Do not despair about climate change Article Swipe

We can yet make amends, manage our impact, change the direction of our development and once again become a species in harmony with nature. All we require is the will. – David Attenborough1 David Attenborough is 94 and has probably seen more of the natural world than anyone alive. If you have not read his most recent book,1 we would like to politely suggest that you do so. His initial chapters which describe clearly, without blame, what we human beings have inadvertently done and continue to do to the planet are confronting. But his vision for the future is optimistic, concluding that we have it in our power to reverse our destruction of habitats like rainforests with its resultant loss of biodiversity, and reverse our pollution and over-fishing of oceans through the intelligent use of natural resources. David Attenborough wants us to stop concentrating on short-term, myopic economic gains and to ‘rewild the world’. We can only promote his message and hope world leaders listen. Attenborough's book gives clues as to how every one of us can do our bit to make a difference. Loren Eiseley (1907–1977), an American philosopher, anthropologist and natural science writer wrote a story called the Star Thrower2 (Fig. 1), which inspired many including Mahatma Gandhi. The story has been re-told in many forms, including as a children's book with a child as the hero. One such version tells of an old man (in some versions, he is an author with writer's block) walking along a beach. He sees a little girl happily throwing starfish into the ocean. He asks what she is doing. ‘Throwing starfish back into the ocean. The tide is out and if I don't throw them in, they will die’. He replies, ‘Don't be silly, there are thousands of starfish, you can't make a difference’. She looks at the one in her hand and says, ‘It will make a difference to this one’. Chastened, the man joins her (and the author overcomes his block and writes about it). So what can we do, each one of us? We will begin with one simple thing you as an individual could do. Currently, we cut down over 15 billion trees a year.1 We have reduced the world's rainforests by half, although rainforests are the most biodiverse places in the world, containing more than half of its land-living species (David Attenborough argues convincingly for the vital importance of biodiversity).1 The main driver by far of continuing deforestation is beef production.1 Beef makes up 25% of our meat consumption but we dedicate 60% of our farmland to raising it.1 It takes almost 9 units of edible crops to raise 1 unit of beef, 5 to raise 1 unit of pork and over 2 to raise 1 unit of chicken.3 We give antibiotics routinely to animals, not to cure diseases but to increase yield, risking antibiotic resistance out of greed.4 Those are powerful reasons to give up eating meat. If you cannot bear to give up meat altogether, Attenborough says if we all eat more plant-based foods and less meat (particularly beef) and dairy, it will make a huge difference.1 Many public health proponents will tell you it is also good for your own health. Another major source of energy expenditure we could easily reduce is transport. There is an irony in taking the moral high ground on North Americans' insistence on their right to bear arms to the detriment of others, when so many of us drive large vehicles which guzzle fossil fuel and are more likely to cause fatal accidents. How did we let ourselves be seduced by these monstrosities? Some years ago, DI traded his car for a hybrid. When he boasted about it, a friend retorted: ‘Now you'll have smug coming out your rear end’. Touché. We make excuses for driving to work, usually alone, when we know there are ways we could save energy by better use of public transport, car sharing, cycling, walking or working from home. We are as guilty as anyone else for driving into work alone regularly, for convenience sake. Getting out of your car, even an electric one, and walking or cycling5 will not only reduce emissions, but it is also good for your health and well-being. As we write this, we are thinking how we can make our daily travel more energy-efficient, then telling ourselves we must actually do it, not just think about it. Our children have led the way in exposing our own inaction.6 We waste a huge amount of energy in our home and work lives. Simply switching off computers, lights and fans when we stop using them makes a big difference. Introducing automated systems in hospitals and elsewhere to save energy eventually saves money, although there is frequently considerable resistance to spending money now to save in future. Individual improvements are not all that paediatricians can achieve. Paediatricians arguably have far more power to influence the political agenda than they realise. People who work in child heath come with integrity and knowledge about the impacts of these changes on our children. Their only vested interest is to care for children, in contrast to others with significant conflicts of interest. Paediatricians need to advocate that it is vital for the current and future health of children to address climate change. Currently, the powerful fossil fuel industry lobby is having more impact than the experts and the evidence on the health and well-being of the world's children. The science on the causes and impact of climate change is clear and the ways in which countries and their citizens need to act are also clear. The most important is that we stop mining and burning fossil fuels. We need to retain our old forests and plant new ones. We need to consume less – energy in particular, but also reduce the variety of other activities that increase our carbon and biodegradation footprint. The very young and the very old are the most vulnerable to the effects of climate change. The innocent and non-consenting victims of climate change (our children) will have a lifetime of exposure to heatwaves, pollution from bushfires and coal burning and the other effects, including mental health problems. According to recent statistics, children already suffer around 90% of the global disease burden from climate change, mostly occurring in developing countries which are the least responsible for climate change.7 Globally, for children under 5 years of age, climate change is predicted to worsen all of the top five causes of death (malnutrition, neonatal conditions, acute respiratory illness, diarrhoea and malaria).8 Figure 2 shows ways in which climate change can influence a range of child health outcomes. Whilst obviously more research is needed to support these claims, we have enough information to act now. Because of the particular vulnerability of children and the way that climate change will amplify existing inequities in disease burden, it is not possible to adequately prevent disease and improve child health without acknowledging and attempting to reverse the factors that create the social and economic gradients in child health outcomes. Predatory capitalism–consumerism has created an environment where we and our children have become dehumanised objects in service of the corporate bottom line and shareholder profits. This is the big driver of environmental degradation and climate change. In Australia today, those making most decisions about the health and well-being of our children are the fossil fuel industry, the alcohol industry, the tobacco industry and the food corporations. Where are the paediatricians in all this? We need to step up and advocate for children. We liken this opportunity to that of the Apartheid system in South Africa. If you were a doctor in that system, the only way to improve the health and well-being outcomes of your population was to eliminate Apartheid. We challenge you all, and the colleges and organisations to which you belong, to step up and take the lead of the children's marches for climate action and attempt to influence our governments. We have no time to lose and we would be joining the increasing numbers of doctors world-wide who are campaigning for climate action. It is not too late to listen to Australia's First Nations people, the world's longest surviving human civilisation, who lived in harmony with the land for over 60 000 years before the Industrial Revolution saw us start to destroy the land.9 Regenerative agriculture also offers the hope of improving soil health to reverse some of the effects of climate change.10 David Attenborough concludes that in a thriving, sustainable future, we would adopt a largely plant-based diet, use clean energy for all our needs and generate minimal waste.1 We can all do our bit to help achieve that future. His book should be mandatory reading for all health-care professionals, but also for all politicians world-wide. The Lancet has led the way on how doctors should respond to climate change with the Lancet Countdown; it has now concentrated on putting the health of children at the forefront with its Children in All Policies 2030 initiative.11 It is time for paediatricians to act.