Global Environmental Change: What Can Health Care Providers and the Environmental Health Community Do about It Now?

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The debate about whether global environmental change is real is now over; in its wake is the realization that it is happening more rapidly than predicted. These changes constitute a profound challenge to human health, both as a direct threat and as a promoter of other risks. We call on health care providers to inform themselves about these issues and to become agents of change in their communities. It is our responsibility as clinicians to educate patients and their communities on the connections between regressive policies, unsustainable behaviors, global environmental changes, and threats to health and security. We call on professional organizations to assist in educating their members about these issues, in helping clinicians practice behavior change with their patients, and in adding their voices to this issue in our statehouses and Congress. We call for the development of carbon- and other environmental-labeling of consumer products so individuals can make informed choices; we also call for the rapid implementation of policies that provide tangible economic incentives for choosing environmentally sustainable products and services. We urge the environmental health community to take up the challenge of developing a global environmental health index that will incorporate human health into available "planetary health" metrics and that can be used as a policy tool to evaluate the impact of interventions and document spatial and temporal shifts in the healthfulness of local areas. Finally, we urge our political, business, public health, and academic leaders to heed these environmental warnings and quickly develop regulatory and policy solutions so that the health of populations and the integrity of their environments will be ensured for future generations. Key words: behavior change, climate change, health impacts. Environ Health Perspect 114:1807-1812 (2006). doi:10.1289/ehp.9313 available via http://dx.doi.org/ [Online 5 September 2006]

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On its 3 April 2006 cover Time magazine proclaimed that we should "be worried ... very worried" about global climate change (Kluger 2006). These discussions are now widespread across all media (from Science magazine to National Public Radio to the movie An Inconvenient Truth). Americans are fast becoming either worried sick or sick of worrying about global warming amid the endless predictions of the coming apocalypse [see, for example, the letters to the editor following Time's story (Time Inc. 2006)]. They are also hearing a steady drumbeat of alarm about other forms of global environmental change, such as loss of biodiversity, species extinctions, and destruction of natural habitats. However, despite a broad scientific consensus that environmental degradation is caused by humans and will impact human health globally, very few exurb-dwelling, McMansion-living, large-lawn-watering, sport utility vehicle-driving, 100-mile-a-day-commuting, endangered-species consuming, therapeutic-shopping Americans acknowledge that their behaviors, and the policies allowing or even encouraging these behaviors, may be implicated and in need of change. Risk perception continues to focus on worries closer to home; a March 2006 Gallup survey (Gallup Poll 2006) reported that concern about global warming ranked lower than eight other environmental issues, such as pollution of rivers, lakes, and reservoirs and toxic waste.

How much should we worry about global climate change and other forms of environmental degradation? Any lingering doubts about its occurrence, as well as humankind's influence, are quickly fading amid new reports of faster-than-expected glacial melting (Overpeck et al. 2006) and unprecedented rates of species loss, deforestation, desertification, and water shortages (Hughes et al. 2003; Jackson et al. 2001; Thomas et al. 2004). The much more challenging question is this: What steps can clinical practice and public health communities take now in an effort to address these challenges?

In this commentary, we argue that the evidence is inescapable that global environmental change is occurring and is caused by policies and human actions that are unsustainable. Global environmental change, in turn, has profound implications for human health. In a recent study, Patz et al. (2005) estimated that anthropogenic climate changes already claim at least 150,000 lives annually. At present, the health consequences of First-World excesses are being felt disproportionately by populations in the developing world. While politicians and business leaders delay, or search for painless solutions that require no sacrifice and have no impact on economic growth, clinicians and environmental health professionals must think rigorously about what can be done now. In this commentary, we summarize the evidence and issue a call to action. More specifically, we urge that a) changing current behaviors be the immediate priority while waiting for larger-scale policy and regulatory solutions; b) clinicians counsel their patients using tools that measure ecological footprints; c) professional organizations assist clinicians in developing and using such tools; d) carbon-and other environmental-labeling of products be implemented to facilitate behavior change; e) the environmental health community develop a global environmental health index for use in year-to-year monitoring that combines "planetary health" with human health; and f) clinicians and environmental health professionals engage in the development and implementation of policy and regulatory solutions similar to those already proposed elsewhere (Brown 2006).

A Brief Review of the Evidence for Global Environmental Change

Several terms, including "global warming," "global climate change," and more recently "global climate chaos," have been used to describe the environmental consequences of collective human activity, most notably steady and historically large increases in greenhouse gases in the Earth's atmosphere. We prefer to address a larger set of global environmental concerns, because other environmental changes that are global in scale are occurring; the consequences are not just about warming and not just about climate. Patterns of resource use (e.g., water, fossil fuels), habitat destruction (e.g., deforestation, desertification), and biodiversity and species loss (Millennium Ecosystem Assessment 2005), in addition to greenhouse gas levels, are closely interrelated, global in scale, human-caused, and have important implications for human health now and in the future. Several authors have noted the interconnectedness of apparently disparate trends: from our "addiction" to fossil fuels, to urbanization and suburban sprawl, war in the Middle East, terrorism, skyrocketing gas and oil prices, and global environmental change (Kunstler 2005; Wilson 2006). However, the public and many public health professionals continue to see these as separate issues rather than part and parcel of the same set of interrelated challenges.

A steady stream of opposing voices [for example, Lindzen …