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.• And in Ghandi’s words ‘Live simply, so that other may

simply live.’

GMC duties of Doctors/health professionals

• 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.

• Same for all health professionals

Preconditions for a health creating 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 everywhere prevalent gap in resources between the materially rich and the materially poor

• If we are to fulfil our obligations health professionals must play a prominent role in addressing these problems.

What do we need to do?

• Inform

• Affirm

• Advocate

• Innovate

• Disseminate

What do we need to do?

• Inform

-- health consequences of Climate change and the widening resource gap – policies for mitigation: – policies for adaptation: – co-benefits of the above

What we need to do

• Affirm. Measure and reduce personal CO2 emissions. Ensure that the organisations we are associated with do likewise.

• Informing and affirming -putting our own house in order- wont solve the problem, but give us the moral right to advocate for global solutions which will.

• When in place, these global solutions will accelerate our own local initiatives.

What do we need to do?

• Advocacy, stressing the need for a global framework which simultaneously tackles climate change and the resource gap, and so is health promoting.

• So a fair shares solution—a fair share of the residual carbon we can emit consistent with a 450 ppm CO2 target, and of the resources which come from these emissions.

• Most feasible present fair shares option is Contraction and Convergence.

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.

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.

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.

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 obesity related disease will be less prevalent.

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.

What do we need to do?

• Innovate-seeking new institutional forms for delivering the C and C framework and

• Disseminate—recruiting as many partners as possible.

Take home message-1

• Global agreement to tackle climate change is imperative for our global good health-health professionals 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.

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.

• Make C and C the framework promoted by the UK at COP 15 ,Copenhagen 2009.

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.

• First steps to a new global framework were taken at COP 13, in Bali Dec 07

• We must aim to make C and C the policy the UK proposes at COP 15 , Copenhagen 2009

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)

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.

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.

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).

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.

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.

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.

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).

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.

Energy equivalents.

• The energy in a kilo ( litre) of oil is 10 kilowatt hours, equivalent to between 100 and 200hours of human work.

• An hour of human work is therefore equivalent to 5-10 grms ( I teaspoonful) of oil

• A 40 litre fill up of a petrol tank is equivalent to between 2 to 4years of human work.

• 1 kilowatt hour=860 kilocals,3.6 megajoules