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Thank you to all the Conversation Leaders for their time and commitment to taking part in this important conversation. Please take a moment to learn about the conversation leaders by clicking on their profile photos. Thank you!

Below is a list of questions to serve as a framework for the discussion in this thread:

  • What challenges have you faced integrating climate change and health?
    • What strategies or tactics were used to overcome them?
    • What more should be done to address continued challenges?
  • What are specific examples of ways to bridge the gap between research and practical scientific implementation? 

One of our most succesful tactics ( at the Gundersen Health System) was to mange the message. Polar bears and African droughts would not hold the sway that improving health, lowering the cost of health care, and improving the local economy.  To get our non-profit board....made up of many local business people.... to allow us to really go after wide scale change and big infrastructure we repeatedly tried to show that we could do all those things.

That said, on our road to dropping our green house gases 90% since 2008, we started with conservation. Not as sexy as giant wind turbines or fields of solar panels, but our facilities are now 54% more efficient, which means we need less green generation power.

Providing health professionals with the communications tools

Health professionals have been excellent messengers in support of strong clean energy and climate policy action, but many of them seek help in how to communicate most effectively with policy makers and with the media. Fresh Energy is partnering with a Minnesota-based group of health professionals to provide communications training, and also to let them know in what venues, and when, their voices can be most effective. We are finding that very focused voluntary communications training allows these busy professionals to gain momentum toward their goals in a fairly short period of time.

Lack of understanding of climate change as a challenge

There is a lack of understanding of what climate change is.In many instances issues of climate change are shrouded in scientific terms which are complex  especially for  frontline communities who are impacted on negatively by the impacts of climate change.By frontline communities in my context I imply the fisherfolk, communities in urban slums, farmers, marine ecosystem communities and indigenous  peoples .

Within my context this  complexity has been addressed through a Climate Justice Project ( implemented by Fahamu Networks of Social Justice  in collaboration with Ibon International) to carry out a project aiming at enhancing  civil society participation  towards an equitable and ambitious post 2015 climate regime.This involves going to  frontline communities and having dialogues about climate change  including  documenetation of impacts of climate change on this communities  .

Through the community dialogues on climate  change  we have observed  enhanced knowlkedge and capacities among communities on the science, economic and the politics of climate change , better understanding of the Intended Nationally Determined Contributions (INDCs) to climate change governance  and a critical analysis of climate change issues from the perspectives of grassroots communities .In addition  communities have had opportunities to voice their issues  on how climate change is affecting them including on health through these dialogues.

For me the greatest challenge thus is demystifying climate change as a whole and addressing the issue of  self blame amongst grassroots communities that they are responsible for the current climate crisis.

challenges - conservation

Conservation is a pretty low hanging fruit in hospitals - it can be linked to ideas about quality in healthcare and it's easier to see the financial savings compared with longer term large capital investments like green generation.

We have experienced this as a bit of a double edged sword though in NZ... we have improving energy efficiency but an inability to tackle the big, difficult issues - like replacing some of the hospital coal boilers.


Recognition of Health in the Global Climate Discussions

It has been difficult for health to compete for the attention of global decision makers with issues like energy, economy and even agriculture. At the United Nations Convention on Climate Change (UNFCCC), health still does not occupy a place of appropriate prominence in multilateral decision making.

In 2009 at COP21 in Copenhagen, health was a footnote on page 7 of the negotiating text. Twenty seven people attended a meeting about the role of health in climate change, most of whom were representatives of the World Health Organization. A few other NGOs including SeaTrust Institute were in the room.  That year, health moved from a footnote on page 7 to a footnote on page 3.

Since then, a health day has been designated during subsequent COPs, and more health professionals attend and present at the meetings. The conveners and attendees are a vibrant and well-informed group of health professionals and interested parties.  Health issues appear in documents and as supportive evidence for negotiating positions; a chapter devoted to health is part of the IPCC AR5 report. But health still remains apart from the mainstream negotiations. The action item in the slogan “put health at the heart of the negotiations” simply hasn’t happened.  Even at the recent COP21 meetings in Paris, while a health day was convened it was offsite and far from the negotiating venue, and therefore drew few who were not already dedicated to the issues of health.  ­

Our organization decided to integrate health as a gauge for climate change decisions in our local development and global educational programs. As such, health does not compete with other agendas but becomes a way to determine whether the decisions are moving towards creating resilience to communities facing effects from climate change. Bringing this information back to the country negotiators and to attendees at the multilateral meetings to show them how health works for their agendas instead of competes with them for scarce resources has been a slow but incrementally successful approach. 

Using Health As A Gauge

Lynn, this use of health as a gauge or indicator for climate change is really interesting! It puts health at the forefront, shaping the program, rather than an afterthought. Can you give us more specific examples of a project in which you did this? How was it measured? How did decision-makers respond? 

Members tagged in this comment: 


At Environmental Defense Fund we have been communicating climate change scientific research  in a way that egnages a wider community in discussions around human vulnerabilitites.

A key element is how (western) scientifc methodlogies allow us to tell a story about climate change and health impacts. However, there are a lot of toher non scientific ways in which these impacts are felt or even described. Different communitites, in different parts of the world experience these impacts and methodologically study them in different ways. 

In this sense, western science is not the only voice in the dialogue, however, it has established itself as a filter to direct the conversation around climate change.

Who is being left out of this conversation?

How to engage them?

Is a crisis around science (and its limits) part of the challenges when we think of responses to the health impacts of cliamte change?

An observation

As a psychological researcher who studies how people respond to messages about climate change, I want to note that the human health dimension of climate change tends to get (and is more likey to keep) people's attention.  Of course people respond to climate change with a pre-set bias - at one end of the spectrum are people who tend toward skepticism and denial (around 15% of the American public) and at the other end are the people who are alarmed by the issue no matter what new information they hear (also around 15% of the American public). It is unlikely that either group will change their response to climate change regardess of how we talk about it or the kinds of impacts we choose to emphasize when we communicate the issue.  However, these two groups make up only about 30% of the public; the other 70% is willing to listen, to learn more, and they may even change their minds.  It turns out that with this 70% (I like to call them "the mushy middle" or "the people who are concerned by not taking (much) action") may be more reachable if the conversation about climate change focuses on health impacts.  In fact, a 2010 study by Maibach, Nisbet, Baldwin, Akerlof, and Diao suggests that people may be most responsive to information about the positive health benefits of climate mitigation actions.

Emphasizing Positive Impacts

I think Christie has an excellent point about focusing on the positive health benefits of mitigation. Expanding the notion to adaptation could change it from resignation (which is sometimes how adaptation and even resilience is perceived particularly by that "mushy middle," ) to transformative.   Youth in particular appear to be open to making adaptation more than just getting by, but rather to create a preferable future. 

emphasizing the postive impacts

Definitely agree. Trying to unfreeze and activate the people who are feeling helpless and hopeless is also important, with messages about individual and collective action combined with the positive impacts that can have on flourishing. I love Niki Harre's book "Psychology for a Better World" - I'm connecting to her talking about the book on YouTube.

One of the things she says is that people don't have the capacity to change unless it's contributing to their happiness.

How do we avoid being Polyannas though?


From Health Impact to Health Sector Impact

Thank you for this opportunity to be able to share our thoughts and experience around the nexus of climate and health.

For two decades, Health Care Without Harm has been working towards transforming the global health sector so that it does not "do harm" on both people and the planet. Our audience has been the health sector, and some of the major initiatives we have undertaken include elimination of mercury in healthcare settings, banning of medical waste incineration, and influencing the supply chain to ensure that medical products are safe and manufactured in a sustainable manner.

Three years ago, we then started the Healthy Energy Initiative (, which aims to mobilize the global health sector to advocate for a move away from fossil fuel-based power generation—particularly coal—and toward clean, renewable, healthy energy options. In our campaign in the Philippines, we have engaged with a wide range of stakeholders, but particularly with health sector leaders who became champions and spokespeople for climate and health.

Since the Philippines is one of the countries in the world most vulnerable to climate change, we have emphasized the importance of addressing climate change to protect the health of the Filipino population. This messaging resonated well with both the health and 'non-health' sectors. However, instead of just focusing on "adaptation" alone, meaning how the health sector can respond to the health impacts of climate change, through the Healthy Energy Initiative we have brought a totally new dimension to the climate-health link - that the health sector itself can make a positive impact within and beyond the sector.

For instance, we have showcased best practices of health facilities that have turned to renewable energy sources and energy efficiency measures as a way of reducing their own ecological footprint. Such examples convey a message of hope to the health community - that they themselves can make a positive contribution to greenhouse gas emission reduction. Furthermore, we have also involved health leaders to speak in fora using the best available public health evidence to inform energy and climate policy in the Philippines.

Finally, in this age of social media, we have also reached out to the next generation of health professionals through Facebook and Twitter, and also developed a short film that illustrates how the health sector can turn the "health impacts of climate change" into "health sector impacting positively on climate change." The film, "The Big Show," which we launched in Paris during COP21 last December, summarizes our message of hope.

The Message

I think Renzo has a key point. We need to not ignore the issues of the impact of the climate changes but if that is too big a focus we can turn into the "worried but not acting " 15% that Christie mentioned. In the US, the Health Care sector is almost 20% of the GDP. We can have a profound direct effect if we become more disciplined and proactive about decreasing our impact. Our success at the Gundersen Health System has been to prove we can decrease those pollutants that cause disease, while saving money for the health system, and improving the local economy. 

Different parts of our communities will respond to different strengths of your program, the communication if done well can adapt and inspire many different groups from the 70% " interested but not [doing much]"

Justice and Climate Change

It is critically important to understand that climate change is as much a problem of social crisis as it is an environmental crisis.  In the 1980s and 1990s, almost 1.3 million lives er affecteed in some maner by climate and weather events according to the World Health Organization.  In the U.S., we are still compiling the toll on our communities from the range of climate-related impacts.  Hurricane Katrina displaced more athan 1 million people, Superstorm Sandy total damage is over $20 billion - and those are only two events.  A crucial part of addressing climate change must include the existing unequal environmental conditions that Indigenous, communities of color and low income communities have endured.  Climate change serves to exacerbate these inequalities unless the disparity in social and economic conditions is addressed.  Until recently, this intersection of race and class in climate environmentalism was not even acknowledged.  Now, thankfully, it is gaining more and more attention.  It is important to remember that the root cause of climate change is our dependence on a fossil fuel economic system. This same system has had devastating effects on frontline communities - degrading air quality; removing mountain tops; producing co-pollutant toxins. The historic burden of the operations of this system were not distributed equally. Certain communities bore the brunt. And now as we move forward in addressing climate change, it is important that any solutions for both mitigation and adaptation repair past harms and move us to a just and sustainable future.

Justice is Key on issues of climate change

I concur with Cecilia that justice is important on issues of climate change.The reality is that communities impacted on by climate change are in many cases already vulnerable communities economically, socially and in some instances politically.A case in  point is the Sengwer which is an indigenous community in Embobut forest, this community has occupied the forest for over 300 years but now is being evicted from their natural habitat under the guise of environmental conservation.This is a community that co-existed with nature , depending on hunting and gathering for survival and which had  developed it's own forest governance system.Interviews held with the Sengwer cite their  forceful eviction as cultural  extinction.

For marine ecosystem communities such as those living in Marereni , Malindi,  some are  small scale farmers , others are fisherfolk, climate change has affected rainfall patterns, mangrooves are getting destroyed to pave way for expansion of salt lagoon by corporates.What is  sadder is that fishermen  whose source of economic livelihood depends on the  ocean are sometimes restricted from accessing  the sea.Fish have also migrated deeper into the sea.On Mfangano Island  ( Lake Victoria) fishermen complain of companies and beach resorts dumping their wastes on the lake , killing fish .This has also resulted into fish migrating deeper into the lake.Fishermen have to  follow the fish  leaving their   wives behind without any form of economic support.This   has resulted to high rates of HIV among fishermen .As sources of fish get depleted  the phenomenon of sex for fish comes in locally known as jaboya where women are forced to have sexual relations with fishermen because culturally women are not allowed to fish.This has health implications in that  it  enhances vulnerability to HIV and other STIs.



One of our biggest ongoing challanges is to convince the public, our health sector and environmental regulators that climate change is not "just" an environmental problem but also a public health issue that will have profound impacts on the many vulnerable communities in our African Region. This is despite a widespread acceptance that environnmental pollution is directly linked to energy and coal and that coal in South Africa is the main driver of climate change.

Fundamentally our public health sector in SA remains largely de-linked from all elements of environnmentalhealth impact assessment and governance which means that the health costs of coal, climate change and costs to health remain largely ignored from the decision making process.

We believe that once we successfully engage the health sector they will have a significant role to play in the mitigation of climate change.



Economic Benefits in Health Sector and Beyond

I believe Jeff makes a good point about the Health Care sector in itself being significant in economic impact, especially in the developed world. There  is another approach we can also  take to make the idea of climate change impact more easily digested by the interested but largely inert populace. At the COPs (COP 21 and previous COPs) we talked a great deal about the co-benefits of health. Many of these benefits are economic boosts to society such as a more productive  labor force with fewer  out-of-work days, fewer resources having to be allocated to health issues and the vulnerability they create,  and greater opportunities for sustainable development. The economics of a healthy population are known and when applied to climate change, the economics of a healty population creates a focus for climate change action by those who already know the wisdom maintaining a healthy population to sustain a healthy economy.


There is much good news among the struggle. First a bit of struggle. In Paris several Australians lamented their rapid falling backwards in many categories around energy use , its impact on health and its impact on the economy. They related that  huge subsidies and favorable legal environment aids the coal companies to make billions. They  do of course pay millions in taxes, although a significant portion of that is ear marked to go into a fund that treats the health effects of coal mining and coal burning. An ill circle.

Better news, the largest Healthcare Quality organization in the world IHI ( Institute for Healthcare  Improvement) not only has  consistent senior level presentations at their International Forum in December but held the first ever Latin America IHI Forum in Sao Paulo .Several thousand from across the continent heard about the connection between health, healthcare providers, and the environment. Finally, at the CleanMed meeting in Dallas in May  a presentation will be given outlining all the environmental policy statements across all the societies and associations in health care in the US.It is an impressive expanse of varying depth and actions, but I would bet it is over 80% more than we would have found 8-10 years ago.

Integrating Climate Change and Health

Climate change is a process that takes long for it's  effects to be felt.As such many people may not be able to directly see the relationship between climate change and health.However , in some instances where there is an extreme shift in weather patterns then communities are able to  see. A case in point is Kenya during the extreme heat  in March 2016  for a duration of around 5 days.There were many compaints of fainting , fatigue  and headaches and this was attributed to the heat.

Other instances include  instances of flooding where  water borne diseases abound hence  there is the element of linking the disease with the weather, increase in reported cases of diarrhoea during floods may also point out to a health problem related to climate change.

Protection from things we can't see

This argument about not being able to directly see the tangible impacts of climate change comes up again and again. But I wonder... in public health we are constantly working with measures to protect people from things they will mostly (we hope) never directly experience... In high income countries this includes: getting people to wear seatbelts, vaccinate their children against diseases like polio, and undertake sometimes invasive screening.

So how come that works? Is climate change a failure of people's imagination, a failure of communication, or something a bit more deliberate? Or is it more about the profundity of change that will need to take place that people like to pretend they can't see things...


Challenges - advocacy and activism

In many countries, including New Zealand, there is a growing sense that government is continuing to wilfully follow down a path of economic growth through fossil fuel extraction, even after having signed the Paris Agreement. At the same time, the news about the climate change trajectory we are on is looking fairly grave.

For the past 6 years OraTaiao: the NZ Climate & Health Council has been very careful to use the gravitas, social standing and group influence of health professionals to take part in "institutionally accepted" advocacy: media work, education, research, policy submissions, polite meetings with politicians, building a coalition of eminent and conservative health professional organisations...

But given the combination of the severe threat to health, the urgency of the issue and the continued inaction, what is the ethical next step?

There seems to be a tension between standing with communities who are refusing to allow governments and industries to continue on a path of climate destruction, and keeping the support of a coalition of conservative colleges by being polite but of limited effectiveness in achieving the kind of urgent change that's needed.

I'm very interested in this quote from the American medical Association (which has since disappeared from the publicly available record I note):

“In general, when physicians believe a law is unjust, they should work to change the law. In exceptional circumstances of unjust laws, ethical responsibilities should supercede legal obligations”

This has been used in the context of "workarounds" to provide access to healthcare for uninsured patients in the US, but it feels like it has some relevance to this discussion.

Here is an OraTaiao media release I wrote recently on this topic, following the presence of doctors and nurses at the blockade of the NZ Petroleum Conference where our Energy Minister handed out new block permits for deep sea oil drilling:

Protecting health through peaceful direct action

Participants in today’s direct climate change action outside the Petroleum New Zealand conference at Sky City will no doubt be labelled radicals and worse. But they are a group of careful individuals with legitimate concerns. Among them are individual health professionals whose job it is to treat the sick as well as to act on the underlying causes of illness and death.

Most of the time, that action takes institutionally acceptable forms. We spend much of our time communicating with patients and the public about risks to our health, as well as attempting to improve public policy for health by generating convincing evidence, providing advice, and taking part in democratic policy-making processes.

But there are rare occasions when our professional ethics demand we go further. Climate change is now one of them. It’s now more than a quarter century since industry and governments have known about the relationship between burning fossil fuels and the existential threat climate change poses to humans and other species. Continued inaction globally, including in New Zealand, has meant we may already have passed some dangerous thresholds – last month blew global temperature records out of the water. To protect health globally (including here) we must now leave 80% of the fossil fuel reserves we already know about in the ground, safely unburnt.

Optimistically, all governments, including our own, signed up to the Paris Agreement in December, promising to eliminate our greenhouse pollution as rapidly as possible to protect human health and address the right to survival of many island states. Then our negotiators came home and our government continued with business as usual. This includes continuing to court the fossil fuel industry, encouraging and supporting them to explore for new reserves of oil, coal and gas in New Zealand. These are radical and dangerous actions, acknowledged widely to be incompatible with future human wellbeing.

Like the threat of nuclear war and the world’s collusion with apartheid in previous decades, climate change is an issue that combines a real, present and urgent threat to health and survival, coupled with knowing inaction and radically harmful government and industry activities. Legitimate concerns across the whole spectrum of society have long gone unheeded, making climate change a justifiable issue for peaceful direct action by affected communities, including by health professionals.


What do you think?

PS. This relates closely to the Justice and Climate Change thread.

communicating within and beyond the health sector
One of the challenges we are facing is balancing the need for simple, clear messaging around the health benefits of moving to clean energy, versus the need to stay grounded in a holistic, evidence-based view of public health. We need to be able to say "clean, renewable energy for all is the most cost-effective and health-positive solution for the health of people and planet," but we also need careful analysis and smart messaging to address nuances such as the following: 
- the significant challenge of energy poverty in many countries, and efforts by the fossil fuel industry to paint themselves as the "cheap" solution
- common but differentiated responsibilities, and the need for tech transfer and financial support to developing countries
- the health impacts that can result from altered land use for the development of large renewable energy facilities eg solar, wind, hydro
In response to J Drake Hamilton from Fresh Energy: I really appreciate your point about focused voluntary communications training being effective in getting busy health professionals to reach policymakers and the media. It's something we are exploring with our global partners as well.
In response to Lynn from SeaTrust: You made a great observation that at the COPs, the offsite health days tend to draw a vibrant and dedicated group of interested parties, but few who are not already dedicated to the health issue. While the Climate and Health Summits are vitally important networking and solidarity-building events that I hope will continue at the COPs, I think we also need to cultivate opportunities for the health sector to make its presence felt in non-health-sector fora and venues -- at COPs as well as at regional, national, and local level policy negotiations. This echoes what Rico is saying about the challenge in South Africa of getting the health sector to actively engage in the energy/environment/climate decision-making processes.