Climate Change and Medical Risk

This post is a part of our Bioethics in the News series. For more information, click here.

By Sean A. Valles, Ph.D.

 After winning the 2007 Nobel Peace Prize, the UN’s Intergovernmental Panel on Climate Change has returned to the headlines. Heeding the growing body of climate evidence, they say, “it is extremely likely [95%-100% likely] that human influence has been the dominant cause of the observed warming since the mid-20th century” (IPCC Working Group I 2013, pp. SPM-2, SPM-12). Unfortunately, according to a March Gallup poll:

In contrast to majority acceptance of global warming as real, Gallup finds Americans less than alarmed. One-third worry “a great deal,” and 34% expect it to threaten their way of life. These could be the attitudes that matter most when it comes to Americans’ support for public policies designed to address the issue (Saad 2013).

That skepticism about climate change’s seriousness (and, to a lesser extent, about humans’ responsibility for it) is impeding democratic action in the US. The leadership provided by a skeptical vocal minority has turned the public dialogue into a dispute over uncertainties in how we predict future climate, whether it is accusing researchers of inadequate “objectivity” (LaFramboise 2013) or publicizing pieces of climate data that seem inadequately explained (Darwall 2013). I encourage my bioethics colleagues to help change the conversation, and re-frame the US climate change dialogue to focus on one crucial fact: even with lingering uncertainties, climate change poses health risks that we would be foolish to ignore.

A 2009 special report by The Lancet and University College London Institute for Global Health Commission declares, “climate change is the biggest global health threat of the 21st century” (Costello, et al. 2009, p. 1693). These are bold words, especially coming from The Lancet—one of the most prestigious medical journals. The report lists a number of health risks: more numerous heat waves will worsen respiratory and cardiovascular symptoms (Costello, et al. 2009, p. 1702), mosquitoes and mosquito-borne diseases will spread and flourish in newly warm areas (Costello, et al. 2009, p. 1702), and extreme weather events will become more common and stronger (impacting mental health, access to food, access to sanitation infrastructure, etc.) (Costello, et al. 2009, p. 1706). The list goes on, and policy groups such as the EPA have demonstrated that they take it quite seriously. A recent article in Bioethics by Cheryl Cox MacPherson explains that such risks make it clear “Climate Change Is a Bioethics Problem” (MacPherson 2013, p. 305).

Unfortunately, bioethicists’ involvement in the climate change dialogue—a crucial medical dialogue—has been the exception rather than the norm. Bioethicists are already expert communicators, researchers, interdisciplinary collaborators, and public advocates in the management of multiple intersecting risks and ethical considerations. They apply this expertise to issues such as tissue donation, vaccination, and pharmaceutical testing. I recommend that they add climate change to their list of priorities. Economic constraints, individual liberty, public welfare, being mindful of social justice; these sorts of difficult climate change considerations are very much in bioethicists’ wheelhouse.

Recent research on science communication indicates that pragmatically it would be a wise strategy to move health out of the background in the climate change dialogue. A recent study compared audience responses to three different presentations of climate change, “emphasizing either the risks to the environment, public health, or national security;” the researchers found that, “across audience segments, a public health focus was the most likely to elicit emotional reactions consistent with support for climate change mitigation and adaptation” (Myers, et al. 2012, p. 1105). Maibach et al. explains that the “dominant mental frame used by most members of the public to organize their conceptions about climate change is that of ‘climate change as an environmental problem’” (Maibach, et al. 2010, p. 2). We all hear plenty of talk about ‘saving the environment,’ but switching to a health frame would offer important benefits.

Re-defining climate change in public health terms should help people make connections to already familiar problems such as asthma, allergies, and infectious diseases experienced in their communities. The frame also presents the opportunity to involve additional trusted communication partners on the issue, notably public health experts and local community leaders (Maibach, et al. 2010, pp. 9-10).

Pictures of forlorn polar bears floating on melting blocks of ice have proved compelling for some people, but a health-centered approach looks more promising as a default strategy.

Shifting the climate dialogue to emphasize medical risk creates a fresh conversation, wherein both unshakable believers and unimpressed skeptics can perhaps recognize the ethical imperative to prevent likely harms. In an analogous situation, I am encouraged by the way that ever-embattled evolutionary biology has become incorporated into the daily life of clinical healthcare workers. The evolutionary biologist Joan Roughgarden points out that (limited) survey data shows “acceptance of evolution is far from unanimous among Christian doctors” (Roughgarden 2006, p. 8). This is cause for great concern, since evolutionary biology shows that the misuse of antibiotics since their introduction in the 1940s has created an environment where natural selection favors the evolution of antibiotic-resistant pathogens, creating a global medical crisis (Chambers, et al. 2009). The good news is that despite the aforementioned (human) evolution skepticism among doctors, as a group they recognize that their actions are partly responsible for the problem of antibiotic resistance. In a recent survey of US physicians (“clinical faculty and residents”), 97% agree “inappropriate [antibiotic] use causes antimicrobial resistance” (Abbo, et al. 2011, pp. 714-715).

Recognizing climate change medical risk as worthy of attention and action does not mean that one must fully understand or even fully trust the underlying science. In the case of the antibiotic-resistant pathogens, the perceived risk (uncontrolled infectious diseases) seems capable of overriding theoretical qualms about natural selection’s role in biology. Analogously, the aforementioned communications research suggests that climate skepticism and climate ambivalence can perhaps be overcome by shifting emphasis to medical risks.

The antibiotic resistance case can also shed light on how to synchronize multiple climate change strategies. Philosopher Stephen Gardiner highlights the dangers of proposed climate change strategies that largely abandon the mitigation of climate change (e.g. reducing greenhouse gas emissions) in order to pursue adaptation strategies to cope with the effects of the change (Gardiner 2004). Indeed, the antibiotic resistance dialogue already incorporates both mitigation strategies (preventing antibiotic overuse in order to slow the evolution of antibiotic resistance) and adaptation strategies (creating treatment guidelines to help patients who have resistant infections) (Centers for Disease Control and Prevention 2013).

Climate change is a growing medical problem, and there is increasing recognition that this needs to be highlighted. Perhaps most importantly, evidence from communications research and the analogous dialogue about antibiotic resistance indicates that framing climate change as a health risk would be a productive shift. I hope bioethicists will increasingly join with their colleagues in climatology, public health, etc., so that together we can make the case for action.

References:

Abbo L, Sinkowitz-Cochran R, Smith L, Ariza-Heredia E, Gómez-Marín O, Srinivasan A, et al. (2011). Faculty and Resident Physicians’ Attitudes, Perceptions, and Knowledge about Antimicrobial Use and Resistance. Infection Control and Hospital Epidemiology, 32(7), 714-718. Retrieved from http://www.jstor.org.proxy1.cl.msu.edu/stable/10.1086/660761

Centers for Disease Control and Prevention (2013). Antibiotic Resistance Threats in the United States, 2013: Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/features/antibioticresistancethreats/

Chambers HF, & DeLeo FR (2009). Waves of Resistance: Staphylococcus Aureus in the Antibiotic Era. Nature Reviews Microbiology, 7(9), 629-641. Retrieved from http://www.nature.com.proxy2.cl.msu.edu/nrmicro/journal/v7/n9/full/nrmicro2200.html

Costello A, Abbas M, Allen A, Ball S, Bell S, Bellamy R, et al. (2009). Managing the Health Effects of Climate Change. Lancet, 373(9676), 1693-1733. Retrieved from http://www.sciencedirect.com.proxy1.cl.msu.edu/science/article/pii/S0140673609609351

Darwall R (2013). The Political Science of Global Warming. The Wall Street Journal. Retrieved from http://online.wsj.com/news/articles/SB10001424052702303464504579106993839343868

Gardiner SM (2004). Ethics and Global Climate Change. Ethics, 114(3), 555-600. Retrieved from http://www.jstor.org.proxy1.cl.msu.edu/stable/10.1086/382247

IPCC Working Group I (2013). Working Group I Contribution to the IPCC Fifth Assessment Report Climate Change 2013: The Physical Science Basis (Summary for Policymakers). Geneva: Intergovernmental Panel on Climate Change. Retrieved from http://www.climatechange2013.org/images/uploads/WGIAR5-SPM_Approved27Sep2013.pdf

LaFramboise D (2013). Warming Up for Another Climate-Change Report. The Wall Street Journal. Retrieved from http://online.wsj.com/article/SB10001424127887323981304579079030750537994.html

MacPherson CC (2013). Climate Change is a Bioethics Problem. Bioethics, 27(6), 305-308. Retrieved from http://onlinelibrary.wiley.com.proxy2.cl.msu.edu/doi/10.1111/bioe.12029/full

Maibach EW, Nisbet M, Baldwin P, Akerlof K, & Diao G (2010). Reframing Climate Change as a Public Health Issue: an Exploratory Study of Public Reactions. BMC Public Health, 10, 299. Retrieved from http://dx.doi.org.proxy1.cl.msu.edu/10.1186/1471-2458-10-299

McGrath M (2013). IPCC climate report: humans ‘dominant cause’ of warming. BBC News. Retrieved from http://www.bbc.co.uk/news/science-environment-24292615

Myers TA, Nisbet MC, Maibach EW, & Leiserowitz AA (2012). A Public Health Frame Arouses Hopeful Emotions about Climate Change. Climatic Change, 113(3-4), 1105-1112. Retrieved from http://link.springer.com/article/10.1007%2Fs10584-012-0513-6

Roughgarden J (2006). Evolution and Christian Faith: Reflections of an Evolutionary Biologist. Washington, DC: Island Press.

Saad L (2013). Americans’ Concerns About Global Warming on the Rise Retrieved October 4, 2013, from http://www.gallup.com/poll/161645/americans-concerns-global-warming-rise.aspx

Subramanian C (2013). Rebranding Climate Change as a Public Health Issue. Time. Retrieved from http://healthland.time.com/2013/08/08/rebranding-climate-change-as-a-public-health-issue/

United States Environmental Protection Agency (2013). Climate Impacts on Human Health: United States Environmental Protection Agency. Retrieved from http://www.epa.gov/climatechange/impacts-adaptation/health.html

Note: The resources for this post include both public access links and Michigan State University Libraries access links. The MSU library links are available to current MSU faculty, staff and students.

Sean A. Valles, Ph.D.,  is an Assistant Professor in the Lyman Briggs College and the Department of Philosophy at Michigan State University.

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