Bengaluru: The increasing frequency of extreme weather events such as erratic rainfall that the Intergovernmental Panel on Climate Change (IPCC) predicted in its October 2018 report is already visible in India. Assam, large parts of western Maharashtra and Kerala have been inundated this monsoon. Once the floods recede, people will be faced with the risk of vector-borne diseases such as malaria and dengue due to water stagnation.

This summer 65% of Indians were exposed to a heatwave in the months of May and June, up from 53% in 2018. This extreme heat has an impact on health and productivity and can cause deaths.

Human health, thus, is one of the most tangible ways people experience climate change. But there is little recognition of this fact, according to Maria Neira, 57, the World Health Organization’s director for public health, environmental and social determinants of health. “Climate change is not just about polar bears and melting of glaciers but also about our lungs,” she told IndiaSpend in an interview.

Every year an estimated 7 million people die prematurely due to air pollution. But while people see the connection between polluted air and health, they fail to notice that many of the gases that cause climate change also cause air pollution, Neira said.

With winter temperatures in the Arctic already 3 deg C higher than in 1990, climate change has turned both critical and urgent. The United Nations is organising a climate summit on September 23, 2019 to discuss the implications as well as mitigation strategies for climate change. The same day the world body will also host a high-level meeting to discuss access to universal healthcare coverage (UHC).

In a telephonic conversation with IndiaSpend, Neira emphasised the health and economic gains tied to investing in climate change adaptation and mitigation. Before joining the WHO in 1993, Neira worked in public health in Mozambique and Rwanda in Africa. She has also acted as a medical coordinator for Médecins Sans Frontières (Doctors without Borders), the international humanitarian medical network, at its refugee camps in Salvador and Honduras in South America during the armed conflict there.

Edited excerpts from the interview:

In the 15 countries that emit the most greenhouse gases, the health impacts of air pollution are estimated to cost more than 4% of their gross domestic product, according to a 2018 WHO report. What are the challenges of dealing with this crisis?

I would like to start by saying that climate change is affecting everyone--whether you are in a developing country or developed one, rural area or urban area--we are all at risk. This is a critical message. Obviously, vulnerable countries would be those that don’t have the capacity to cope with the consequences of climate change, and those consequences are necessarily due to the fact that you will have meteorological disasters like droughts, floods or heatwaves. These will be increasing. Vector-borne diseases like malaria or dengue particularly will increase because of the humidity and weather conditions.

The problem with climate change is that it will be attacking and destabilising the major pillars of our health, which is our capacity to have access to safe water, food and shelter. Related to the health is the quality of air that we breathe. If we have a drought, that might put at risk the agricultural production and create food scarcity. People will then begin migrating due to the fact that they don’t have food. And obviously the same (will happen) with water.

The causes of climate change and air pollution are very similar. We are seeing a massive air pollution situation which is one of the big consequences of that (climate change).

So, all of that together presents a major challenge for our health and well-being.

Indian cities have some of the world’s worst air quality. India’s cities also occupy 11 of the 15 slots in WHO’s list of most polluted cities in the world in terms of toxic particulate matter. What should the response to a problem of this magnitude be?

I think recognising the fact that there is a major problem with air pollution is critical. We have to assess the sources of pollution. Not all countries will have similar sources. In the case of India this assessment has been drawn. There are very good studies and very good plans as well.

I think now it is more about accelerating the political will to implement all of those actions that are already very well-defined. You have very good specialists in India, very good scientists and very good planners; very good national plans and city plans. I think now the question is about accelerating those plans and recognising that the mortality caused by air pollution is absolutely unacceptable. Add to the fact that there are many kinds of chronic diseases that are linked to air pollution and the causes behind hospitalisation.

We know very well that this is a very wise economic, social and health investment. Tackling air pollution will bring enormous benefits not only for health but the socio-economic development of the country as well.

You’ve written about the need for urban planners to design our cities better with more open spaces keep changing climate in mind. Within a same city too climate change would affect inhabitants differently based on whether they live in a high-rise and can afford air conditioning or live in a slum without access to cooling options. Equity needs to be an important part of how we frame policies for climate change, should it not?

This is a critical point. If you are living in slums where you don’t have the capacity to cope and adapt to climate change--for instance, water scarcity--then you may see a rise in vector-borne diseases. You might not have many healthcare facilities that are resilient to climate change. In rural areas you might not have the capacity to tackle the process of climate change yourself by diversifying your agricultural production.

The poor population, which are not the ones contributing to the causes of greenhouse gases pollution, are the ones that are most affected. This is very unfair because if we put a map of the world looking at the countries that are responsible for the most warming, those are the ones that are less affected. Continents like Africa who have contributed very little to the global warming are among those who are most affected.

In the case of India, those in the slums and the rural areas are not contributing much to the CO2 emissions but they are the ones who are suffering dramatically the consequences of climate change. So, there is an issue of equity here and the poor people are the ones who will be suffering the most.

The high-level meeting on UHC as well as the climate summit are on the same day. Despite the UN’s stand on public health and climate change links the overlapping dates of the meetings would force policy makers to choose one over the other. This has already raised questions about the mixed message the UN is sending out to the rest of the world.

Well, we have been working very hard with the secretary general (of the UN) on the climate summit to make sure that health is very prominent. I think we have succeeded because the secretary general’s office has recognised now that the startling impacts of climate change is a public health agenda as well.

When we talk about climate change, think about air pollution and the fact that there are 7 million premature deaths occurring every year due to air pollution. The causes of air pollution and climate change overlap almost 70% of the times. This is still affecting half of the world population. For us this is a health agenda. Climate change is a health agenda.

We have two big health commitments. One is requesting countries to endorse WHO air quality standards. If we can ensure that countries support that commitment then countries will need to have a better public transport system to reduce that pollution.

You will invest more in renewable energy and therefore you will reduce pollution. You will be increasing access to cleaner fuels at the household levels for the people and that will mean reducing pneumonia, reducing lung cancer rates, reducing COPD (chronic obstructive pulmonary disease), reducing stroke and reducing ischemic heart disease.

Considering the meetings are on the same day, policy makers and leaders from different countries would be forced to choose one over the other.

I don’t know how this happened. I think it was more the result of a process that the UHC high level event was already proposed and then the secretary general said they need to have a climate summit because it was getting very urgent. But I see an opportunity to get reinforcement from each other and saying, okay, there is no universal health coverage if you don’t make sure your healthcare facilities are resilient to climate change.

Nearly two in every three Indians were exposed to a lethal heatwave this summer. Nearly 59,000 farmer deaths in the past three decades could be linked to climate change, according to a 2017 study. Yet, action in terms of mitigation and adaptation has been very slow in many countries despite the science. How does one overcome that gap?

Certainly, science has been there for a long time. I don’t think that this can be an excuse. Whenever I talk about air pollution, for instance, and the fact that we have seen 7 million deaths I am always saying that politicians will be requested to defend their lack of action, sometimes even in the courts, and it is happening in the UK and in France.

People can’t say “I didn’t know this”, because the science is there. It will depend on how we as a civil society will push that science for more action. How we put pressure on our politicians to accelerate and be more ambitious.

From the WHO what we have been trying to do very strongly, particularly in the last two years, is linking air pollution and climate change.

People understand the connection between asthma and air pollution, for them that is very easy. Understanding the connection between climate change and health is a little bit more difficult but they see the connection between the bad quality of air they breathe and their health. It is not just the big glaciers and the polar bears and the planet. When we talk about climate change we need to talk about our lungs as well.

What is the key takeaway for policy makers based on the available science? Also, how much time do we have to mitigate and adapt?

In terms of adaptation and mitigation the message I am giving to politicians is that is a good investment. It is not just the health, it will bring enormous benefit. And the costs will be perfectly covered by the returns. Put your economics on the table as well. Look at the rich countries, the Scandinavians. They are environment-friendly and they are very rich. This view, that an economy cannot grow without destroying the environment, is fake, is false, it is wrong. There are major economic interests in doing things without destroying our lungs and our environment. This is one message.

Second, this is very urgent. This is not the question of 2050. The question here is how many lungs or losing quality of life or even losing our brain power are you ready to accept. Because if we don’t take strong action we know that we are losing thousands of lives. No extra deaths are acceptable. You need to keep that in mind every day when you are a politician. You need to ask that question. More I postpone (action) the more lives I am not saving.

(Shetty is a reporting fellow at IndiaSpend.)

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