Monday, May 30, 2016

A disturbing dream

Last night I had a terrible and vivid dream. I was high up on a ridge, where I could see parts of the plain below in the far distance where over a million people live. And I watched with growing horror how fire was occurring in several places and spreading through increasing parts of the city, in some places joining each other. Later in the dream I turned in the other direction and nearby high rises had been gutted, turned black. I had the radio on and realised the radio wasn't reporting it.

Several decades ago I read "the 100th monkey" and while it seems that book was concocted there is a similar phenomenon: socially transmitted panic or understanding reaching most once a threshold of enough people with the understanding is passed. Regarding climate change the slowly boiling frog story seem more apt (let's hope that story is also not literal) .. to me, the evidence of climate change and its civilisation destroying consequences is so strong that we should be engaged in a post-Pearl Harbor like frenzy to decarbonise our energy system. Yet, most of us, including most politicians and most media, ignore these warnings, just as Churchill's warnings about the Nazis were ignored until it was too late.

Below is a description of Carl Jung's dream which can be interpreted as forewarning the Great War:

This account is from Jung's autobiography Memories, Dreams, Reflections.

In October [1913], while I was alone on a journey, I was suddenly seized by an overpowering vision: I saw a monstrous flood covering all the northern and low-lying lands between the North Sea and the Alps. When it came up to Switzerland I saw that the mountains grew higher and higher to protect our country. I realized that a frightful catastrophe was in progress. I saw the mighty yellow waves, the floating rubble of civilization, and the drowned bodies of uncounted thousands. Then the whole sea turned to blood. This vision last about one hour. I was perplexed and nauseated, and ashamed of my weakness.

Two weeks passed; then the vision recurred, under the same conditions, even more vividly than before, and the blood was more emphasized. An inner voice spoke. "Look at it well; it is wholly real and it will be so. You cannot doubt it." That winter someone asked me what I thought were the political prospects of the world in the near future. I replied that I had no thoughts on the matter, but that I saw rivers of blood.

I asked myself whether these visions pointed to a revolution, but could not really imagine anything of the sort. And so I drew the conclusion that they had to do with me myself, and decided that I was menaced by a psychosis. The idea of war did not occur to me at all.

Soon afterward, in the spring and early summer of 1914, I had a thrice-repeated dream that in the middle of summer an Arctic cold wave descended and froze the land to ice. I saw, for example, the whole of Lorraine and its canals frozen and the entire region totally deserted by human beings. All living green things were killed by frost. This dream came in April and May, and for the last time in June, 1914.

In the third dream frightful cold had again descended from out of the cosmos. This dream, however, had an unexpected end. There stood a leaf-bearing tree, but without fruit (my tree of life, I thought), whose leaves had been transformed by the effects of the frost into sweet grapes full of healing juices. I plucked the grapes and gave them to a large, waiting crowd...

On August 1 the world war broke out.

Monday, May 16, 2016

The Case for Change: Health in the ACT

My talk  at the Canberra Nurses conference, May 31, 2016 Slides at: http://www.slideshare.net/ColinButler/nurses-case-forchange2016

Australians are living longer, and so are people overseas. Yet, some of the underlying foundations of health, both here and globally, are eroding. This has not yet translated to a fall in Australian health indicators, but could such a decline be around the corner?
Evidence of deterioration in health status, for some vulnerable groups, has already been documented in the US and elsewhere.
Government services in Australia, as in many countries, face increasing pressure to manage more with less. This applies not only to the health system, but also for social security, Indigenous affairs and other sections where budget cuts have the potential to harm health.1
Additionally, within health, there is a perception not only of increased patient2 expectations, but increasingly powerful (and costly) technologies and treatment to diagnose and treat illness. Do we really get value from this?
Another underlying health “determinant” is adverse global environmental change. A prominent example is the warming and “wilding” climate. While some effects may seem sleeping, far in the future,3 others, on reflection, may already be with us – and not that hard to understand.4
Some have even argued that adverse “eco-social” 5 changes have the potential to harm the life support system of civilisation, with effects far worse than even the 2008 financial crisis.
Such gloomy futures are not inevitable. Canberra, compared to most places, is a wealthy and privileged city in a wealthy and privileged nation. Together, we can contribute to the profound transformation that is needed for a better future.

Notes

1. eg the Australian government can no longer bail out the car industry and this will worsen unemployment. At the same time, unemployment benefits remain far below the poverty level.
2. I know most nurses used to prefer the word “client” (and this may still be the case) but for me the word “client” sound too business like, too market-driven. It is actually a symbolic evidence of one of the problems I’m trying to explore, regarding health cost blowouts and unreasonable expectations; eg if I am rich and sick and a “client”, it suggests to much that the dr/nurse/health system is for sale; with services (including basic care) to be purchased .. but if I am poor I can’t purchase as much care, and then I resent it ..  and my expectations also rise (as I see what others get) .. increased inequality erodes overall health. It’s also a question of what kind of society do we want?
4. Most of Tasmania was shrouded in smoke in January 2016, in part from drying and increased temperature. Almost its entire population is inhaling high levels of smoke particles for at least a week. This significantly harms the health (cardiac as well as respiratory and general) of vulnerable people.
5. Causes that are neither entirely environmental or social, but arise through the interaction of environmental and social factors.

Saturday, May 7, 2016

Human and animal health: From Virchow and Osler to Influenza and Ebola

One Health can be traced to the 19th century pioneers Virchow and Osler, each of whom were extremely famous (medical) doctors, and each of whom recognized and was intensively involved with identifying links between animal and human health. Virchow is credited with coining the word “zoonosis”. In 1976 the veterinarian Schwabe coined the term “one medicine”, initiating a revival of interest into connections between infectious diseases, nutrition, and livelihoods involving animals and the human animal. Interest in this work, published at a time when infectious diseases in humans were thought to be in decline (at least in high income settings), was bolstered by the emergence of HIV/AIDS and the recognition and emergence of numerous other infections, albeit of less importance to human health (than HIV/AIDS).
 
In the last decade, as knowledge of and the extent of the environmental crisis has deepened, attempts have been made to broaden the scope of One Health to include dimensions of environmental change and even social medicine (an aspect for which Virchow was also a pioneer). However, such a scope may be too broad for most One Health practitioners.
This talk will position One Health in the wider framework of contemporary environmental public health, and will present several case studies showing linkages between human and animal health, and, to a lesser extent, between these aspects and environmental and economic change. These case studies will include trichinellosis, rinderpest, HIV/AIDS, ebola, influenza and hendra. Animal welfare will also be mentioned, as will be the risk that adverse global environmental and social change, if too long continued on its current trajectory could create a milieu for a catastrophic breakdown in public health.

Slides: here
Podcast (ABC radio): here 
Selected references
Cardiff R.D, Ward J.M.,Barthold S.W. ‘One medicine—one pathology’: are veterinary and human pathology prepared? Laboratory Investigation.2008;88:18-26.
Saunders L.Z. Virchow’s contributions to veterinary medicine: celebrated then, forgotten now. Veterinary Pathology. 2000;37:199–207.
Zinsstag J, Schelling E, Waltner-Toews D, Tanner M. From "one medicine" to "onehealth" and systemic approaches to health and well-being. Preventive Veterinary Medicine. 2011;101:148-56.

Colin Butler is professor of public health at the University of Canberra (since 2012) and is also a Visiting Fellow at the National Centre for Epidemiology and Population Health at the Australian National University. He graduated in medicine in 1987, from the University of Newcastle (NSW), and for several years worked as a rural general practitioner, in Tasmania. However, his main interest has long been health in “developing” countries, and he has slowly been able to contribute to efforts to improve global health. He is editor of Climate Change and Global Health (CABI, 2014, 2016), and senior editor of Health of People, Places and Planet. Reflections based on Tony McMichael’s four decades of contribution to epidemiological understanding (ANU Press, 2015). Colin also edited a WHO Technical Report, relevant to One Health, called Research Priorities for the Environment, Agriculture and Infectious Diseases of Poverty (2013). In 1989 Colin also co-founded two health and development promoting NGOs, called BODHI and BODHI Australia. In 2009 the French Environmental Health Association named him as one of “a hundred doctors for the planet”. Colin was also an ARC Future Fellow from 2011-2015.




Climate change and health: another lost opportunity


The US has just released another major assessment into climate change: 20 megabytes, 405 pages, heaven knows how many references. There is an editorial about it in Environmental Health Perspectives, called "Marking a New Understanding of Climate and Health.

The editorial includes the claim: “It is possible to design and implement interventions to limit the impacts and accompanying human suffering caused by climate change, but only if we make the research investments necessary to improve our understanding of how climate change worsens health and determine the most effective interventions.”

The editorial does not hint (either in this sentence or the whole article) that we need aggressive greenhouse gas mitigation. This sentence promotes the delusion (fallacy and conceit are alternatives) that all we have to do to cope with climate change is better understand the effects and develop interventions (adaptation).

Closely related, the editorial (and probably the whole report) gives no idea of the potential scale of impacts; no hint that climate change, interacting with other dimensions of planetary overload/planetary boundaries/limits to growth/basic tenets of evolution (i.e. limits to inter-group co-operation) has the capacity to unravel civilization.

The editorial claims: “The assessment breaks new ground by providing quantitative projections of the influence of climate change on five different environmental public health problems, including extreme heat, air pollution, food- and water-related illness and safety, and vectorborne disease. The report also expands a critical discussion of the mental health implications of climate change, and greatly broadens consideration of the issues facing especially vulnerable populations, such as children, the elderly, and the socioeconomically disadvantaged.”

Perhaps this is new ground in the sense of new “ quantitative projections” for these 5 areas, but the areas themselves are far from new.
In contrast, three relevant peer reviewed papers (Butler et al 2005, Butler and Harley 2010 and Butler 2014) that do break new ground are ignored, as is my edited book (none are cited in the full report).
Each of those papers and the book argued that health workers should understand there is a qualitatively different, much more important, class of effects than these 5 (with or without mental ill-health.) These are generally called "tertiary" in my writing, but synonyms include systemic and catastrophic.
Recently, Hansen et al’s paper was released, warning sea level rise could reach several metres this century, leading to retreat from most coastal cities. In addition another paper has just been published warning the Western Antarctic Ice Shelf is also more vulnerable to rapid melt than realised.
How can the world (even the US) adapt to the health effects of such sea level rise? Even 1 metre of sea level rise by 2100 will be very problematic for the US.

Miami, increasingly flood-prone and not able to defended by existing technology (from sea level rise) is not mentioned in the full report, other than a reference to mental health following Hurricane Andrew. And sea level rise is just part of the problem.

However, sea level rise is mentioned as a key finding: "Climate change will increase exposure risk to coastal flooding due to increases in extreme precipitation and in hurricane intensity and rainfall rates, as well as sea level rise and the resulting increases in storm surge [High Confidence]. 

I have yet to find if the report estimates how many internally displaced Americans this will mean by 2100, but I think it will be many millions. In the last week about 80,000 Canadians have had to leave Fort McMurray; due in part to climate change; not all of them will leave. Refugees are already leaving parts of Louisiana.

It is however a lost opportunity to produce such a lengthy report that appears to fail to acknowledge the potentially catastrophic dimension to climate change and health. I wish it were not so, but without that dimension I would not be interested in it at all .. there are so many other issues in health. But "planetary overload" is always on my mind; I wish it would recede but it won’t.

Tailpiece

In April, 2016, I and 13 colleagues submitted a 750 word letter about these issues to Environmental Health Perspectives. The journal replied that they do not publish letters in response to editorials, but they encouraged us to write a commentary. I hope we can do that shortly.

Health of People, Places and Planet: Reflections based on Tony McMichael’s four decades of contribution to epidemiological understanding

Published last year, available entirely for free at (http://press.anu.edu.au/publications/health-people-places-and-planet). Co-edited by myself, Tony Capon (director of the UN University International Institute for Global Health) and Jane Dixon, published by ANU Press.

This book has three main goals. The first is to celebrate the work of a great public health figure, the late A.J. (Tony) McMichael (1942–2014). Tony's most famous and influential book was called "Planetary Overload" (Cambridge University Press, 1993) - its forward is reprinted in the book.

The second goal is to position contemporary public health issues in an interdisciplinary context and in ways that highlight the interdependency between the environment, human institutions and behaviours; a broad approach championed by Tony. The third aim is to encourage emerging and future public health leaders to advocate for policies and cultural change to sustain and improve human health, from a foundation of objective scholarship.

The book’s foreword and 38 chapters were written by people who were inspired by Tony; many of whom worked with him at some point in the last 40 years. Its structure reflects five major public health domains, each of which Tony made major contributions to in an extremely productive academic life: occupational health and safety; environmental and social epidemiology; nutrition and food systems; climate change and health; and ecosystem change and infectious disease. The final section, ‘Transformation’, is dedicated to Tony’s desire for public health scientists to propose adaptive and mitigating solutions to the problems they were observing.

Each section contains at least one key publication involving Tony. There is also a selection of artworks from an exhibition which formed part of the conference held to honour Tony at The Australian National University in 2012. This conference formed the first part of Tony’s festschrift, completed by this book.

Friday, May 6, 2016

Climate change, anger from Canada, and a "social vaccine"

Anger from some (hopefully only a few) in Canada 

The message below was sent to someone at my university, apparently in response to my linking of the devastating fires in Alberta, especially Fort McMurray with climate change. It was hostile and angry, claiming that I taking pleasure "taking victory laps" as a result of the intense suffering now occurring in Canada.

From: *** (name withheld by me)
Date: 4 May 2016 10:30:27 pm AEST
To: ***  (name withheld by me)
Subject: Colin David Butler
Hello ** (name withheld by me)

Someone who identifies as a staff member in the faculty of health, Colin David Butler, is taking victory laps, on twitter, on top of people who are currently running for their lives.
https://twitter.com/ColinDavdButler

Not only are his tweets shameful, but they are scientifically inaccurate - wild fires have been in the Boreal Forrest for its entire existence. It is highly dubious to claim climate change had anything to do with a city burning down.

He is sullying the name and reputation of the University of Canberra and quite frankly Australians in the eyes of Canadians and compassionate and empathetic people everywhere.

While I don't have any suggestions for course of actions to deal with his smug and undeserved self-importance, I do believe as dean, you should be made aware of it.

Respectfully from Canada,

name withheld by me

**
Some of my tweets which may have upset this person so much included:

"All of tarsand oilsand city's 80,000 pop'n ordered to flee wildfire in Alberta #climatechange karma #divest #350"

"Linking #FortMcMurray fire & #climatechange unpalatable but we must face truth to prevent worse"

"resentment linking #climatechange with #FortMacFire but it's like telling a guy with a heart attack to stop smoking"

"Agree #climate change. #FortMacFire http://www.slate.com/blogs/the_slatest/2016/05/04/fort_mcmurray_alberta_wildfire_forces_major_evacuation.html?wpsrc=sh_all_dt_tw_top … via @slate But many resist acceptance, just like smokers until a heart attack"

Nothing here (or otherwise posted) can or should be interpreted as gladness.

**

The day before I received this complaint via my university I had posted a blog called “The Fort McMurray fire, climate change and grief”. In it I argued that though there is never a good time to give bad news the links between climate change and catastrophes need to be made near the event; just as someone with a heart attack must  be advised of the link with smoking.

Eric Holthaus, a meteorologist writing for Slate, has also argued that now is the time to discuss the links between the fire and climate change. He too has experienced a backlash for linking the fire with climate change, and describes several others who have, including Elizabeth May, the leader of the Canadian Green Party.
 
May in turn was criticised by the Canadian Prime Minister, Justin Trudeau, who claimed that her suggestion that the disaster was "very related to the global climate crisis" was neither helpful, nor accurate. But he also said: "It’s well known that one of the consequences of climate change will be a greater prevalence of extreme weather events around the planet."

We’ve lost our old climate

May also said "We’ve lost our old climate. 

With that, unfortunately, I agree.

She also says: "We must transition away from fossil fuels as quickly as possible". I agree with that, too, and it is happening. Demand for electric cars is, for example, growing fast.

I think the backlash from Canada is understandable, given the grief and fear that so many are now experiencing. Trudeau, newly in power, must also tread a fine line. If he offends the oilsands lobby too far he will surely court disaster, yet others, including Elon Musk (surely today's equivalent of Edison and Tesla) and Bill McKibben, are indeed calling for politicians to do just this. Musk has called for a revolt against the fossil fuel industry, accusing politicians of bowing to the “unrelenting and enormous” lobbying power of the fossil fuel industry.

A growing number of locations and populations around the world are affected by climate change, especially in low-income settings. It is not just Fort McMurray. These include millions of the poor in India, suffering heat, drought and groundwater depletion, those affected by recent superstorms in the Philippines and Fiji, and at least five reef islands in the Solomons, just reported as being submerged elsewhere in the Pacific.

I have never heard of or experienced any of the anger now flowing from Canada directed towards those who have linked climate change and catastrophe in poor locations. Bearers of bad news have never been popular, but I think the Canadian hostility reflects a degree of guilt, and I write this knowing that it may well trigger additional hate-mail. Perhaps, such expressions of hate and resentment need to be released as part of healing, similar to how abscesses release pus.

There is encouraging news that technological innovation which could soon lower emissions growth, but  the challenges of sustainable development and the promotion of equity are much deeper than solving the energy crisis and better technology.

There is still, probably, time to reduce the worst effects of climate change. But if we don't face up to the links then we will be like a smoker who not only gets a heart attack but dies of lung cancer.

A social vaccine

I hope more in mainstream media get interested in these ideas. That would contribute to the ""social vaccine", I first described in a chapter in my first edited book "Climate Change and Global Health" in 2014 and then in the blog. Social media is a good start, but it is not enough.

PS If this blog does infuriate you please let me state that I am truly appalled by what is happening, in western Canada, though alas I am not surprised (my first scientific letter on climate change and health having been published in 1991). My motive for writing this is to try to prevent worse events. I am a professor of public health, I graduated in medicine almost 30 years ago and I have seen (and experienced) a lot of suffering. I also have some experience of grief, and wildfires, including losing a house to fire. I truly do not mean to upset anyone, but I also think emotions can be released unintentionally, and sometime their release can help healing.