The health of people and society at large is a product of the social circumstances in which we live, our networks of relationships with other human beings, and our interactions with our built environment, with nature and so with the planet. Our genetic make up and our health care service are of lesser importance.
Global warming is already having an impact on these wider determinants of health. Unpredictable exposure to extremes of weather will cause important problems for food growing and water availability. A sea level rise of one metre will displace 120 million people. The female anophelene mosquito responsible for malaria will increase its range, producing an estimated 60 million additional cases of malaria each year. All these will provoke social, economic, and demographic dislocation. For our continuing good health we must control global warming. Most observers now agree that the only practical way of doing this is to regulate our carbon use by implementing a carbon cap and trade mechanism, as detailed in Contract and Converge.
While technological fixes are important they cannot in the foreseeable future completely replace fossil fuels. To get to the low carbon society within the regulatory framework of C and C means that we will have to reduce our energy consumption. The only increase in energy we should promote is energy generated by human effort. The good news is that this process will have important health benefits.
If we look at the epidemiology of death in rich countries, we can immediately understand why. In the UK heart attacks and strokes account for around 300 000 of the 550 000 deaths each year. Many of these deaths occur in young people. Atheroma, the gumming up of arteries, is the disorder that underlies most of these strokes and heart attacks. Atheroma was virtually unknown in traditional, low carbon societies. It has emerged to be the biggest killer in modern industrial societies, societies that have also provoked global warming.
The factors underlying this atheroma epidemic are well known. Perhaps the most important are lack of exercise and diabetes, which is primarily a disease of the non‐exercising obese. High energy, salt, and fat rich diets and high blood pressure, a consequence of all these, are also important risk factors. Add to these unemployment, lack of social engagement, and disadvantage, and smoking, commonest in marginalised communities, and we get a profile of the circumstances in which atheroma flourishes.
Thus the social changes common to industrial societies have provoked both atheroma and global warming. They are both consequences of the same cause, and will both respond to the same measures, which I outline below.
In our low carbon, low energy society, we will all use more human energy, as was the case in societies before the emergence of atheroma. We will walk, bike, and use public transport, activities that will reclaim the streets, increasing the sense of community and perceptions of safety. We will eat much less meat, moving towards organic, locally produced mainly vegetarian diets, all of which greatly reduce the present substantial fossil fuel load of food. We will insulate our homes, and find innovative ways of using renewable energy, with both carbon reducing and job creating benefits. We will move the balance of activity towards localisation. These changes will help create a fitter, slimmer more engaged population. A healthier population, and fortunately one that delivers government health targets.
A final and essential health benefit of the C and C regulatory regimen is that there will be a transfer of resources from the rich to the poor. On the basis of equity, each person will get an equal allocation of the capped amount of carbon. Those who don't use their allocation, mainly the poor, will be able to sell it at market rates to those who wish to use more than their allocation, mainly the rich. This redistribution of wealth will reduce disparity, a crucial measure if we really wish to improve public health.
Given this market mechanism, it will be in everyone's interest to minimise the amount of carbon we use. Just as all of us strive to live within our financial means, we will strive to live within our carbon means, with the evident financial benefit this brings.
In essence the C and C regulatory framework moves society toward the social environmental and economic circumstances conducive to good health.
The health service will also be beneficially touched by a low carbon world and C and C. At present around 90% of health interventions take place locally. In line with government health strategy, and enabled by the information revolution, this percentage is increasing. Low energy societies will accelerate this trend to locally based health provision. Finally health facilities can be exemplars for many low carbon initiatives, as shown in the London regions initiative building for health.
To summarise, a public health initiative guided and regulated by a C and C framework will help us meet all our governments targets for personal health. In addition this most elegant and conceptually simple idea will help mitigate the two important problems undermining our global health, global warming and the disparity of resources between the materially rich and the materially poor. Everyone is interested in health. All of us must be delighted that we have an elegant solution to so many of our health problems. Let's move to implement it as soon as possible. Let's use C and C as a shorthand for good public health.