Time for a Focus on Climate Change and Health

Sixteen years ago, this journal published an editorial by Hans Baer (2008) on the need for a critical medical anthropology of global warming in the face of what was emerging evidence of the effects of climate change on human health. In his essay, Baer urged medical anthropologists to bring our insights on the relationships between inequalities and structural determinants of health to the conversation about climate change, in light of its origins “in the capitalist treadmill of production and consumption” (Baer 2008:3). A lot has happened since then: evidence for the effects of climate change on lives across our shared planet is mounting, the world has faced the COVID-19 pandemic, awareness of the interdependence of human health with that of other forms of lie and ecosystems has increased, and the population displacement, xenophobia, and food insecurity that we associate with political instability and armed conflict is now exacerbated by changing and extreme weather patterns. What have contributors to this journal had to say about climate change over this time period?

Since Baer’s editorial, Medical Anthropology has published surprisingly little on climate change and health. This is not for the want of exhortation; there have been eight editorials (including an introduction to a virtual special issue) in 2010, 2012, 2014, and 2019, drawing attention to the relatively low engagement from medical anthropology, encouraging submissions on the topic, and pointing to not just the relevance of our expertise, but also the growing urgency as climate change has moved from an alarming future to a present reality (Alley and Sommerfeld 2014; Cartwright 2019; Manderson 2010, 2012a, 2012b, 2019; Singer 2014; Trostle 2010). Despite these calls, the journal has published just seven research articles since 2008 that directly reference climate change (Adams et al. 2011; Eichelberger 2014; Griffin 2020; McMullen and Dow 2022; Singer et al. 2016, 2022; Wainwright 2017). As the effects of climate change on health become increasingly evident, we ask why it is that this urgent issue does not yet appear to be mainstream amongst medical anthropologists?

The 2023 Lancet Countdown on Health and Climate Change documents the impacts of the decade-long 1.14°C increase in global temperatures. Growing numbers of people are exposed to dangerously high temperatures as global temperatures increase year on year. A world that is 2.7°C hotter in 2100 than it is now is increasingly likely as global CO₂ emissions increase, oil and gas companies fail to observe the Paris Agreement, investment in fossil fuels continues to grow, and the renewable energy sector moves too slowly (Romanello et al. 2023). Furthermore, climate change is damaging the environments and ecosystems that support our health. According to the 2023 Intergovernmental Panel on Climate Change (IPCC) report, between 3.3 and 3.6 billion people are living in environments that are “highly vulnerable to climate change,” and for these people mortality is 15 times higher than it is for those who live in the places that are least vulnerable (IPCC 2023:5). According to Greta Thunberg, “37 percent of heat-related deaths are caused by climate change, roughly 10 million die each year from air pollution, and as our planet continues to warm, malaria and dengue could put billions more at risk by the end of the century” (Thunberg 2022:133). A priority is therefore not only efforts to mitigate climate change, but also ensuring that these most vulnerable people are supported to adapt (UNFCCC 2023).

It is estimated that in people aged over 65, heat-related deaths have increased by 85 percent in 2020 in comparison to the decade between 1990 and 2000 (Romanello et al. 2023:1). The proportion of people over 65 is set to grow in many nations, and as patterns of urbanization continue, alongside the heating effects of cities, the danger of heat will become a more pressing issue (Vicedo-Cabrera 2022). The risk of heat-related death or sickness is unequally distributed: in addition to age, the quality of housing, access to cooling environments or technologies, underlying health conditions, and pregnancy, all shape vulnerability. As Singer et al. (2016) found in their ethnography of Latino communities in a city in the USA, racialized populations are not only vulnerable to heat, they are not given adequate access to information on how to protect themselves, or involved in decision-making in how their communities might prepare to adapt to living in urban heat islands. The climate is not just heating; it is becoming less predictable. Seasons can no longer be relied upon and, as Wainwright (2017) has noted in her research on air quality and breathlessness in Uruguay, this will change the epidemiology of some conditions such as chronic obstructive pulmonary disease.

Changing and increasingly extreme weather patterns mean that in addition to heatwaves, we can expect more drought, flooding, and hurricanes. As well as the immediate threat to life, homes and infrastructure, and the attendant pressures on emergency services, this is having an impact on food security. Already 127 million more people are “experiencing moderate or severe food insecurity compared with 1981–2010” because of climate change (Romanello et al. 2023:1). Increasing CO₂ levels have been linked to the loss of essential nutrients (zinc, iron, vitamin B, and protein) from staple food crops, fish are struggling to survive in warmer oceans, and a decrease in pollinating insects could mean that important food plants will not be available in the future (Myers 2022). Clean water and sanitation are also at risk when floods damage infrastructure and contaminate water supplies (IPCC 2023:30).

We can also expect to see an expansion in the distribution of vector-borne diseases such as malaria, Lyme disease, and dengue. As these diseases travel around the world to areas where populations do not have any immunity to them, or the transmission season extends in already endemic areas, there is a need for increased surveillance so that already pressured health systems services can prepare to deal with them. Antimicrobial resistance (AMR) will complicate treatment as antibiotics, antiparasitic pharmaceuticals, as well as insecticides lose their efficacy. There is increasing evidence of a link between warmer temperatures and AMR (Brownstein et al. 2022).

Ecoanxiety and climate change denial exist in an uneasy tension. Fear of what the future holds is contributing to a global mental health crisis and, for some, this is translating into a reluctance to have children (McMullen and Dow 2022). For others, conspiracy theories and resistance to state-led initiatives, such as the fifteen-minute city or to vaccination, indicate anxieties and fears of another sort.

It is not all negative, however. Efforts to mitigate climate change, such as reducing CO₂ and methane emissions, are likely to reduce the ten million deaths a year that are currently attributed to air pollution (Shindell 2022). As more people cut down their consumption of meat and dairy in favor of a plant-based diet, there will be nutritional benefits with positive knock on effects for chronic illness such as diabetes 2, and individuals will develop a healthier gut microbiome. As more people cycle and walk instead of using their cars for shorter journeys, and as green spaces are cultivated in cities, there will be positive impacts on physical fitness and mental health.

There is nothing listed above that represents unfamiliar terrain to medical anthropologists. In particular, this journal has a strong tradition of charting the impact of socioeconomic and intersectional inequalities on health. These are well-known and well-rehearsed. As focus increases on Indigenous peoples (the Lancet 2023 report references “harnessing and capturing the knowledge of Indigenous communities through meaningful engagement” (Romanello et al. 2023:6), for example), care needs to be taken to ensure that they are not expected to provide a solution to a catastrophe that they did not cause, whilst at the same time fostering inclusive approaches to ensure that only locally acceptable action is taken. Recent debates about decolonization have brought with them an increasing recognition that Indigenous Knowledge is not so much an object for anthropological study as it is knowledge in its own right (Sultana et al. 2023). It is perhaps trite, but nevertheless important, that we keep a focus on the multiple ways in which the health effects of climate change will also be unevenly distributed as climate injustice will increasingly become evident. Still, the evidence is there: the pressing question is what can be done to make sure that it is acted upon when it comes to climate change?

So why is it that research articles on climate change do not feature more prominently in the pages of this journal? Is it because climate change will bring with it more of the same? Many of the health problems with which it is associated have, after all, long been familiar ground for medical anthropology: vector-borne diseases; emerging infectious disease; sanitation, access to clean water, and drought; food insecurity and malnutrition; and disasters such as floods and hurricanes. As the concept of the Anthropocene has been interrogated by anthropologists, we can add the increasing recognition of multispecies approaches for thinking about antimicrobial resistance and emerging infectious diseases, and the relevance of expanding our attention to veterinary medicine and agriculture as we apprehend the interconnectedness of human health with the health of other forms of life on the planet through paradigms such as One Health and Planetary Health (Alves Duarte da Silva et al. 2023; Brown and Nading 2019; Segata et al. 2023). We are perhaps only beginning to come to grips with other consequences of climate change: the health effects of heatwaves, the declining quality of the air and consequent respiratory conditions, and ecoanxiety.

Is it the tendency of anthropologists to focus on the local that makes global phenomena like climate change difficult to perceive (Trostle 2010:223)? Or is it something temporal, related to how climate change is experienced, not so much as an event but as an everyday phenomena? As Joshua Griffin wrote in his article on the effects of climate change on food sovereignty in Iñupiaq Alaska, “on most days, climate change is experienced as a quasi-event in the background of everyday life” (Griffin 2020:342). It is likely that much of our work as medical anthropologists is already about climate change, but we need to first recognize this ourselves – both when we analyze our field data and in our writing – and then to signal our contributions more loudly. For this reason, we yet again call for articles addressing how global climate change plays out in the local contexts of our research, and ask our authors to work with us to make clearer how our everyday work already addresses the challenges that climate change brings.

We wish to thank the Associate Editors and the Editorial Board for their contributions to the running of the journal. In particular we are sorry to lose the following who have stepped down after over a decade of valuable service: Sean Brotherton, Carolyn Sargent, and Susan Levine. We are delighted to welcome five new board members: thank you to Emily Yates-Doerr, Eva Fiks, Cassandra White, and Mei Zhan for accepting our invitation this year, and Michele Friedner who joined as an Associate Editor in December 2021. Finally, we extend our thanks to Victoria Team for her dedication in managing the editorial office, and Oğuz Alyanak for his continued contributions as Editorial Assistant for Social Media.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Rebecca Marsland

Rebecca Marsland is co-editor of Medical Anthropology, and a Senior Lecturer at the University of Edinburgh. Her current research focuses on honeybee health, and One Health.

James Staples

James Staples is co-editor of Medical Anthropology, and a Professor of Social Anthropology at Brunel University London. His current research includes an ongoing interest in the experiences of people affected by leprosy in India, as well as a more general interest in disability.