Interview with Dr Marina Romanello, a data scientist in the Institute for Global Health at University College London who is also on the Lancet Countdown team, an international collaboration that tracks progress on health and climate change.
What are the main ways in which you view the current health and climate crises as being connected?
It’s also important to note that climate change comes from the deterioration of our natural systems, and ‘zoonotic’ diseases may become more frequent as we interact differently with wildlife.
In addition, we’ve heard a lot during the pandemic about the linkages between air pollution and Covid-19. We know that pollution exacerbates underlying health conditions, such as heart disease, that make you vulnerable to the worst cases of Covid-19. We’ve all seen how emissions plummeted during the various lockdowns, though it probably doesn’t have much of an impact in the longer term.
In terms of how we’ve dealt with the pandemic and how our lives have transformed, there are so many links with climate change and our interaction with the natural environment. We’re appreciating what it means to get back in touch with a more sustainable way of interacting with nature. We’ve also been able to walk down the street or cycle without having the danger of constant traffic.
Your latest Lancet Countdown report for 2020 noted that national health services have increasingly linked up with meteorological services to boost health adaptation planning. Was that influenced a lot by Covid-19, or did this trend start before the pandemic?
Marina Romanello: That had already been changing, because health systems are starting to see how environmental drivers generate acute crises that can overwhelm systems – so we have to prepare and respond to environmental and climatological emergencies.
We know that as the climate changes and we’re exposed to new infectious diseases, peaks in air pollution and dietary-linked pathologies, health systems will start suffering increases in demand. And with Covid-19, we’ve seen how we don’t have the luxury of dealing with just one crisis at a time: you cannot just make the hurricane or heatwave wait until you’re done with Covid-19.
Covid-19 has really exposed how fragile our health systems are. We have to adapt them, strengthen them and build resilience so that when we have another pandemic and we have these ‘multi-hit’ scenarios of drought, lack of food, extreme weather events and infectious diseases, our health systems are resilient to them.
Do you think that health and climate have been linked together enough in the past?
Marina Romanello: I don’t think they were linked enough, and I don’t think they are linked enough today either.
Since we started publishing our Lancet Countdown indicator reports in 2016, however, we’ve seen that more and more health systems and people are starting to understand climate change as a health threat, and the World Health Organization has a humongous job in bringing that awareness.
The National Health Service in England recently declared that it will become net-zero in carbon emissions by 2045, earlier than national commitments. The biggest unique health system and fifth-biggest single employer in the world making this commitment is really a testimony of progress. The fact that it happened in the midst of a global pandemic also shows that the NHS is acknowledging the urgency of the climate crisis.
But climate change is still not homogeneously accepted as a fundamental health threat, and we’re still not seeing the full response that we need from health systems and professionals in taking this forward. We really need to ensure that the whole world is in this together, because, as much as Covid-19, climate change does not respect country boundaries.
Why do you think that not enough of a connection has always been made between the two crises?
Marina Romanello: I think one of the big reasons is that climate change is not the cause of death on anyone’s death certificate: you don’t drop dead in the street because of climate change, you all of a sudden have a heart attack from underlying conditions because of extreme heat.
That’s why it’s so important to have and communicate the data to the health community and the general public, which is what we try to do with the Lancet Countdown. We have to start exposing what is the driver behind increases in deaths or changes in patterns of infectious diseases, and we have to acknowledge that our health depends more than anything on the environment we live in.
The health system can also be very reactive, even though we know that prevention is so cost-effective. For example, when there is a wildfire, we focus on the immediate crisis: we have to assist patients and put the fire down. But then another fire comes and we do the same: it’s about the emergency and not thinking about hey, how do we stop this from happening altogether? We need to look at the climate crisis so that we stop having these frequent fires and reduce their intensity.
Is it also to do with a lack of resources in many countries to deal with the wider climate issue at the same time?
Marina Romanello: To tackle the climate crisis, you don’t necessarily need more resources, but you need to change where you put them. Huge investments are needed to reach emissions commitments and shift to a low-carbon economy, but one thing to keep in mind is that those commitments are incredibly cost-effective, particularly when you take into account the enormous healthcare costs from climate change.
If we can restructure our society and systems in a way that generates lower road traffic and air pollution, more active lifestyles, more liveable environments, healthier diets and cleaner water, we have a huge opportunity. Also, for every pound spent investing in renewable energies and energy efficiency, you create three times more jobs than if you invest the pound in the fossil-fuel industry.
It’s really important that as we start having all of these recovery funds available from Covid-19, we don’t do what we do by default – going back to the old economy that is fossil-fuel-based. That economy is unsustainable and we won’t be able to keep going down that road much into the future, because we have the Paris Agreement and the commitments that we need to keep.
We’re in a quite critical moment now, in which we’re still in the pandemic but we’re starting to shape and draft what recovery looks like. It’s precisely now that we have to put the focus on what will come out of this.