Treading on thin ice: building climate resilience or going in the wrong direction?
Austerity policies, fuel poverty and rising homelessness make the NHS and our social care system less able to cope under extreme conditions
The UK is the world’s sixth largest economy, yet people are still falling ill — even dying in the thousands — here because of a combination cold homes, cuts to public services and homelessness. As a junior doctor, I’ve seen the kind of human suffering this causes, both in A&E and looking after unwell elderly people on a longer-stay ward, and for me, the recent freezing-cold weather we’ve had has put the issue into sharp relief.
At first glance, the health impacts of cold weather might seem unrelated to the UK Health Alliance on Climate Change’s work. But the connections are clear, and in this instance, they extend as far as the weather itself. Whatever Nigel Farage may think, the weather brought by the ‘Beast from the East’ seems to be related to sudden stratospheric warming and unusually high Arctic temperatures, and so to climate change. We can’t expect climate change to be a gradual, predictable warming worldwide, but rather a destabilisation of climate systems likely to cause an increase in unpredictable weather patterns and extreme weather — leading some scientists to argue for the term ‘climate disruption’ instead.
The links to health are also clear. Many hospital admissions of frail older patients with conditions such as chest infections could potentially be prevented if they were able to heat their homes properly, with fuel poverty estimated to kill around 3,000 people per year in the UK. By investing in good-quality home insulation for those in fuel poverty, many of these deaths could be prevented — saving them money and reducing CO2 emissions at the same time. Meanwhile, according to the homelessness charity Crisis, the number of people sleeping rough across the UK has increased for the seventh year running, up 134% from 2010 levels, and they predict a further 47% rise in rough sleeping over the next decade without urgent action. The health of homeless people, people with alcohol and substance misuse disorders, severe mental illness and people on very low incomes is at risk not only from cold weather, but also from climate-related extreme weather events like heat-waves and flooding, for many of the same underlying reasons.
Since 2010, spending on local public services such as housing and social care has fallen dramatically, with disproportionate impacts on the most vulnerable groups. On average, council budgets have fallen by 26% over that period, due to falling support from central government and externally-imposed constraints on their ability to raise more funds by raising taxes locally, and despite rising demand because of population ageing and rental price changes far outstripping wage growth. The strain placed by year-on-year budget cuts on councils’ ability to properly plan ahead for climate change may already be starting to show. One of the most important ways is that policy-makers seem to have become less able to think effectively about long-term needs and impacts, given that they are increasingly struggling to meet their statutory duties and the basic needs of the populations they serve.
As a result, many evidence-based interventions in areas vital to creating a more environmentally sustainable health system — such as active transport, improving housing insulation, promoting healthier diets and reducing air pollution — have fallen by the wayside with councils having to prioritise statutory services over discretionary work in areas with a longer-term focus. Properly scaled up, many such schemes could offer major benefits and cost savings both for the NHS and for society as a whole, both by keeping people out of hospitals and by preventing early deaths, as well as reducing emissions.
For example, a 2013 scheme set up by Sunderland CCG — in which GPs ‘prescribed’ the installation of double glazing, efficient boilers and loft insulation for patients living in cold, damp homes — found that their healthcare visits reduced by a third, the average temperature in people’s homes rose by over 3°C and their heating bills fell by £30 a month, making it easier for patients to afford healthier food and improving quality of life. However, there has been very limited progress in improving the energy efficiency of UK buildings in recent years. Since the savings from such schemes don’t accrue directly to local authorities, cash-poor councils rarely feel able to justify significant expenditure within their increasingly limited budgets, and there has not been a concerted drive from central government either, other than by the devolved governments. As a result, the proportion of households living in fuel poverty has remained roughly static at around 11%, from 2005 to 2015.
Maybe we need to start thinking differently about what effective climate adaptation looks like, looking much more broadly than flood barriers or heat health warning systems. Perhaps public policy which fails to prevent homelessness or reduce fuel poverty widens inequalities, and leaves the NHS struggling to cope with essentially predictable demand, like winter pressures, should be seen as a sign of inadequate climate change adaptation. Health risks from climate change are also likely to interact with more immediate health impacts of austerity policies, including reduced access to health services, impacts on wage growth, homelessness and the rising number of people reliant on food banks. It’s easy to see how this could increase vulnerability to global food price shocks related to poor crop yields of the kind climate change already seems to be causing. Because its effects are disproportionately felt by marginalised groups, climate change threatens to further widen health inequalities without concerted policy action. If, as health professionals, we really want to help our communities build resilience to the health impacts of climate change, we will also need to compel governments to address the underlying social and economic determinants of ill health and inequality.
The impact of austerity policies and rising inequality on health cannot be considered in isolation from sustainability and climate resilience — there’s a two-way relationship between them. I’d argue that our vulnerability to climate change may even be increasing because the services provided by both local authorities and the NHS are now so stretched that they can barely cope even under normal circumstances, let alone the additional stress of extreme weather. It’s clear that we urgently need fairer, more forward-looking policies to safeguard health in the face of climate change, and getting more involved in advocacy with the UK Health Alliance on Climate Change seems like a great place to start.
Dr Isobel Braithwaite, Junior doctor at University College Hospital, London, and member of the Climate and Health Council
The views expressed in this blog are the author’s own and do not reflect the official opinion, policy or position of the UK Health Alliance on Climate Change.
