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Inaction & Inequality on Climate Change Kills – Sooner or Later, We Will Understand

18 Oct 2021

Looking ahead to COP26, Dr Gareth May writes about the need for global leaders to take action in response to the unfolding climate catastrophe.

COP26 is fast approaching, and with it, the policies and promises which will determine how successful or otherwise this generation will be at tackling the greatest threat to our planet’s survival. For the first time ever, this key decision making conference will address the impact of climate change on the global health community1. The resulting dialogue and determinations will have reverberations throughout the world of health and social care for generations to come.

As members of this global health community, we are inextricably linked to the future wellbeing of our colleagues, patients, and fellow citizens. We can no longer exist in isolation as the poorest nations, who contribute the least to this human-driven global catastrophe, are forecast to suffer the largest degree of societal, economical, ecological and geopolitical harm2. As Dr. Martin Luther King Jr noted; “Injustice anywhere is a threat to justice everywhere. We are caught in an inescapable network of mutuality3.”

This inequality has been shown to permeate and persist throughout all facets of the global health and climate change crisis. According to the WHO, of the estimated 4.2 million premature deaths worldwide due to outdoor air pollution in 2016, 91% occurred in low- and middle-income countries4. The UN in their World Water Development Report in 2020, state that natural disasters such as extreme heat, drought, erratic rainfall and flooding, are all increasing in severity and frequency, with the overwhelming burden of human and financial cost carried by Asia and Africa5.

This has led to the invention of the term “environmental underclass” whereby the global poor breathe dirty air, drink contaminated water, live in substandard housing, eat under-nourishing and insecure food, and are ultimately burdened with a more severe degree of ill health6. To compound this injustice, the global poor have less educational and economic opportunities to avail of the technologies and medicines which ameliorate their suffering7. We only have to cast our minds back as far as the COVID-19 pandemic and the global inequality in vaccine supply to illustrate the unfair distribution of both health burden and health care8.

However, as grotesque and unfair as these facts of climate change and global health are, the worst pandemic of all is the silent, insidious and indifferent stance of inaction. Despite all the glitz and glamour of global dignitaries descending on Glasgow in a matter of weeks, there remains a deadly gulf of inaction between what is being said, and what is being done about climate change. This is most eloquently summed up by Greta Thunberg when she addressed the world leaders at this year’s Youth4Climate summit, “blah, blah, blah…this is all we hear from our so-called leaders, words that sound great, but have so far led to no action.9

In September 2021, global health leaders published a tough-to-read, albeit essential article in over 220 health journals10. Of the many pertinent points, they illustrated the collective inaction of the global elite by stating, “targets are easy to set and hard to achieve. They are yet to be matched with credible…plans.” and, “the greatest threat to global public health is the continued failure of world leaders to keep the global temperature rise below 1.5° C and to restore nature.” This inaction is no longer credible and as members of the global health community, we have a role and a responsibility to mitigate for those which we serve. We need to act now to safeguard the health of those tomorrow.

We have the tools, the knowledge, and the moral obligation to act in the best interests of our colleagues, patients and fellow citizens. We must hold our global leaders to account, prevent further damage to the global health community, educate others on the environmental crisis, and ultimately, build a more sustainable and fairer global healthcare system. In years to come, rather than pondering, “why didn’t we do more sooner?”, we should be proclaiming how we came together as one to create a more just and healthier world.

If only our world leaders could be visited by the Dickens’ ghost of Christmas past – maybe then, with the gift of hindsight, and the knowledge of unfolding climate catastrophe, would their actions amount to tangible changes. Until then, I hope you will join me in making tiny changes to your life, as we embark upon this greatest hurdle of human endeavour.

Sin é.

Dr Gareth P. May MBChB BMSc (Hons)
Trainee Committee Representative
Climate Change & Sustainability Working Group
Royal College of Physicians and Surgeons of Glasgow
E: T: @RCPSGTrainees


  1. WHO. COP26 Special Report on Climate Change and Health: The Health Argument for Climate Change. 2021. Accessed 18 Oct 2021.
  2. Diffenbaugh NS and Burke M. Global warming has increased global economic inequality. PNAS. 2019; 116(20): 9808 – 9813.
  3. King ML. Letter from Birmingham Jail. London: Penguin Classics; 2018.
  4. WHO. Ambient air pollution: a global assessment of exposure and burden of disease. 2016. Accessed 18 Oct 2021.
  5. United Nations. UN World Water Development Report 2020. 2020. Accessed 18 Oct 2021.
  6. WHO Europe. Environmental health inequalities in Europe: Second Assessment Report. 2019. Accessed 18 Oct 2021.
  7. Fleming KA, Hortin S, Wilson ML, Atun R, DeStigter K, Flanigan J, et al. The Lancet Commission on diagnostics: transforming access to diagnostics. The Lancet. 2021; S0141 – 6736(21)00673 – 5.
  8. Tater M, Shoorekchali JM, Faraji MR, Wilson FA. International COVID-19 vaccine inequality amid the pandemic: Perpetuating a global crisis? J Glob Health. 2021; 11: 03086.
  9. Carrington D. ‘Blah, blah, blah’: Greta Thunberg lambasts leaders over climate crisis. The Guardian. 2021. Accessed 18 Oct 2021.
  10. Atwoli L, Baqui A H, Benfield T, Bosurgi R, Godlee F, Hancocks S et al. Call for emergency action to limit global temperature increases, restore biodiversity, and protect health. BMJ. 2021; 374: n1734.

Category: Climate Change

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