Germany: Climate protection means health protection

The health sector must prepare for climate change and reduce its own carbon footprint. The German Climate Change and Health Alliance Director looks at health systems reforms and emission-free hospitals.

esanum Interview: Looking at the long term, to act now

In order to ensure a long-term protection of health and sickness prevention, the health sector must be prepared for climate change-related challenges and also reduce its own carbon footprint. This is what the German Climate Change and Health Alliance (German acronym: KLUG e.V.) is working for. Dr. Christian Schulz, KLUG’s Managing Director and Head of the Climate Change Unit of the Clinic for Anaesthesiology and Intensive Care Medicine at the Rechts der Isar Hospital (Munich, Germany), reveals in an esanum interview what responsibility employees in the healthcare sector bear and what emission-free hospitals look like.

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esanum: Dr. Schulz, a study recently published in the Lancet Planetary Health indicates that more than 150,000 premature deaths could be prevented in Germany every year through appropriate climate protection. Can you summarise for us what you think are the most important findings of the study?

Dr. Schulz: This study works with modelling. If we start from the Paris Accords and work through the measures that would have to be implemented to achieve the climate protection goals, the models show that we can prevent already some 150,000 deaths. It is important to note that this is a modelling study, which means that these calculations are also based on a certain degree of uncertainty. However, it is crucial that the potential of climate protection measures is presented in a quantitative way.

esanum: Do the study results also offer concrete potential calls to action for politicians and policy makers?

Dr. Schulz: Of course, the results are yet another call to action, but even without the study there has been overwhelming evidence for politicians to take action for years, if not decades. What is special about the new study is that it shows that action in the present is already linked to benefits for society - and in a direct way. The study is thus a contribution to decoupling any perceived benefits from a temporal latency. That is one of the problems with climate change action: "Why should I take climate protection measures if we will only have problems in 10, 20, 50 and 100 years?" That's harder to get people to understand. The problems have been there for a long time.

esanum: Which disease patterns are being given more focus in public health due to climate change?

Dr. Schulz: If you take climate change directly into the field, we have various diseases that occur more frequently with it. These are, for example, infectious diseases. In Germany, we also have heat-related excess mortality, which in some cases is significantly higher than that caused by COVID-19. So we have premature deaths at this point. We also have a higher incidence of dermatological and allergological diseases, which we are already seeing. In addition, in other parts of the world - this is something that we as physicians should have on our radar - we have climate-related deaths as a result of extreme weather events. In the Caribbean, for example, there were at least 750 deaths last year due to extreme, intense hurricanes, in the last storm season.

esanum: Could KLUG detect any deviations in terms of emissions in 2020 compared to previous years due to COVID-19 and lockdown?

Dr. Schulz: The problem is that we have to get to zero emissions. With the way we do business, we have a carbon budget that will last for maybe another 7 to 10 years if we want to keep to our obligations under the Paris Climate Agreement, which is binding under international law. We did see a slower rise in CO2 in the atmosphere due to less mobility. Nevertheless, it is crucial to observe that the CO2 concentration continued to rise. So we have a measurable decrease in emissions, but still a significant increase rather than decrease in CO2 concentrations in the atmosphere. Therefore, an effect can be shown at this point, but we are still far from a reversal of the fundamental trend.

esanum: KLUG is also committed to the Zero Emission Hospitals project. What do zero-emission hospitals look like?

Dr. Schulz: We campaign against climate change, and in our view that means campaigning therefore for health, because we know that climate protection is synonymous with health protection. This means that we are working to put hospitals on the path to emission-free health care, analogous to the NHS (the UK’s National Health Service) which has been on this path for years. In the UK, hospitals have whole departments that don't care about anything else except sustainability.

Moreover, it is the case that not only do we need to eliminate a carbon footprint caused by the hospital system, but we also have the opportunity to play an important role in the transformation of the entire health system. The health industry is one of the sectors in which most people in Germany work for. For this reason, and because of the high social standing that health professionals have in Germany, we can have a great multiplier effect.

We are of course also challenged by the preparations needed to shift many frameworks and grap the consequences of climate change: We have to prepare ourselves in the form of heatwave action plans, we have to strengthen the resilience of structures in order to be protected against extreme weather events. We also need to prepare for a change in infectious disease patterns. Basically, each discipline needs to consider for itself, "What is my part in mitigating the climate change crisis?" Avoid the unmanageable, is also a strategy here. Secondly, we have to think about how we can adapt to what is coming. This is summed up by shifting the idea: we need to also "manage the unavoidable".

esanum: So physicians and all people in the health sector have an even greater, special responsibility to take measures to mitigate the climate crisis?

Dr. Schulz: Health professionals do not have a greater responsibility in principle, but they are probably the ones who quickly understand the link between climate protection and health protection. Therefore, people from this group are probably also the most likely to carry this important discourse into societies around the world.

esanum: Unfortunately, there is also a recurring claim among some people in science and medicine that there is no climate change. What do you think is the right way to counter fake news, false claims and denial?

Dr. Schulz: You always have to consider how much attention you need to give to these claims. In the end, we also see a pattern repeating itself with climate change. Similar discussions have already taken place with regard to smoking and the negative consequences of smoking. Campaigns have been launched from the profiteering industry to undermine the consensus that smoking is harmful through dubious studies and subsequent claims that there is no scientific consensus. Such claims have influenced opinion-forming in such a way that the smoking ban and the advertising ban were adopted much later than they should have been.

In the case of climate change, one can see similar mechanisms being used by the fossil fuel industry. Exxon, for example, has known for decades that CO2 emissions are fuelling the climate crisis. They have very accurately foreseen what is coming and have repeatedly delayed this discussion by lobbying and deliberately working against reforms in order to continue to support their business model. That's why I believe that we need to do much more to educate people about the negative impact of lobbying by industries that are now increasingly losing their traditional structures and processes due to climate change.