A recent conference in Dublin heard speakers highlight the importance of public health in promoting climate action. David Lynch reports
“We need to figure out how to give glory to prevention again.” That was the central message of Dr Maria Neira, Director of the Department of Public Health, Environment and Social Determinants of Health at the World Health Organisation (WHO), who addressed a recent conference in Dublin.
The Environment, Health and Wellbeing Conference 2023 was jointly organised by the HSE, Environmental Protection Agency (EPA), and the Economic and Social Research Institute (ESRI).
Dr Neira, who is a specialist in endocrinology and metabolic diseases, spoke by video-link and highlighted figures that showed the impact of environmental factors on global health.
According to the WHO, an estimated 12.6 million people died as a result of living or working in an unhealthy environment in 2012 – nearly one-in-four of total global deaths. Environmental risk factors, such as air, water and soil pollution, chemical exposures, climate change, and ultraviolet radiation, contribute to more than 100 different diseases and injuries.
“Recently, I was talking to a very high-level person in a development agency, and he said ‘Maria, there is no glory in prevention,’” Dr Neira told attendees at the conference.
“I’m afraid this is true. There is no glory in prevention. The moment you prevent a disease everybody forgets.”
“People forget once you have an effective vaccine, nobody will be giving glory to the vaccine every day; people take it for granted, which is great. We removed lead from the gasoline, nobody is thinking every day about the figures for the neurological disorders that we probably have been able to avoid by removing the lead.
“Every day in a country like yours [Ireland], when you turn on the tap, you have clean and safe water, but we don’t have everyone in the city saying ‘thank you for preventing all the diseases’ [caused by unsafe drinking water].”
Dr Neira said public health doctors “need to work with that” and highlight the benefits of prevention.
She made this point in the context of climate change and its impact on health.
“We need the right strategy, but maybe the right tactics as well. The topic is so important,” she said. Dr Neira added that if environmental risk factors can be “modified” there would be a significant positive impact on the global burden of disease and mortality. It would also help achieve improvements in hospital care and reduce the economic cost to the health system.
She underlined that the positive public health argument for climate change can be effective in moving public opinion on the issue.
The health argument for climate action is crucial, she maintained, noting that many people were tired of “apocalyptic” messages in regards climate change. She said the health argument for climate action was one of “hope”.
Air quality
Ms Laura Burke, Director General of the EPA, told the conference that we “should recognise in Ireland that air quality is generally good”. She noted Ireland was “compliant with EU standards” in regards air quality.
However, more work was required to meet the more “stringent” WHO guidelines.
“This is where the aspiration should be; this is what the EPA has been calling for, for a number of years. It is not okay just to meet the minimum bar.”
She welcomed the publication of the Government’s “long-awaited” Clean Air Strategy for Ireland, which was published last month. “It is great that it is now published, there is a commitment in that strategy to reach the WHO guidelines by 2040,” said Ms Burke. “That’s great, but it’s a long time to 2040. So what are the actions that can now happen immediately to move us towards those guidelines?”
Inequality
A number of speakers at the conference raised the issue of inequality and environmental health, noting how not all communities were impacted equally.
“We have to also remember that air pollution does not impact everybody in an equal way,” said Ms Burke.
“What we are now seeing… is the evidence suggesting that the health of people of low socio-economic status tends to be more affected by air pollution than the health of the general population.”
“So, when we are talking about air quality, it is no good for a section of the population being okay; we need to be looking right across the population. The most vulnerable in society have the least say in where they live, where they go to school, where they work, how they travel, how they achieve their goals. So we need to be conscious of that disparity in environmental exposure in air pollution, and ensure that really targeted actions are taken to ensure that those most vulnerable also have a clean healthy environment.”
Noise pollution
The EPA Director General said that after air quality, environmental noise was the most persistent cause of health issues. She noted European-wide research that showed long-term exposure to excessive environmental noise and road traffic caused increased levels of heart disease and premature deaths.
“At least 18 million people are impacted by noise [across Europe]. Five million have their sleep disturbed because of exposure to noise from transport,” she said.
“Similar to air pollution, some communities are more affected than others.”
Ms Burke said there needed to be planning around management of the noise impact on health and wellbeing.
“And also something that is relatively new in people’s consciousness – the increased provision and accessibility to dedicated quiet areas, particularly in high population density areas.”
Dr Jenny Mack, Public Health Medicine Consultant with the Institute of Public Health, told the conference that her central message was that the “climate emergency is a health emergency”. The environment in which we live has a direct impact on our health, Dr Mack said. She stated that global challenges, such as climate change and air pollution, were interlinked and posed significant health risks. She added that they contributed to a substantial number of deaths worldwide every year.
Mr Gerardo Sanchez, an environment and health expert at the European Environment Agency in Denmark, told attendees that he was not invited to many medical conferences 10 or more years ago, but this “had changed” in recent years.
Mr Sanchez highlighted the importance of clinicians and doctors in raising environmental health issues as they are among the most trusted groups in all European societies “and they need to play a leadership role”.
Dr Neira agreed on the important impact of doctors, and she made a specific reference to the “great work” carried out by the Irish Doctors for the Environment group.
She added that environmental health was mainly “primary prevention”, while the public were more familiar with the area of “secondary prevention” such as hospital care.
Dr Neira said it was vital that the importance of a “primary healthcare approach” to the health of the population was made clear in public health messaging.
COP28
The 2023 United Nations Climate Change Conference, more commonly referred to as COP28, will be held in Dubai in November and December.
Dr Neira said this was the first time ‘health’ would be the specific focus of an entire day of the event. This, she argued, was a significant opportunity for public health to have an impact on the issue of climate action.
“There are opportunities at COP28… for the first time ever we are having a health day,” she said.
“This has taken a long time to bring to this point… but we need to make sure that we use this opportunity to demonstrate that investing in mitigation of the consequences of climate change is probably one of the biggest public health opportunities ever.
“So it is an opportunity to practise primary prevention… transition to clean sources of energy, renewable sources for energy that will be so beneficial for climate change, but also pollution and the prevention of the deaths caused by air pollution.”
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