Robin Stott BMJ Carbon Council

1. Robin StottBMJ Carbon Council

2. Obligations of Doctors • Two equal obligations: • To care for individual patients in a humane compassionate and scientifically effective way, without regard to status, sexual orientation, origin or any other. • To ensure that the society we live in is health creating, so that all global inhabitants can enjoy good health.

3. Preconditions for a health creating global civilisation • All peoples have reasonable access to economic and social resources. • Earths gifts are shared amongst humans fairly without compromising future generations and other than humans • Present attempts to be create this healthy world are undermined by two great problems-global climate change and the gap in resources between the materially rich and the materially poor. • If we are to fulfil our obligations doctors must play a prominent role in addressing these problems.

4. The Themes. • Human induced global warming, triggered by the industrialised countries, is with us. Atmospheric CO2 levels are the best marker of this. • Changes in our climate are already having an impact on the social, economic and environmental determinants of health, and this impact will magnify with time. • Materially poor communities will suffer most, and the resource gap between the ‘poor’ and the ‘rich’ will increase. Whilst global warming exercises the rich minority world, the gap is the dominant concern of the majority world. • For the continuing well being of humans , other than humans and our planet, we MUST forge a global alliance to combat global warming. On the grounds of equity and pragmatism solutions must address the concerns of both the minority and the majority world. • Solutions must therefore create a virtuous cycle of activity, where global environmental, social and economic gains are delivered synergistically. • Contraction and Convergence, developed by the Global Commons Institute, is an excellent virtuous cycle policy tool, and the most feasible option available at present. There are many benefits to our wellbeing of adopting Contraction and Convergence. • By articulating these benefits and through our advocacy of C and C , health and other professional groups will offer the hope and inspiration necessary to counter global warming, and so act in accordance with our obligations.

5. Atmospheric CO2 levels, global warming and fossil fuel use. • Stable level from 10,000 years ago to 1800-280ppm.( not above 300ppm for 400,000 years) • Present level 380ppm,increasing by 2ppm/year. • Global temp has risen in parallel-predicted increases for 21st century are around 0.5 C/decade. • Fossil fuel is burned predominantly by the rich North. 80 million barrels oil/day- USA 20 million, China 6, Japan 5, Germany 3, India 3,UK1.9. • Per capita emissions (tons of CO2 ):USA-20: UK-10: Africa>1: China-3.0 : India-1.5. • ‘Sustainable’ per capita emission is approx 1 ton/year. This amount is dependent on preservation of carbon sinks.( The biomass, particularly tropical forests ,and the sea)

6. Ecosystems and Health-Impacts of climate change • A Source of energy and materials. • A Service for water, food , micronutrients and carbon recycling. • A Sink for pollutants. • A Space for living working and aesthetics. • 60% of all ecosystems are already degraded or being used unsustainably. • Global warming will aggravate the situation.

7. Global climate change-aggravating the problem • Unpredictable exposure to extremes of weather affecting water supply and crops. • Expansion of range of disease vectors. Falciparum Malaria already causes 500 million cases/year, with one million deaths. • Thermal expansion of water plus melting land based ice leading to sea level rises.100 million people and many cities are within half a metre of present sea level. • Ensuing demographic, social and economic dislocation, with the likelyhood of 100 million new climate refugees.

8. Deprivation and disparity, which will get worse with global warming. • 800 millions go to bed hungry. 1 billion have no access to clean water. • Of 700 million primary school children, 125 million, mostly girls, don’t go to school. • 2 billion people live on incomes below $1,000 /year: 1 billion on $30,000 /year. • This disparity exists in both rich and poor countries. • Personal income is a good marker of this disparity. Globally, ratio of income between top 20% and bottom 20% has moved from 1:135 (1998) to 1:150 (2004). Gini coefficient in UK was 0.29 (1980), 0.4 (2002).

9. Contraction • Set a globally agreed carbon Budget, aimed at keeping atmospheric CO2 levels below 450ppm. • Reduce this over an agreed, but negotiable time scale (probably 50 years) until the amount emitted equals the amount the world can cope with.( approx 8 billion tons of CO2: 1.4 tons/person/year). • But this amount depends on protecting carbon sinks. • By CONTRACTING the amount of Carbon emitted, this process will stabilise atmospheric CO2 levels. • Allocate an equal entitlement of this capped budget to every global citizen.

10. Convergence • Move rapidly to an equal entitlement of the carbon budget to each person in the world. A CONVERGENCE to an equal share of earths bounties and support systems. • Then frugal emitters( usually the poor) will be able to sell their unused entitlements to the profligate emitters( the rich). For compelling financial reasons, all will invest in low carbon initiatives. • Given that each ton of CO2 entitlement will have a substantial financial value, this process will enable a framework based market transfer of money to the poor to fourish. • This would more than cover $ 120/person which the UN millennium project has estimated will be required to deliver the millennium goals in Africa.

11. Contraction and Convergence • Creates a policy virtuous cycle at a global level, enabling economic and social progress within environmental limits. • Unleashes a worldwide boom in low carbon entrepreneurial activity. • Facilitates the development and implementation of virtuous cycles for coping with the ‘problems ‘ of waste, excessive fossil fuel use, biodiversity loss, noise at National, regional , community and personal levels. • Implementing virtuous cycles is essential for promoting sustainability and wellbeing. • The many virtuous cycles of policy facilitated by C and C will deliver major health benefits.

12. Health Benefits of C and C. • Those arising from the mitigation of Climate change. ‘KEEPING our COOL’ • Those arising from the related transfer of resources. ‘NARROWING the GAP’ • Those rising from the facilitation of other virtuous cycles, moving those living in the Rich North to more physically active non obesogenic societies, in which atheroma related disease will be less prevalent.

13. Atheroma and global warming • Atheroma, narrowing of the arteries, is the basis of most deaths in the developed world. • Half of the 550,000 deaths /year in the UK, • 11% of global deaths. • Commonest in non exercising obese ( diabetic), eating high salt high cholesterol and energy dense foods, smoking and suffering from low status.

15. Atheroma and global warming • Atheroma occurs in the obesogenic societies of the minority world. • These societies have flourished with the availability of cheap and plentiful fossil fuel energy. • And are therefore the societies which provoke global warming. • In carbon constrained societies, there will be a move to localism. We will once again use more human effort, as was the case in societies before the availability of cheap fossil fuel. • The move to localism will unleash a series of virtuous cycles moving us toward a non obesogenic society. The reduction in the prevalence of atheroma will be an excellent marker of improvement.

16. Doctors Advocacy • Inform • Affirm. Measure and reduce personal CO2 emissions. Ensure that the organisations we are associated with do likewise. • Advocate, stressing the need for a global framework.

17. Take home message-1 • Global agreement to tackle climate change is imperative for our global good health-doctors have a crucial advocacy role. • Participation of the majority world is dependent on carbon constraint being coupled to a transfer of resources to the yet to industrialise and industrialising countries. • These countries can then share in non fossil fuel dependent progress. • The framework based market of Contraction and Convergence is the most feasible presently available tool to achieve this end.

18. Take home message -2. • C and C will facilitate many other virtuous cycles, providing a boost to sustainability and wellbeing, and therefore public health. • Think, advocate and implement Virtuous cycles at all levels, including those which protect the globe’s carbon sinks. • Join the many others who are clamouring for the global virtuous cycle of C and C. • Aim to make C and C the framework promoted by the UK at COP 13.

19. UN Framework Convention on Climate Change:UNFCCC • UNFCCC came into force on 21.03.1994.Its three objectives are to: • Gather and share info on GHG emissions , national policy and best practice. • Launch national strategies for addressing GHG emissions and adapting to expected impacts, including the provision of financial and technical support to developing countries. • Co-operate in preparing for the impact of climate change.

20. Conference of the parties to UNFCCC ( COP) • COP is the supreme decision making body of the UNFCCC. It is open to all signatories, and meets each year. • The next meeting, COP 13, is at Nusa Dua, Bali 3-14 Dec2007. • We must aim to make C and C the policy the UK proposes at COP 13.

21. Take up of C and C. • Senior advocates in the European Union , India, Africa and UK. • Archbishop of Canterbury , Michael Meacher, Ken Livingstone,and Colin Challen, chairman of the UK parliamentary all parties climate change group. • German Advisory Council on Global climate Change. • Aubrey Meyer, director of the GCI and inspiration behind C and C gets City of London 2005 lifetime achievement award. • Fleming, the Tyndall centre and Domestic Tradeable Quotas ( Local variant of C and C).

22. Virtuous cycles facilitated by C and C • * Regional/National Level : Distributed energy networks. • * Community level: Influence procurement to create virtuous cycles of activity.-( the health service buys around £11 billion worth of products each year) . e.g: • a) locally grown organic food supplying health facilities. • b) Influencing new buildings to improve the economic, environmental and social circumstances of the localities in which they are built. • * Personal level: Set and promote good examples :e.g. • a) ride a bicycle, • b) Insulate our homes using local materials and local workers.

23. Millennium goals-2015 • Reduce by 75% maternal mortality rate. • Halt and reverse AIDS/HIV epidemic. • Halve number of people living without access to water/sanitation. • Reduce under 5 mortality by 66%. • Halve the number of people living on less than $1/day. • Universal primary education.

24. Mandela • Its not a tragedy to die with dreams unfulfilled, but it is a tragedy not to dream. • Mandela’s dream , shared by me and billions of others, is of all humanity living with each other in harmony and balance, and living in the world without destroying it. • So develop a flourishing global civilisation.