11 Dec Climate change and respiratory health
Climate Change and Respiratory Health, brought together four leading experts – Heather Adair-Rohani from the World Health Organization (WHO), Rebecca Nantanda from Makerere University Lung Institute, Laura-Jane Smith from the British Thoracic Society, and John Sampson from Johns Hopkins University to explore different facets of the impact of climate change on respiratory health and care. This was the last of three High Stakes Conversations hosted by Every Breath Counts, on 12 November 2024 to mark World Pneumonia Day and COP29.
Session moderator, Leith Greenslade of Every Breath Counts, opened the conversation with the 2021 Global Burden of Disease estimates of 2.8 million respiratory disease deaths attributable to air pollution, including 1.8 million from chronic obstructive pulmonary disease (COPD), 650,000 from pneumonia, and 370,000 from lung cancer. Roughly half of these deaths are from indoor and half from outdoor sources except for lung cancer, with outdoor air pollution the greatest contributor. Ninety-four per cent of air pollution-related respiratory disease deaths are in low- and middle-income countries (LMICs).
Heather Adair-Rohani from WHO kicked off the expert presentations by describing the common drivers of climate change and air pollution as domestic fuel use for cooking and heating, agricultural, transport, and industry emissions (electricity generation), and waste burning. She outlined the new 2021 WHO Air Quality Guidelines and underscored the wide gaps in achieving the targets for almost all countries. For example, no country has achieved an average concentration of PM2.5 (particulate matter 2.5 micrometres or less in diameter) of 5 µg/m3 per year and 15 µg/m3 for more than 3 to 4 days per year, according to the State of Global Air Report 2024. Adair-Rohani underscored that PM2.5 is the most dangerous pollutant because it can penetrate the lung barrier and enter the blood system, causing cardiovascular and respiratory disease and cancers. There are also WHO targets for PM10, ozone (O3), nitrogen dioxide (NO2), sulphur dioxide (SO2) and carbon monoxide (CO). Adair-Rohani also drew attention to the WHO Guidelines for Indoor Air Quality: Household Fuel Combustion and to the WHO Clean Household Energy Solutions Toolkit (CHEST), as currently almost one in three people lack access to clean fuels and technologies for cooking in the home. She concluded by encouraging engagement in the WHO’s flagship Second Global Conference on Air Pollution and Health in Columbia in 2025.
“Nine out of ten people live in areas where air pollution exceeds WHO air quality guidelines and 2.3 billion people still rely on polluting energy for cooking.”
Rebecca Nantanda from the Makerere University Lung Institute in Uganda summarized recent data on outdoor air pollution and respiratory health across Africa, which is home to eight of the ten countries with the highest PM2.5 exposure according to State of Global Air Report 2024. She cited data that daily PM2.5 exposure among school-age children in six African cities is well above the level allowed by WHO (15 μg/㎥), that children exposed to high levels of PM2.5 have lower lung function, and that healthcare visits for asthma and pneumonia increase during high PM2.5 days. Nantanda argued that children in many parts of Africa are at an increased risk of adult asthma and COPD and that exposure begins in the womb. She quoted data that just 17% of air quality management strategies in Africa focus on outdoor air pollution and decried the paucity of research on outdoor air pollution and chronic respiratory disease when Africa’s fossil fuel use will double by 2030 and 60% of Africans will live in cities by 2050, up from 15% in 1960. Nantanda concluded that there is an urgent need for outdoor air pollution prevention and mitigation strategies to reduce the incidence of chronic respiratory diseases across the continent.
“Urbanization, combined with climate change, will be among the greatest challenges to development in Africa because of their impact on air pollution and heat which are both associated with high vulnerability and low adaptability among people with chronic respiratory conditions.”
Laura-Jane Smith from the British Thoracic Society presented a new Position Statement on Climate Change and Lung Health, which sets out how the respiratory care profession can mitigate the impact of climate change and the carbon footprint of respiratory healthcare by changing the way they care for patients in the UK, where respiratory disease affects one in five and is the third largest cause of death. The position statement calls for a greater focus on preventing respiratory disease by vaccination, smoking cessation, and behaviors that improve air quality (e,g., reduced car use). Smith highlighted smoking as a key driver of both respiratory disease and climate destruction, as in addition to the healthcare costs of smoking, cigarettes contribute to deforestation, air and water pollution, and waste (1.3 million disposable vapes are discarded every week in the UK!), and have a carbon footprint of 80 million tonnes CO2 per year. The statement supports a new generation of more climate-friendly respiratory care tools and practices including phone alerts so patients can avoid risk (e.g., high air pollution days), low-carbon inhalers, and reductions in “over-diagnosis and use of energy-hungry therapies. Currently, many inhalers, especially metered-doses inhalers, rely on propellant gases which contribute significantly to a user’s carbon footprint when compared to dry powder inhalers. She decried the lack of focus on climate change and lung health at all levels of medical education and flagged that the society is creating a Sustainable Respiratory Care Toolkit to help clinicians improve their practices. Smith concluded that clinicians can play a major role in reducing the impact of respiratory care on climate change and have much wider impact on climate change and lung health broadly, as nurses, doctors, and scientists are still among the most trusted authorities ins the UK with over 75% trust ratings.
“Climate change is the greatest threat to health that world has ever faced and respiratory diseases will worsen as the world warms further, increasing the demand for respiratory healthcare and at present the resources allocated don’t match the need.”
Finally, John Sampson from the Global Alliance of Perioperative Professionals (GAPP) at Johns Hopkins University presented a flagship effort in West Africa to build climate-sensitive and energy-efficient oxygen plants at hospitals in The Gambia, Sierra Leone, and Liberia as part of the African Infrastructure and Relief Support (AIRS) Project. AIRS, implemented by the Society of Critical Care Medicine and funded by Direct Relief, is installing energy-efficient Vacuum Swing Adsorption (VSA) oxygen plants which use 30% less energy than Pressure Swing Adsorption (PSA) plants and powering them with solar panels to pipe the oxygen directly to bedside. This not only increases the supply of medical oxygen to the hospital, but reduces the high costs of diesel generators to power the hospitals and the diesel trucks to transport oxygen cylinders to and from the hospital. In this way, Sampson argues, hospitals can convert their diesel dollars into health dollars and reduce the high CO2 emissions. A stable supply of affordable power also means hospitals don’t have to ration care (e.g., only provide oxygen for some hours of the day) . Solar Sierra Leone Bo Hospital 2022 no power failures He stated that prior to AIRS, hospitals were spending 50-100% of their monthly budget on buying oxygen cylinders or running diesel generators. The high energy costs of mobile concentrators is also acknowledged in the landmark WHO Energizing Health Report. He underscored that oxygen is an essential medicine without a substitute that is also energy hungry – you need a lot of power to generate medical-grade oxygen. Accordingly, governments and donors must have an energy plan before they procure any new oxygen generation technology otherwise governments and hospitals in low-resource settings will not be able to run the new oxygen equipment and may be forced back into buying expensive and dirty trucked cylinders. Sampson concluded with an appeal to governments and donors to invest more in energy-efficient oxygen technologies powered by renewables (solar, wind, geothermal, hydro) and to ensure that hospitals have the energy to operate new equipment, before it is procured and delivered.
“Governments and donors should be supporting energy-efficient, climate-friendly oxygen generation from the beginning, utilizing more VSA technology to build oxygen plants on hospital grounds, powered by renewable energy and piped to bedside to reduce the heavy financial and environmental costs of diesel generators and trucks to transport cylinders.”
The conclusion of the final High Stakes Conversation was that climate change will keep contributing to an increasing global burden of respiratory disease – infectious and chronic – largely by worsening air pollution. This in turn will increase demand for respiratory therapies that are either power-hungry, like oxygen, or high carbon emitters (e.g., COPD and asthma inhalers). To disrupt this toxic relationship where climate change drives greater demand for dirty respiratory care technologies which in turn drive more climate change, governments, industry, and donors must work together to invest in cleaner technologies generated close to where patients reside and powered by renewable energy.
You can watch the entire conversation here.
High Stakes Conversation #3, November 2024
The recordings from High Stakes Conversation #1, Medical oxygen and respiratory pandemics, and #2, Medical oxygen and the SDGs, can also be found here.