Environmental Sustainability and Health Equity in a Post-COVID-19 World—A Transdisciplinary Perspective

Vol 8 #8. September 17, 2020

Ana Hategan MD^1,✉, Mariam Abdurrahman MD, MSc²

Author information

1  Clinical Professor, Geriatric Psychiatrist, Division of Geriatric Psychiatry, Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. ✉ [email protected]

2  Part-time Lecturer, Staff Psychiatrist, Department of Psychiatry, University of Toronto, St. Joseph’s Health Centre (a division of Unity Health Toronto), Toronto Ontario, Canada

Clinical significance

There is an increasing recognition of the inextricable linkage between health and climate. As with the global COVID-19 crisis, climate change poses a fundamental challenge, with a critical and sustained threat to global health. The climate crisis is at our doorstep, affecting the planet’s inhabitants with a reach far beyond the current pandemic. A quick view of pandemic effects on climate may suggest prominent benefits; however, the sustainability of such benefits is yet to be determined. The global economic slowdown precipitated by the pandemic state of emergency has resulted in decreased energy consumption. Recent data showed that the COVID-19 crisis dramatically reduced global fossil carbon dioxide emissions during the months of lockdown and physical confinement [1].

In contrast, pre-pandemic data show that global carbon dioxide emissions were rising by about 1% per year over the previous decade [1]. During the early phases of the pandemic, global emissions were estimated to fall by as much as 7% this year compared with 2019 [1]. If the scenario of a 7% annual reduction in fossil carbon dioxide emissions were repeated over the next decade, it may put the world on track to limit climate change to a 1.5 °C warming by mid-century, in keeping with the Paris Climate Agreement’s target [1]. While the pandemic has led to a temporary drop in carbon emissions related to small scale productivity (e.g., in-person entertainment and retail, individual and mass transportation, institutional energy consumption), other carbon-intensive practices (e.g., manufacturing and transporting goods, energy supply to homes) have continued. As such, the pandemic reduction in carbon emissions is unlikely to arrest climate change but it can promote climate change mitigation.

Although the pandemic resulted in rapid short-term solutions to limit the spread of the infection, in a post-COVID-19 world it is not feasible to continue to shut down the economy or limit human activity outside the home. It is also likely that post-pandemic government actions and economic incentives will act as an accelerant to the economy but simultaneously increase the global carbon footprint for decades to come. This is particularly important to emphasize because previous patterns of economic recoveries were often accompanied by rapid growth in carbon emissions [2]. However, we can remain cautiously optimistic that the growing sense of collective responsibility for environmental stewardship will result in the generation of greener solutions.

While some of the damage to the planet might be irreversible, it is not too late to positively alter the course for future generations [3]. Addressing both the coronavirus and environmental crisis requires collaboration and innovation in order to achieve a shared goal of a salubrious future. Moreover, effective climate change mitigation and adaptation initiatives require such collaboration to go beyond interdisciplinary boundaries and transcend geographical, socioeconomic, and political boundaries. The World Health Organization emphasizes the potential of transdisciplinary collaboration by integrating the natural, social, and health sciences in a humanitarian context through creation and synergy of change agents [4].

The authors present a prototype of a transdisciplinary approach to interprofessional climate change integration aimed at promoting health equity through a climate sound post-pandemic reawakening.

Climate change and health equity require transdisciplinary paradigm shifts for a sustainable medicine

Evidence suggests that climate change, health and disease, class and race, are closely linked, an association readily evident in the unfolding COVID-19 pandemic [5]. For example, in the United States, age-adjusted hospitalization rates for patients with COVID-19 were highest among non-Hispanic American Indian or Alaska Native and non-Hispanic black persons, followed by Hispanic or Latino persons when compared with white persons [6]. Climate change also disproportionately impacts the health of low-income communities and communities of color [5], in addition to influencing migration patterns. This is increasingly evident given the rising numbers of environmental refugees from developing countries, due to a combination of sea-level rise, extreme weather events, droughts and water scarcity.

One strategy to address the health and climate-related inequalities exemplified by the COVID-19 pandemic is universal health coverage which may remedy inequitable access to both preventive and acute care. Achieving the World Health Organization’s goal of global universal health coverage by 2030 includes taking steps towards equity and social inclusion [7]. These critical steps are necessary in order to address the broader determinants of health including reducing health system vulnerability and minimizing long-term health impacts of environmentally related events. Nations with existing universal healthcare systems may serve as case studies. In addition, they can lay the groundwork for solutions that target equity and human rights to ensure resilience in both pandemic preparedness and climate change adaptation.

Moving towards a healthier planet and healthier people requires cooperation and governance rooted in a human rights-centered approach. Under international human rights treaties, such as the 1966 International Covenant on Economic, Social and Cultural Rights, countries have obligations to recognize, promote and protect the right to health, specifically achieving “the highest attainable standard of physical and mental health” (Article 12), including taking steps to prevent epidemic health crises [8].

There is growing recognition that addressing climate change is an inextricable component of achieving the right to health [9]. The Paris Agreement acknowledges that in taking action to address climate change, countries will concurrently execute their obligation to promote the right of all to health [9].

The way forward

In this time of heightened public concern, the pandemic crisis of 2020 cannot be the sole focus of attention; the climate crisis is equally critical, given the clear interaction of these crises. The COVID-19 pandemic has shown that no matter the crisis that nations face, people are central to the matter. As climate change has been deemed one of the greatest public health challenges of our century, in 2019, the American Medical Association was among several medical and public health groups that issued a call to action asking leaders to recognize climate change as a health emergency, and to work intersectionally to prioritize action on mitigating climate change effects [10, 11]. All eyes are currently turned to the shared global liability of pandemic effects. It is imperative that this occur concurrently with increasing recognition of the collective responsibility for environmental stewardship. Now is the time to channel the rising tide of concern into meaningful public action on climate change.

Addressing climate change and health equity requires transformational change in economic resource utilization. Many climate solutions offer increased health benefits and opportunities to promote greater health equity, and ultimately, greater climate resilience [5]. The global population must work collaboratively towards the ability of all citizens to thrive within the finite resources offered by nature. Central to that vision is the idea of a shared human right to prosper and succeed. Without doubt, racism, oppression, and exclusion are incompatible with the vision of environmental sustainability, and are inextricably linked with poor health outcomes.

Moreover, a framework for action is necessary in order to develop integrated solutions to these overlapping climate-health challenges. Whereas we live in an increasingly globalized world, functional international relationships must endeavor to integrate issues related to economic prosperity, peace, and health. As the COVID-19 pandemic has demonstrated, any science-based framework of adaptation to climate change and climate resilience must prioritize equitable outcomes and advance accountability by promoting good governance.

Conflict of Interest Statement: The authors declare no direct conflicts of interest concerning the subject matter of this article.

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