences of global warming (http://www.megastories.com/warming/bangla/intro.htm). What now going on is: stopping the dam with a finger! References: 1. Patz JA. Global warming, health and Bangladesh: Stopping the dam with a finger! BMJ 2004; 328:1269-70. Competing interests: None declared |
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Mark A. Sircus O.M.D., Director of IMVA Brazil
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Though it is not pleasant to look at what is happening in the world, we must ask, is our resistance to looking deeply at events and their primordial causes increasing the force and the need for nature to crash down on us? The melting of the polar icecaps is perhaps the single most devastating event impacting on world health and climate conditions, diminishing now at a faster rate than any scientist has expected, at almost 1 percent per year. “The rate of 9% per decade rate of melt is happening three times faster than originally thought, and could continue even faster than that,” says Josefino Comiso, senior scientist at NASA's Goddard Space Center. Implications for global climate patterns are catastrophic as arctic snow and ice are integral in controlling Earth's temperatures by insulating the atmosphere from land and ocean heat. Tom Agnew, a research meteorologist at the Meteorology Service of Canada, says the warming trend is due to greenhouse-gas emissions from burning fossil fuels. It is unclear whether reversing the trend is possible. "The whole system is very slow to start," he says, "and also very slow to stop." Norwegian researchers close to the problem are confirming scientist’s worst fears indicating that this process is accelerating and others are speculating that we are experiencing solar cycles that are increasing temperatures slightly, but not enough to account for the intensity of the changes. Competing interests: None declared |
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venkoba R srinivas, Consultant Geriatrician Chennai, India Pin: 600028
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The concerns about the global warming and the exepcted sequelae are real, whether one likes the movie ' Day after tomorrow' or not! This is just one of the flaws we in the scientific community, should take the blame for. The basic flaw in our medical system seems to be that we are focussing less and less on prevention and concentrating more on treatment and 'damage limitation' strategies. This of course suits the big drug companies well! The usual response from the Academics and clinicians is that they dont have funds for 'Prevention' related projects. Ample money is available, surprise surprise, from the drug companies for drug trials. If only we could pool money from Philanthropists, NGOs and anyone else for that matter, and start honestly for simple, workble solutions for the ills of our health care system, the world will be a much better place for us to live in - certainly for our grand and great grand children! I personlly feel the issue of global warming is but one of the perils of ignoring preventive methods in real life. Competing interests: None declared |
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