Public healthPublic health and climateand climate change: head in the 

d lisand or line in the sand?in the sand?

d hDavid Pencheon

CHICAGO 1995CHICAGO 1995

Eric KlinenbergEric Klinenberg, (2002).

“Heat Wave: A Social Autopsy ofSocial Autopsy of Disaster in Chicago ”Chicago.

Chicago IL:Chicago, IL: Chicago University PressPress. 

Paris 2003Paris 2003

Richard KellerRichard Keller.(2015).

“Fatal Isolation: the devastatingthe devastating Paris heat wave of 2003 ”2003.

Chicago IL:Chicago, IL: Chicago University PressPress. 

Slow motion emergenciesSlow motion emergencies dramatically increase the frequency of extreme events

What does it mean to beWhat does it mean to be “healthy”?

“ to have access to and control over…to have access to, and control over, those things that enable us to live lives that h l d i ”have value, purpose, and meaning…”

…after Amartya Sen

Creating the right environments for health:

Natural/physical

Social

Natural/physicalenvironment

Socialenvironment

Economicenvironment

‐ Barbier, E.,1987. The Concept of Sustainable Economic Development. Environmental Conservation, 14(2):101‐110.( )‐ Adams, W.M. (2006). "The Future of Sustainability: Re‐thinking Environment and Development in the Twenty‐first Century."Report 

of the IUCN Renowned Thinkers Meeting, 29–31 January 2006.

Against increased activity:e.g. 18% increase in hospital admissions 

Threats• climate change

i ti

Opportunities• new technologies

• migration• social unrest and disengagement• political kickback / disruption

• social movements• communications and

• air and water pollution• natural resources depletion• biodiversity destruction

• change 

• global economic crises• new / emerging diseases• artificial intelligence andartificial intelligence and 

automation• rising inequalities and exclusion 

“The opposite of poverty isn't wealth…The opposite of poverty isn t wealth…

… the opposite of poverty is justice.”Bryan Stevenson.

How?How?E.g. • Grid

decarbonisation• Vehicle efficiencyVehicle efficiency• Supports 30%

reductionE.g. • Energy and travel efficiency• Anaesthetic gasesg• Models of care• Public health• Supports 58% reduction

Wicked problems“problems resistance to resolution” (not evil problems!)

• No clear, widely agreed, definition of the problem• Incomplete contradictory changing and contested:Incomplete, contradictory, changing, and contested:data, beliefs

• Purely scientific/engineering/rational approaches fail• Purely scientific/engineering/rational approaches fail• Classic examples:

– climate change– health care / improvement / protection– pandemics (AIDS/influenza )– pandemics (AIDS/influenza…)– energy (esp. nuclear energy)– social injustice / inequities / inequalities

Engagement awareness advocacyEngagement, awareness, advocacy

1. Simple clear messages, repeated often, by a variety of trusted voices.y

2. The less you say, the more you are heard.3 S h hi l l3. Say the things are most relevant to people4. Understand (by listening and researching) ( y g g)

which messages have most value.

Ed M ib hEd Maibach,PHE Conference 20178

Dr. Margaret Chan, DG of WHO:“ f f 21“…climate change is the defining issue for the 21st century… The evidence is there, and it is compelling. Here is my strong view: climate change and all of itsHere is my strong view: climate change, and all of its dire consequences for health, should be at centre-stage, right now, whenever talk turns to the future of g , g ,human civilizations. After all, that's what's at stake.”

This is not just a scientific and technical issue, it’s a 

communication engagement andcommunication, engagement and political issue…

“It is difficult to get a person toIt is difficult to get a person to understand something, when their 

salary depends on them not d t di it ”understanding it.”

Upton Sinclair

Reduce the harm and socialand social

injustice caused by current healthby current health,

economic and social systemssocial systems

Improve theImprove the causes of health andhealth and fairness

Embed this in “Quality”

Public ServicesPublic Services (Social Value) Act ( )

2012“…all public bodies in England and Wales are required to consider how the qservices they commission and procure might improve the economic social andmight improve the economic, social and environmental well‐being of the area.”

3 things3 things

1. Don’t break the bank2. Don’t break the law2. Don t break the law3. Don’t break your principles and the contract 

h i h f iyou have with future generations

SummarySummary1 C lli i i d t1. Compelling awareness raising and engagement.2. Combine the science, and values, opportunities into…3 governance and leadership3. …governance and leadership4. Give permission, legitimacy and mandate to at every level5. Monitor, reward, and hold to account, ,6. Be positive: focus on health and justice7. Be ready for change when others are8. Embed:  Normalise and formalise in every contact and 

contract9 Think and act outside the normal boundaries of9. Think and act outside the normal boundaries of 

professional practice

• Connect• Learn• Active• Active• Notice• Give• Eat• Rest

Sl• Sleep

David Pencheon david pencheon@nhs netdavid.pencheon@nhs.net

Head in the sand…or…..line in the sand?

Dr David Pencheon, DirectorSustainable Development Unit (SDU)  NHS/PHET:   +44 (0) 113 825 3220M:  +44 (0) 7900 715184 ( )E:  david.pencheon@nhs.netW: www.sduhealth.org.ukW:  www.sduhealth.org.ukT:  @pencheon1B: BMJ Blogs / carbonB:   BMJ Blogs / carbonA:  c/o NHS England, Victoria House, Capital Park, 

Fulbourn Cambridge CB21 5XB UKFulbourn, Cambridge, CB21 5XB, UK