A Climate of Inequality

Am I a good person? I am ashamed to say I recently flew to Perth for a medical conference and had a wonderful time. For a time, medical conferences were all virtual due to the transport limitations prescribed by COVID. Why should this not continue? After all, the main purpose of conferences is to enhance medical education. The appeal of in-person conferences lies in the human desire for socialization and travel. This sits uncomfortably with the fact that doctors are supposed to be thinking of the greater good. Climate change dictates that choosing an in-person conference over a virtual one carries a cost to society.

Ganatra and colleagues (1) have previously discussed the significant burden health care contributes to the carbon footprint. From transport to appointments, medical equipment, anesthetic gases … and of course medical conferences that encourage air travel. Even the health care advances that academics strive toward can contribute to societal harm. High-income countries often have specialized tertiary referral centers. Patients suffering from rare diseases can travel hundreds of miles to receive expert care, compared with low-income countries with only a local health care center. The inequality of expert health care is an ignored contributor to climate change.

My carbon footprint has never been smaller than during the month I spent in Ghana. I travelled via “tro tro,” a shared van packed with people that would leave only when full, rather than at specific times. I experienced the country’s frequent mandated power outages. The disadvantaged families that I cared for were creating the least carbon emissions without even trying. They were walking and cycling out of necessity. Governmental policies in these regions are inconsequential when compared with the smallest of policy changes for wealthy countries, yet these are the very people who stand to suffer most from climate change. The increases in natural weather disasters, changes in access to food and water, and increased vector-borne disease are all likely to affect low-income countries more severely. Countries that are the most responsible for carbon emissions and have the most financial stake when discussing emission strategies are also the least likely to be affected by the consequences.

I come from a rural area of New Zealand where a large proportion of the community works in mining or relies on jobs centered around fossil fuels. My uncle makes a living selling coal. He was recently out shoveling coal while awaiting a hip replacement. Despite excruciating pain, he persevered because, like many others in this community, the alternative is risking his livelihood. When governments consider carbon emission policies, it is easy to forget the connotations associated with labor workers. The people at the coalface, so to speak, are often low-income earners. These are the people at the mercy of governmental policy without the means to make adaptations. Not only does climate change lead to inequities, but the solutions to fight it threaten to replicate this inequality.

I shift uncomfortably on my flight, not due to the limited space in economy, but due to the disturbing thought that even though I am a socially responsible doctor, I struggle to give up luxuries despite knowing the implications. The theoretical consequences are not as vivid as the espresso in front of me in a plastic cup.

References

1. Ganatra S, Dani SS, Al-Kindi SG, et al. Health care and climate change: challenges and pathways to sustainable health care [Editorial]. Ann Intern Med. 2022;175:1598-1600. [PMID: 36279542] doi:10.7326/M22-1241

Leah Jones, MBChB, MHSc

Leah is a general medicine and dermatology trainee from New Zealand. She completed her medical degree at the University of Otago and her Master of Health Science at the University of Auckland. She has an interest in health care equality.