How could climate change affect my health?

This BBC podcast is supported by ads outside the UK. If you're struggling to keep up with all the latest innovations in tech and what they'll mean for your life, Ted Tech has you covered. Get ahead of the curve with digestible downloads on some of the biggest ideas and technology from AI and virtual reality to clean tech. Find Ted Tech wherever you get your podcasts. Hello and welcome to the climate question from the BBC World Service. I'm Greer Jackson. And this week, how is climate change affecting our health? And what can we do about it? I'm joined by two doctors to discuss from Malaysia, Dr. Jamila Mahmoud. Jamila is an obstetrician and gynecologist was special advisor to Malaysia's prime minister on public health and has worked in humanitarian aid for over two decades. Today, she's executive director at the Sunway Centre for Planetary Health in Malaysia. Welcome. Thank you very much. It's a pleasure to be here. Next to her is Dr. Omniya El Omrani. Trained in Egypt, Omniya worked in Cairo's biggest public hospital and is vice chair of the global climate and health alliance. That's a consortium of global climate and health organisations. Thank you so much for joining us. Thank you. It's such a pleasure to be here. Jamila, why did you become a doctor? That's a difficult question. I think so many things. First of all, I was challenged to say maybe I won't make it as a doctor. So I took the challenge and did medicine. I also saw my father die from cancer when I was only 11 years old. So I think, you know, being in an out of a hospital, seeing him must have had an effect on me as well. But most of all, I just like people. I like the caring industry. I come from a family that's very caring and very generous. So I think medicine is the best fit for me. Omniya, best fit for you for the caring? Or was there another reason that you entered the profession? I mean, the main reason is like Dr. Jamila. I really wanted to have a career around helping people in every way that I can. And when I was studying science and biology, I felt well, I'd like to do that for the rest of my life. Like, how can I have the opportunity to be working with people to be helping them in any way that I can? And in Egypt, it was a chance for me to do that. And I was the only doctor in my family. And my father really wanted me to do that. And he recently passed away. But anyway, I always feel that I'm doing what he always is part for me to do. And at the same time, whether working on health of the people or the health of the planet, it is a career that is constantly offering service to people. So where did climate change enter the picture for you, Jamila? Actually, quite late. I must admit, when I was a medical student, climate change did not feature in our curriculum. It was in my humanitarian career. I worked more than 20 years in this. And coming from Asia, I saw a lot of the impacts of climate change with severe weather events, flooding, cyclones, particularly in countries like Philippines and Bangladesh. And seeing up front the impact of climate change on health, particularly the fact that climate change and the impacts of health are not gender neutral. So as an obstetrician and gynecologist, I mean, it really sort of woke me up. Probably the most compelling moment for me was watching a woman in Mozambique having to climb up a tree to give birth during the very severe floods in the year 2000. I thought, you know, as an obstetrician and gynecologist, gosh, you know, this is not how women are supposed to have their babies. And how climate change is also a threat multiplier, how it's also related to social equity. It is so important for us as physicians to really seriously undertake the responsibility of knowing about the impacts of climate change on health, but also being strong advocates. I've seen that video, that woman giving birth in a tree and having given birth to a child myself, I cannot even fathom how she did that. Absolutely, I mean, I've delivered many, many babies and it's not easy to deliver one, you know, in a proper labor ward rather than on a tree. So I can't imagine, I mean, you train that woman should probably be a real super duper obstetrician because, you know, she can do it in such terrible situations. But guess what? In 2019, I was back in Mozambique after severe flooding at the time I was working with the International Federation of Recross and Recreason. And I was just, you know, telling a midwife in the community I was about the story and she just smiled and pointed to a child that I was playing with actually and said, well, his mom just gave birth on a tree. And I said, my goodness, 19 years down the line as a humanitarian, I felt I was putting band-aid on gaping wounds, right? So we need to address the underlying drivers of why health is so severely impacted by climate change yet we're not doing enough. We'll come to that very pivotal question later on in the program because omni I wanted to ask you where climate change started entering in your workplace. I mean, you worked in Cairo in the biggest public health hospital there. What were you seeing on the wards? So I started working on climate change when I was a medical student. I was really lucky to be part of this incredible medical student organization of over 1 million medical students from over 140 countries. And we had a small program that focused on climate change, understanding the research on how climate change affects health and also going to climate conferences and really joining young climate activists in their movement. And I was very engaged in that. But the realization started when I did an internship in emergency medicine in the US. It was the first time for me to go. And during my second week and there was Hurricane Irma. And I was in the emergency hospital and I saw patients who are coming with dark injuries, but also those who needed care and the hospital. The generator was not working. So they're unable to get the urgent care that they needed or even the medication that they needed living with chronic diseases and just became a slow realization. But then when I went back to Egypt, I started my residency. I was doing general surgery and then reconstructive surgery. And not a single day would pass without a child and then their brothers and their sisters coming with an asthma exacerbation or a lung infection. I became a normal thing to do that you would prescribe for them a treatment for their chest condition. But then you would postpone this urgent surgical care that they needed because they cannot undergo any anathesia. And then I started to realize, well, if they come and then their family members come and their younger siblings come. We're treating them but then we're sending them to the very environment with high levels of air pollution that is causing their health to deteriorate. Both their lung health but also their neurological and their mental health. And as Dr. Jamila said, as doctors, we need to bring the narrative to it's no longer an environmental issue. It's children's health that is being devastated continuously even at a chronic level through the air that they breathe, the food that they can't access, the water that they don't have. And just to really spell out for listeners who don't perhaps know what the link is between air pollution and climate change when we burn fossil fuels in this particular instance in our cars, be that petrol or diesel. It releases not only planet warming gases but these tiny particles, particularly matter, then go into the lungs and the body and have very serious health effects. I think it's one of the biggest killers. Is it one in five people die from air pollution? Well, about seven million people have premature deaths per year. And nine out of 10 children breathe in polluted air globally. -Series. -Yeah. And so Omnia, there you were dealing with the impacts of climate change in hospitals, in Egypt, in the US. Were you actually trained to deal with it when you were learning to be a doctor? The only remotely relevant module I had was around occupational health where heat was mentioned as a threat to people who work in construction. And I decided because I was part of this medical student organization, we did a global survey across 112 countries over 2000 institutions. And we asked is climate change taught in your medical curriculum? If yes, how is it taught? Are you also taught about air pollution in particular, which is much more clear link for doctors? So basically more than 85% of the institutions in the countries that we had had no mention of climate change in their training or the curriculum of doctors. So this means 85% of doctors worldwide are not trained about climate change. And even if they are, we also mapped out how it was a very inconsistent of a module, a lecture, it's non-mandatory. There are no particular assessment on it. So there's a huge gap. And we're asking, we're expecting doctors to be at the front line of responding, but they are not provided with the knowledge or the tools or the ways to treat the patients that they are going to get. Jameela, what do you think? I think thanks to Omnian, her friend's study, that was 2020. A lot has changed since then. In the UK, for example, the curriculum for medical schools on climate change has advanced. And I think it's really progressed a lot. I can certainly say in our own experience in Malaysia, we are at my university at least introducing planetary health, which is broader than climate change and health, that includes pollution and so forth. As a mandatory component of education among all undergraduates since this year. And from now on, Next year it's now a higher education blueprint. It will be rolled out throughout the country for all disciplines. What are you putting in the curriculum? What is it that doctors need to know? I think it's not just doctors. Well doctors in particular need to know the particular risks to health. Let me give you an example. Someone comes in with a myocardial infection, with a heart attack, right, or stroke. And you don't take a history whether they've been exposed to the sun for a long time, whether they're working outdoors and so forth. But the risk of cardiovascular event is much higher when you're exposed to extreme heat. So you might miss the fact that that was the primary driver, right? So the effect treatment? It doesn't affect treatment, but it helps you to better understand the environment they come from. Because at the end of the day it's not just about prescribing medicine. It's also about ensuring that the social conditions, the other determinants of health, because 85% of the determinants of health are outside the medical care complex. Prevention. Prevention, anticipation of possible medical complications that will happen. I mean, the UK right now is also going through a little bit of a heat wave. So what are the things you might expect to happen? Who will be most vulnerable? They will be the elderly, will be women. It will be people who are working outdoors and so forth. So I think having that understanding, better prepares you to anticipate, better prepares you to take a much more comprehensive history and understanding the conditions. But also understanding the impacts, for example, with vector-borne diseases. Same as ketos and tics and so forth, right? There's a rise in dengue virus infections that could be deadly. They're seeing it now in temperate countries and where again medical students and doctors may not have been exposed to a lot of learning on tropical diseases. So it means that we need to better understand that global health issues now are truly global that tropical diseases are no longer confined to the tropics, right? Omnia. What I wanted to add is also another anecdote here in the UK. So recently, doctors noticed that patients who are living with mental health conditions are coming during extreme heat waves with mental health emergencies that their body cannot adapt to the heat. And this is actually because their psychiatric medication has a side effect of impairing the body's ability to self-regulate and to adapt to increasing temperature. And this is actually like because of the heat physicians would anticipate reducing the dose of the medication or changing it because temperature are increasing. But because those adjustments was not done, patients go into the emergency room with heat stroke. That's why it's fundamentally needs to be taught in the curriculum. It's not a short site for them, but they never learned about it. Get ahead of the curve with digestible downloads on some of the biggest ideas in technology. From AI and virtual reality to clean tech, find Ted Tech wherever you get your podcasts. A reminder you're listening to the climate question from the BBC World Service. I'm Greia Jackson and we're asking how is climate change affecting our health and what can we do about it? We have two doctors here to share their insights, Dr. Jemila Mahmoud and Dr. Omnial Omrani. We've just been discussing how lots of doctors aren't trained in climate health. There's some changes there. But what are the major challenges that we haven't mentioned that they're facing, Omnial? So you need more doctors, but you also need hospitals and health care facilities that are able to adapt to the impacts of climate change. This means that you have early warning systems. You have hospitals that can anticipate the next climate disaster, the next flood, the next infectious disease. And for hospitals to be able to do that, you need the funding and the right government policies that would prioritize that. And also similarly, one of the things we're working on is how can the health sector itself reduce its own carbon emissions and its own carbon contribution? How big is the global health sector's contributions to the crisis? At a global level, it's 3.5% from global carbon emissions. Simulance flying. Yes. And it's also about the principle, right, as doctors, our moral duty is to do no harm. And that also translates to our workplace that we don't want to contribute to the issue of climate and to the carbon emissions that is driving it. And at the same time, there is the case to make if you reduce carbon emissions, you can also save a lot of costs that will improve the quality of the health care service that you are delivering to our patients and our communities. How big is the cost saving, do you know, Jimi? It depends on what adaptation measures you take. Generally, I mean, I can speak for our own experience in Malaysia. In the Ministry of Health is really going through a decarbonisation exercise, a race to zero or so to speak. And they've already seen the profound benefit. Millions are saved. But more than that, as Omnia rightly mentioned, it's about how do you build systems that will be able to better withstand mitigate, but also adapt to climate change? And I think particularly, I want to raise the importance of nurses and community health workers and allied health workers, right? Nurses are probably the most trusted people in the world, nurses and doctors. And I think, you know, this is where they play a very, very important role in being able to also educate the patients and look at alternative measures that can be taken. I think in UK, social prescribing has become very, very important. The pointers of nature bringing nature into your prescription, ensuring that, you know, nature doesn't just help you to cope with the mental health stress, but also bringing nature to urban cities, you know, cools down cities significantly there by reducing risks of heat strokes and heat shocks and so forth. I cannot believe how sort of interwoven health is with so much. I mean, your mind just must be full of information. I don't know quite how you bring it all together. Yeah, but eloquently. But this is why planetary health is so important. This is what Omnia and I are real champions of because it's a new approach, right? And what it explicitly tells us is that the health of human civilization is very dependent on the natural systems, which means is the environment's the planet. You cannot have healthy people with a healthy planet. We need finance, we need social justice, we need economic development that is pro-planet, that's pro-people. And, you know, I'm pretty proud that in my country now we've developed a national planetary health action plan that will go through parliament soon to really push for a systems approach so that we will achieve the sustainable development goals eventually. What would a sort of hospital that's resilient to say floods or hurricanes or drought? Would it actually look like Omnia? Can you help us visualise it? If we're talking about the mitigation and like reducing the carbon emission coming out of the hospital, thinking about what kind of energy is powering and in Egypt, for example, we've been having a huge expansion of installing solar panels on hospitals starting with Charmé-Shaykh, which is a coastal city, up to Cairo. And it's being put not just as an opportunity for us to reduce our own emissions, but it's also cheaper. And it's reliable for us to do that, especially in Egypt. And then at the same time early warning systems are so important, it's so fundamental. And when you look at the components of a healthcare system and we call it like building blocks, so you're starting from the health workforce, you're looking into the supply chain itself, you're looking at the equipment, how can you improve even the maintenance of equipment, the amount of carbon and money that you save from properly maintaining the life cycle of medical equipment? It's incredible. Another thing is the use of anesthetic gases. There are anesthetic gases that are carbon intensive. And if you choose one that is more carbon-friendly, you are going to get the same patient outcome, but you're actually reducing carbon emissions. And similarly goes for the use of energy. Similarly goes for waste disposal. So these solutions are there proven by so many studies globally of what works. Doctors are also looking at the amount of water that you can save by washing your hands before surgery. There are studies up to that extent. Wow. And mentally, I think we need to shift from treatment to prevention. I think we've got to go back to making sure people remain healthy and therefore not required to go to hospitals. And of course, the other aspect of it is also looking at making sure that healthcare is also decentralized to community-based approaches and bringing the community into finding solutions that work for them. I think that anything that's. I've seen this in action. I was so many ways. One of the best examples, I'm a big fan of this, is a program in Kalimanta not far from Malaysia in Indonesia where us three, one of the organizations that came out of Health in Harmony, there's a lot of deforestation in Kalimanta and what they did was spoke to the community to say, "Why are you cutting down the streets?" And they said, "Well, because we kind of fought healthcare and that's how we get our income." So what they did was, you know, basically put down your machetes, will provide you healthcare. In return, we'll train you on alternative livelihoods, on organic farming and so forth. You can pay by bringing a seedlings, you can bring manure and so forth. You know, and what happens is the way we work. win-win situation. Communities got healthier, their health co-benefits, their environmental co-benefits, trees grew back, and it's a brilliant win-win situation. Another good example is in Thailand, in the Nam Mountains in Thailand, which is a catchment area for water, and deforestation was going on in a private bank, agriculture bank came in and said, "Okay, let's look at how we might prevent deforestation and got them to plant medicinal herbs, for example, so they got alternative source of livelihood, they got better access to health care with more income, and they protected the water chain." So, communities will know what they need, they can adapt, they can tell us and teach us that there can be very low cost approaches to finding health solutions that have both economic and planetary benefits, and likewise, environmental solutions that will have health co-benefits. Is it just the community here that we need to take action? I mean, what sort of responsibility do, for instance, these big climate conferences have, or governments? Where do they fit into that picture and support in communities, but they'll presumably have a much bigger role than that? I think we need both, right? Global meetings are very difficult to navigate, particularly in the current geopolitical climate, but I think the more local we get, not just in terms of communities, but also cities, mayors, local leadership, regional leadership. We've seen mayors stepping up, making sure that urban hit islands address cities are cooled down, better facilities are there to prevent emissions. So, I think everyone needs to pay a price. As I always say, the research, the evidence is clear. The thing that I always say is that we have to work at the speed of science and not the pace of politics. Easier said than done, though. Absolutely, absolutely. But, you know, we need political will. Ultimately, the elephant in the room is how do we get leadership today to wake up to realise the planet will survive, we won't. We're on a trajectory which is going to be extremely dangerous for humanity. We have time to reverse it if we make the right decisions. Why do you think there is this lack of political will that Jermel is describing on? I think fundamentally it's the narrative around climate, because there is the narrative around climate doomism which leads to loss of agency and especially in money with the young people that I work with. They feel a lot of burnout and they feel while what we're doing is it going to make a difference. I think the second thing is also the complexity of climate science and this is why we need to be able to translate the complex numbers and targets and temperature increases into human stories and bringing in why we need to act on climate. Dr Omni El Omrani and Dr Jermila Mimmi, thank you so much for joining us on the climate question this week. Thank you so much. It's been great. Thank you so much for having us. The production team this week where producers Diane Richardson and Jordan Dunbar, the editor with Simon Watts and the sound engineers were Philip Bull and Tom Brignor. Send us your climate questions for a future show. No quandary too big or too small. The email is the climate question at BBC.com. I've been Grey Jackson and we'll see you next time. Bye bye. Get ahead of the curve with digestible downloads on some of the biggest ideas in technology from AI and virtual reality to clean tech. [Music]