Vector Issue 12 - 2011

Introduction
The world’s first major conference on the global
environment was held in Stockholm, in 1972.
At that time few doctors seemed aware or
concerned about the global environmental dimension
to inequality 1 , though the medical profession had
by then a long history of working to promote health
in low income settings [2 , exemplified by Albert
Schweitzer, who divided his time between Europe
and the hospital he had established in French
Equatorial Africa.
In 2009, as the world anticipated the biggest
climate change summit since Kyoto in 1997, the
issue of climate change appeared to almost head
the international agenda. The health literature also
published many papers on this issue [3-5] . Yet, since
then, developed nations including France, the U.S.
and Australia have retreated from the rhetoric which
briefly raised hopes of leadership from the rich
world. This is not because of any weakening in the
evidence or scientific consensus, but a possibly fatal
weakening in the political support. The current year
has been the hottest on record, and the drought in
Russia and the Ukraine (during July to August 2010)
has triggered the sharpest rise in grain prices seen in
30 years [6 . Speculation is undoubtedly a major cause
of this rise, but the market is likely sensing and
reflecting increasing global concern and volatility.
This heat wave is consistent with climate change.
Health effects of
climate change:
primary, secondary
and tertiary
The list of health conditions associated with climate
change can seem bewildering; from the fairly obvious
to the obscure, such as gastroenteritis caused by
Vibrio Parahaemolyticus [7] . One way to categorise
these diverse manifestations is by grouping the most
obvious effects as ‘primary’ and less obvious effects
as ‘secondary’. Primary effects include heat waves,
heat stress, and the physical impacts from extreme
weather effects such as storms and fires. The latter
group includes ecologically mediated vector borne
diseases, such as malaria, and other communicable
diseases whose epidemiology will be altered by
climatic and associated ecological variation, from
plague [8] to hantaviruses 9] .Many more details of these
effects are available elsewhere [10] .
There is one more level of effect that must be
considered, here called ‘tertiary’ 10, 11 .Ultimately,
these effects should cause the greatest anxiety, to
society and therefore to health. Yet, among the vast
literature concerning climate change very little
discusses the likely impact upon global health from
the bleak social and physical conditions to which
much of the world appears to now be heading. It
perhaps takes courage rather than imagination to
contemplate a nuclear-armed world in which sea
level has risen by a metre, and where the grain yield
in South Asia has declined by 18 to 22% 12 , ven though
global health,
www.ghn.amsa.org.au
32
sustainability and
doctors
vector FEB 2011
colin david butler
national centre for epidemiology
and population health,
australian national university