A Persuasive Presentation Connecting the Dots Between Climate Change and Public Health

2018 Lancet Countdown on Health and Climate Change Brief for the United States of America By Renee N. Salas, Paige Knappenberger, and Jeremy Hess

London, England: Lancet Countdown; 2018 32 pages

The Lancet is a weekly peer-reviewed medical journal that began publishing in 1823 and is among the most prestigious medical journals in the world. In 2015, the Lancet began systematically monitoring the health implications of climate change. In late 2017, along with the American Public Health Association and more than two dozen other partners and collaborators, the Lancet released the 2018 Lancet Countdown on Health and Climate Change Brief for the United States of America, tracking 41 indicators of climate change and health and offering suggestions to reduce the cumulative risk. The 2018 Lancet Countdown highlights the key threats to our nation. The 32-page brief unambiguously connects the dots between climate change and human health, asserting that climate change is already seriously affecting US public health and the economy.

MESSAGES

Salas et al. offer interesting data, observations, and policy-related suggestions predicated on these data throughout the US brief. I find five observations particularly compelling:

• •Vulnerability and exposure to acute and chronic climate-related health hazards are already widespread in the United States, and these health impacts have been spreading across the country;
• •Adaptation and resilience planning are centered in selected cities and states and are increasing;
• •Mitigation actions are already reducing risk and yielding health benefits as well as avoiding costs;
• •Economic and financial costs are billions of dollars a year and threaten the US economy; and
• •Public and political involvement is growing.

The authors of the 2018 Lancet Countdown came to these conclusions about the United States by assessing 41 indicators, including temperature increases, for example, an increase in heat waves; losses in labor productivity; impact of smoke from fires on fine particles in the air; and increases in vector-borne diseases.

VALUE ADDED FOR PUBLIC HEALTH PRACTITIONERS

These five messages are not revelations for AJPH readers who have been following this evolving global challenge. The messages may not be new, but the persuasive presentation is valuable to each of us, and the comprehensive tracking of indicators of climate change and health allows quantitative information that can be updated. We touch on four elements of the brief that are especially noteworthy.

First, the report covers recent issues that we hear or learn about from the media, but they are presented in a single place and the report offers more breadth and depth about some of them. For example, we assume that California has borne the brunt of the wildfire problem. But my students, who are mostly from New Jersey and New York, were surprised when they saw that Pennsylvania and other parts of the Midwest and the Northeast also have recently had many wildfires, as well as days with extremely high heat and heat island–producing weather. The health message is reinforced by strong graphs and maps. Also, the report devotes a section to Hurricane Maria’s horrific impact on Puerto Rico. Salas et al. point out that the factory that produced most of the island’s intravenous fluids was shut down and affected medical procedures across the United States as a whole. Again, the Puerto Rico example is accompanied by strong visual aids.

Second, the report devotes little space to complaining about the US federal government’s less than progressive role in the world community. Instead, the report provides data and graphics to show that US states and cities have taken aggressive action to reduce their carbon footprint, and many of these places have developed plans to adapt to climate change. We note that this encouraging presentation stands in strong contrast to neo-Malthusians, who during the 1970s made young people feel that there was nothing they could do to stop mass starvation and that the end of civilization as we knew it was around the corner. I remember thinking that I was wasting my time studying; why bother! This report is not a gloom and doom portrayal of the present and future. The authors not only call for more education to persuade the public that there is something that we can do but also argue for more training of the next generation of health practitioners to be more effective in calling for action. Notably, the report calls for hospitals to take the lead in cutting carbon emissions, another positive action that public health practitioners can take.

Third, I applaud the effort to estimate the economic consequences of climate change. The US federal government, including leaders of both political parties, used economic costs to the United States as justification for not engaging and withdrawing from international fossil fuel reduction efforts. An earlier AJPH editorial called for engaging naysayers on economic self-interest grounds.¹ This report estimates the economic costs of wildfires, water loss, lost wages, and other climate change–enhanced impacts and supports their observations with striking visuals. We can use these arguments and graphics with American audiences, especially union members and farmers, about the economic and health-related vulnerabilities of not supporting local and international climate mitigation and resilience efforts.

Fourth, I am impressed by the metrics, maps, and drawings used to convey the messages. This report has some of the best, perhaps the most effective, graphics that I have seen about climate change effects. Here are several examples. One map shows that the year 2017 was the hottest year on record in almost every part of the United States. The red and orange colors are not subtle. Another example is that it is difficult to convince Americans that vector-borne diseases, ticks, and mosquitos are a serious threat to them personally and the United States as a whole; instead, Americans think that these organisms are a problem for portions of Latin America, Asia, and Africa. This report offers data and figures that show that mosquito-, tick-, and flea-associated illnesses quadrupled in the United States between 2004 and 2016. Overall, even if the information is not new, this report offers more than two dozen maps, charts, and other figures that will grab and hold the attention of busy people. Frankly, some of these are like daggers in the arguments that the effects of climate change are only in developing nations and that Americans need not be concerned about the impact here.

UNAMBIGUOUSLY CONNECTING THE DOTS

Overall, using 41 indicators supported by visual displays, the Lancet and its partners have unambiguously connected the dots between climate change, public health, and economic and political consequences in the United States. These partners will continue to monitor and assess progress and setbacks. They make no pretense that this will be anything other than a multigenerational struggle for the opportunity to protect ourselves and future generations. You can sign up with the Lancet to receive notification of new reports, and this brief is available online.