National Institute of Environmental Health Sciences

By Wendy Anson

Two new reports published in The Lancet provide insights on the global environment and its potential effects on the health of world populations. The first report tracks a series of health and climate indicators to monitor how the response to climate change could affect human health. The second report looks at the economic cost of pollution-related disease. Both highlight that the burden of these environmental threats fall unequally on children, the poor, and people living in low- and middle-income countries (LMICs).

“These two new reports from The Lancet provide crucial benchmarks to NIEHS and other institutions conducting environmental health research. They also help track efforts to translate that research into actions that can protect the health of people, especially those in low- and middle-income countries,” said John Balbus, M.D., NIEHS senior advisor for public health and director of the Global Environmental Health program.

Lancet Countdown on Health and Climate Change

The 2017 report from the Lancet Countdown on Health and Climate Change gives the current status of 40 indicators across five key areas in health and climate change: climate change impacts, exposures, and vulnerability; adaptation planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. The indicators were laid out by the inaugural Lancet Countdown report from 2016. The Lancet Countdown on Health and Climate Change is a collaboration of 24 international academic institutions and intergovernmental organizations from around the world that will report annually on climate change and the state of global public health until 2030.

The report details how climate change will affect all populations but highlights that adverse impacts will disproportionately affect vulnerable populations and people in LMICs. “Climate change exacerbates social, economic, and demographic inequalities, with the impacts eventually felt by all populations,” the authors wrote.

The 2017 report outlines how higher air and sea temperatures can affect storm strength and frequency, floods, droughts, and heat waves, all of which can affect human health. For example, the number of vulnerable people exposed to heatwave events increased by about 125 million from 2000 to 2016. Increasing temperatures can exacerbate existing health problems in populations, including cardiovascular disease and chronic kidney disease. These weather extremes can also result in changes in crop yields, the spread of infectious disease, and climate-induced population displacement and violent conflict.

The report warns that if government and global health community responses to mitigate and adapt to climate change are slow, it will result in an irreversible and unacceptable cost to human health. However, the authors also note that while progress has been historically slow, the past 5 years have seen an accelerated response, showing clear and unprecedented opportunities for public health.

For example, there is now a growing international awareness that replacing fossil fuels with renewable energy can reduce morbidity and mortality from air pollution. From 1990 to 2013, the U.S. succeeded in lowering the carbon intensity of its energy system by nearly 7 percent. Other high-income countries, such as Germany and the U.K., also reduced carbon intensity. The authors conclude the transition to low carbon electricity generation now appears inevitable.

The Role of the Health Profession

The report suggests that health care systems should work to ensure that they are resilient to the impacts of weather-related disasters. It notes that climate-related events can impair the continuous delivery of medical services by interrupting critical infrastructure services essential for the functioning of health care systems. The report documents widespread vulnerability of health system infrastructure, citing as an example that only 2 of 9 countries in the Africa region reported national efforts to enhance health care system resilience to climate threats. The Countdown also includes an indicator for health care sector greenhouse gas emissions, but notes that the U.K. is the only country in the world that currently reports on these emissions.

Additionally, health care professionals should be aware of the harmful health effects of climate change, as well as the immediate and long-term health benefits associated with reducing greenhouse gas emissions. “The health profession not only has the ability but the responsibility to act as public health advocates by communicating threats and opportunities to the public and policy makers and ensuring climate change is understood as being central to human well-being,” the authors wrote.

The Lancet Commission on Pollution and Health: Putting a Price on Pollution

Released October 19, the Lancet Commission on Pollution and Health report addresses the full health and economic costs of air, water, and soil pollution. According to the report, 9 million premature deaths in 2015, or 16 percent of all deaths worldwide, are linked to pollution. Estimates of economic costs associated with pollution total more than $4.6 trillion each year.

“This is the first analysis to report the impacts of all kinds of pollution in all parts of the world, both health and economic,” said NIEHS Hazardous Substances Branch Chief Bill Suk, Ph.D., who was among the more than 40 international authors of the report. He noted that Goal 10 of the NIEHS 2012-2017 Strategic Plan calls for evaluating the economic effects of exposure reductions. “This report links exposure and disease to economic implications on a worldwide scale.”

Examples of the forms of pollution the authors analysed include air and water pollution, workplace or occupational exposures, and lead contamination. They examined economic costs associated with pollution-related disease, such as hospital costs, lost time from school or work, and diminished economic productivity. According to the authors, the burden of pollution falls disproportionately on the poor and children.

Suk noted the benefits of including economists on the Lancet Commission on Pollution and Health. “We realized we need to look at the impact that pollution is having on health, but also from the economic standpoint of how much pollution is really costing.”

The report includes a comprehensive list of recommended solutions. “The good news is that much pollution can be eliminated, and pollution prevention can be highly cost-effective,” the authors wrote.

Responsible Economic Growth

The authors explain that contrary to common beliefs about economic growth, developing countries do not need to pass through a phase of pollution on the road to economic development. Instead, by formulating sound laws, policies, and regulations to control pollution, developing countries can minimize environmental degradation and pollution-related disease as they industrialize.

Suk also emphasized the importance of incorporating economics, human health, pollution prevention, and overall cost savings into the entire cycle of a product. He explained that we now have the technology to track sources, locations, and development of pollution. “There’s a way that a ‘circular economy’ of renewable materials and products may be able to minimize waste and pollution as well as cost,” he said. “We can no longer afford to continue to make things and then throw them away if we want to conserve our resources and protect our health.”