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RACP Climate Change and Health Position Statement Developed by The Royal Australasian College of Physicians (RACP) Climate Change and Health Working Group. Opening statement The medical profession has a duty of care to protect and promote the health of our patients and the community1,2i. Climate change presents a current and ongoing threat to human health globally 3,4,5. The medical profession has a responsibility to advocate for strong action to mitigate climate change and its consequences and to understand and promote adaptation measures to protect human health. The RACP calls on its members and the wider Australasian community to act on climate change in the interests of the health of our patients, young and old, and our society. The Evidence National and international scientific institutions agree that climate change is occurring and is anthropogenic6,7. The risks on human health cannot be ignored. As individuals, groups, organisations and societies we must act to be ready to respond to, and where possible prevent, adverse impacts on health. Impacts on Human Health According to The World Health Organisation there is widening recognition that there will be increased health and security risks due to climate change. The current and future impacts of climate change on human health are likely to be both direct and indirect: Direct impacts of climate change from more frequent and intense extreme weather conditions may result in injury, heat-related illness, exacerbation of cardiorespiratory disease, and premature mortality; Indirect impacts of climate change include the potential for increases in the prevalence of food and water-borne disease; changes in the distribution of vector- borne disease; deterioration in air quality; reduced access to food and safe drinking water; negative impacts on mental health and wellbeing; increased mortality due to population displacement and conflict; and damage to ecosystem services supporting human health8; Flow-on effects of climate change that will impact on health systems and service provision include socio-demographic changes, risks to global security including competition for resources9, and stresses on health infrastructure and services10. Indirect health impacts of climate change are likely to be significantly greater than the direct health impacts of climate change according to The World Health Organisation. Although developing countries will be most vulnerable to these impacts, developed countries such as Australia and New Zealand will also be affected11. The Most Vulnerable Climate change is a health equity issue. Those least responsible for carbon pollution are often those disproportionately affected12. These include the disadvantaged populations, Indigenous communities, children and the elderly, those with chronic and pre-existing illness and disability, and those in developing countries13,14. Climate change has the potential to exacerbate current and intergenerational health inequities and specific strategies are needed to identify and protect those most at risk. Financial Risk to Health Systems In 2010 it was estimated that climate change was responsible for economic losses equivalent to 1% of global GDP, or around $700 billion15,16 (2010 PPP). In the health sector, climate change represents a significant financial risk to health systems, through the increasing costs of expanded emergency services, the need for additional healthcare facilities, extended surveillance programs, resettling displaced groups and reductions in workforce productivity. Benefits of Action There are significant immediate health benefits that flow from taking action on climate change, including reducing levels of chronic disease, respiratory and cardiovascular illness; improved life expectancy; less pressure on the healthcare system including fewer medical consultations and fewer hospital admissions and improved workplace productivity. This can be achieved through initiatives that promote reduced vehicular use and more active travel, better urban design, a more vegetable-based diet, and reduced energy generation from fossil fuels17,18. There will be benefits to the medical profession and the health sector from taking steps to mitigate climate change, including public health, financial, health equity, reputational and environmental benefits. For example, making health services more energy efficient and reducing waste will reduce the cost of patient care as well as the carbon footprint. Australia and New Zealand are among the countries with the highest per capita carbon emissions in the world, but are highly regarded sources of research. As such, Australia and New Zealand can play an important role in reducing emissions through activities focused on mitigation. The health sector needs to work closely with other sectors of the community to ensure that adaptation strategies are health-enhancing (for example, the provision of shade in public places to encourage physical activity and reduce UV exposure, and safe opportunities to walk or cycle). The Role of the RACP There is an increasing number of medical organisations in Australasia and elsewhere, that are taking a strong position on climate change1,19,20,21,22. The RACP, as one of the leading medical organisations in Australia and New Zealand, recognises its responsibility in relation to health issues. We acknowledge our responsibility to inform, act and lead on issues that are most likely to impact upon our members and the health of patients and the community. Climate change is one of the most important of these issues. The RACP can be a leader in advocating for and promoting action to mitigate and adapt to climate change. i These include the World Health Organisation, World Medical Association, Australian Medical Association, Royal College of Physicians, Royal College of General Practitioners and the Association of Surgeons of Great Britain and Ireland. 1. The Royal Australasian College of Physicians. Constitution. RACP Website. Available at http://www.racp.edu.au/page/racp-governance. Accessed 08/01/2013 2. Medical Board of Australia. Good Medical Practice: A Code of Conduct for Doctors in Australia. 2010. Section 5: Working within the health care system, 5.3 Health advocacy pg 10. Available at http://www.medicalboard.gov.au/Codes-Guidelines-Policies.aspx. Accessed 08/01/2013 3. McMichael AJ. Climate Change and Health: Policy Priorities and Perspectives. Chatham House Briefing Paper. December 2011. 4. Costello A, Abbas M, Allen A, et al. Managing the health effects of climate change. Lancet 2009. 5. World Health Organisation. Gender, Climate Change and Health. 2011. Available at http://www.who.int/globalchange/publications/reports/gender_climate_change/en/index.html. Accessed 08/01/2013 6. Anderegg, W, Prall J, Harold J. and Schneider S. Expert credibility in climate change. Proceedings of the National Academy of Sciences. 2010 107(27):12107-12109. 7. Cook J. Is there a scientific consensus on global warming? Skeptical Science. Available at http://www.skepticalscience.com/global-warming-scientific-consensus.htm. Accessed 08/01/2013 8. Biodiversity: its importance to human health. Interim executive summary. Ed Eric Chivian. 20002. Centre for health and global environment. Harvard Medical School. Available at http://env.chass.utoronto.ca/env200y/ESSAY04/Biodiversity.pdf. Accessed 07/02/2013 9. International Institute for Strategic Studies. The IISS Transatlantic Dialogue on Climate Change and Security. Report to the European Commission. 2011. Available at http://www.iiss.org/programmes/climate-change-and-security/transatlantic-dialogue-on-climatechange-and-security/. Accessed 15/01/2013. 10. National Research Council, Steinbruner JD, Stern PC, Husbands JL. Climate and Social Stress: Implications for Security Analysis. Board on Environmental Change and Society – Division on Behavioural and Social Sciences and Education. 2012. Available at http://www.nap.edu/catalog.php?record_id=14682#toc. Accessed:15/01/2013 11. Jarvis L, Montgomery H, Morisetti N, Gilmore I. Climate change, ill health and conflict. (Editorial) BMJ 2011. Available at http://www.bmj.com/content/342/bmj.d1819. Accessed: Copy on file. 12. World Health Organisation. Atlas of Health and Climate. 2012. Available at http://www.who.int/globalchange/publications/atlas/report/en/index.html. Accessed 08/01/2013 13. Kjellstrom T, Weaver H. Climate change and health: impacts, vulnerability, adaptation and mitigation. NSW Public Health Bulletin. 2009. Vol. 20(1–2). 14. The Climate Institute: Climate Change Health Check 2020. 2008. Available at http://www.climateinstitute.org.au/articles/publications/climate-change-health-check-2020--report.html. Accessed 08/01/2013 15. DARA Climate Vulnerability Monitor: A Guide to the cold calculus of a hot planet– Executive Summary. 2012. Available at http://daraint.org/climate-vulnerability-monitor/climate-vulnerabilitymonitor-2012/. Accessed 08/01/2013 16. Stern N. Stern Review: The Economics of Climate Change - Executive Summary. 2006. Available at http://webarchive.nationalarchives.gov.uk/+/http://www.hm-treasury.gov.uk/sternreview_index.htm. Accessed 08/01/2013. 17. Climate and Health Alliance (CAHA): Our Uncashed Dividend. 2012. Available at http://caha.org.au/publications/. Accessed 08/01/2013 18. Kaplan S, Sadler B, Little K, Franz C et al. Can Sustainable Hospitals Help Bend the Health Care Cost Curve? The Commonwealth Fund. 2012. Available at: http://www.commonwealthfund.org/Publications/Issue-Briefs/2012/Nov/Sustainable-Hospitals.aspx. Accessed 08/01/2013 19. Australian Medical Association. Position Statement on Climate Change and Human Health. 2008. Available at https://ama.com.au/position-statement/climate-change-and-human-health-2004-revised2008. Accessed 08/01/2013 20. Royal College of Physicians. What is the RCP doing about Climate Change? 2011. Available at http://www.rcplondon.ac.uk/policy/reducing-health-harms/climate-change. Accessed 08/01/2013 21. Royal College of General Practitioners. Climate Change, Sustainable Development and Health. Available at http://www.rcgp.org.uk/policy/rcgp-policy-areas/climate-change-sustainabledevelopment-and-health.aspx. Accessed 08/01/2013 22. Association of Surgeons of Great Britain and Ireland. Consensus Statement on Cost-Effective Surgery. Available at http://www.asgbi.org.uk/en/publications/consensus_statements.cfm?utm_source=itineris&utm_medu m=em ail&utm_campaign=issue%2074. Accessed 08/01/2013