Elsevier

The Lancet

Volume 389, Issue 10074, 18–24 March 2017, Pages 1151-1164
The Lancet

Review
The Lancet Countdown: tracking progress on health and climate change

https://doi.org/10.1016/S0140-6736(16)32124-9Get rights and content

Summary

The Lancet Countdown: tracking progress on health and climate change is an international, multidisciplinary research collaboration between academic institutions and practitioners across the world. It follows on from the work of the 2015 Lancet Commission, which concluded that the response to climate change could be “the greatest global health opportunity of the 21st century”. The Lancet Countdown aims to track the health impacts of climate hazards; health resilience and adaptation; health co-benefits of climate change mitigation; economics and finance; and political and broader engagement. These focus areas form the five thematic working groups of the Lancet Countdown and represent different aspects of the complex association between health and climate change. These thematic groups will provide indicators for a global overview of health and climate change; national case studies highlighting countries leading the way or going against the trend; and engagement with a range of stakeholders. The Lancet Countdown ultimately aims to report annually on a series of indicators across these five working groups. This paper outlines the potential indicators and indicator domains to be tracked by the collaboration, with suggestions on the methodologies and datasets available to achieve this end. The proposed indicator domains require further refinement, and mark the beginning of an ongoing consultation process—from November, 2016 to early 2017—to develop these domains, identify key areas not currently covered, and change indicators where necessary. This collaboration will actively seek to engage with existing monitoring processes, such as the UN Sustainable Development Goals and WHO's climate and health country profiles. The indicators will also evolve over time through ongoing collaboration with experts and a range of stakeholders, and be dependent on the emergence of new evidence and knowledge. During the course of its work, the Lancet Countdown will adopt a collaborative and iterative process, which aims to complement existing initiatives, welcome engagement with new partners, and be open to developing new research projects on health and climate change.

Introduction

WHO estimated that, in 2012, 12·6 million deaths (23% of all deaths worldwide) were attributable to modifiable environmental factors, many of which could be influenced by climate change or are related to the driving forces of climate change.1 The 2009 UCL–Lancet Commission: managing the health effects of climate change2 described the ways in which climate change acts as a force multiplier for threats to global health. This initiative has drawn on long-standing expertise and leadership in the health and climate field, including from institutions such as WHO and the Intergovernmental Panel on Climate Change (IPCC), and a previous call for the systematic monitoring of health outcomes related to climate change.3, 4

The 2015 Lancet Commission on Health and Climate Change: policy responses to protect public health5 built on these foundations and explored the health benefits of climate change mitigation and adaptation policies. As first described in the 2009 Lancet series, greenhouse gas mitigation across a range of sectors can result in considerable improvements in public health.6, 7, 8, 9, 10 Taken together, the potential to avoid substantial impacts of climate change and the potential co-benefits of climate change mitigation and adaptation led the 2015 Lancet Commission5 to conclude that “tackling climate change could be the greatest global health opportunity of the 21st century”.

The direct impacts of climate change result from rising temperatures, heatwaves, and increases in the frequency of complex extreme weather events such as windstorms, floods, and droughts.11 The health and social consequences of these events are far-reaching, ranging from reduced labour productivity and heat-related deaths, through to direct injury, the spread of infectious diseases, and mental health effects following widespread flooding. The effects of climate change will also be heterogeneously mediated across different environmental and social systems, resulting in changing patterns of the burden and distribution of infectious diseases, changes in food productivity, and potential effects on food and water shortages, population displacement, and conflict (figure 1).3 Climate change places undue burden on the countries least responsible and least able to respond, with low-income and middle-income countries experiencing multiple impacts simultaneously.12

The Rockefeller Foundation–Lancet Commission on planetary health13 described how sustained human health and development are dependent on flourishing natural systems. This Commission13 and others14 have drawn attention to the fact that human activities are breaching environmental limits across a range of areas, driving terrestrial and marine biodiversity loss, ocean acidification, depletion of freshwater, soil degradation, and other potentially irreversible processes.

At the international level, the Paris Agreement provides the framework for future international cooperation and national action on climate change. Modelling suggests that the full implementation of all mitigation actions pledged by national governments would limit average global warming to around 2·7°C by 2100—an improvement on the high-end 4·8°C or more scenario, but substantially higher than the agreed UN target of “well below 2·0°C”.15

Responsibility for implementation of the Paris Agreement now falls on national governments. The next 15 years, from 2016 to 2030, are a crucial window that will determine the trajectory of climate change and human development for the coming century. As part of this transition, countries will have to undergo a shift from understanding climate change solely as a threat, to embracing the response to climate change as an opportunity for human health and wellbeing. Tracking and communicating this transition will be the central focus of the Lancet Countdown.

Section snippets

Aims of the Lancet Countdown on health and climate change

The Lancet Countdown aims to track the impacts of climate change and the speed of the transition to a decarbonised global economy (a transition that is already underway); analyse and show the health benefits available; provide a global picture of successes and obstructions in this shift; draw out exemplary case studies for shared learning; and engage with policy makers and the broader health community to better communicate the opportunities available in responding to climate change both for

Indicators of progress: a call for input and engagement

The work of the Lancet Countdown is divided into five working groups, responsible for specific sets of indicators and their integration. Proposed indicator domains for these working groups are outlined in the panel and below. These indicators and indicator domains are presented for consultation with varying degrees of certainty, ranging from the presentation of a specific indicator through to the description of a broad domain within which several indicators might be present.

The ongoing framing

1: Health impacts of climate hazards

The health effects of climate change are projected to become increasingly severe in the future, and threaten to undermine the gains made in public health and development during the past half-century.3, 5 The effects of climate change are unevenly distributed within and between countries, with all risks having important social, economic, and geographical mediating factors.19 The first working group of the Lancet Countdown proposes seven indicator domains to be considered and then tracked.

2: Health resilience and adaptation

Adaptation interventions designed to minimise the health impacts of climate change are already required. The second working group of the Lancet Countdown will therefore focus on the design and deployment of adaptation and resilience interventions. It will particularly draw on data collected for the WHO climate and health country profiles, including responses to surveys from national ministries of health.19

3: Health co-benefits of climate change mitigation

The existence of ancillary health benefits (co-benefits) of climate change mitigation policies provides a powerful incentive to accelerate policy change, as these benefits are experienced in the near term, whereas the benefits of climate change mitigation are largely observed in the long term. As noted, however, such benefits are not automatic, and care is needed to avoid unintended adverse consequences for health. To assess progress in climate change mitigation and the potential resultant

4: Economics and finance

Article 2 of the Paris Agreement establishes the importance of ensuring financial flows consistent with a pathway towards a low-carbon economy. The Lancet Countdown's fourth working group will focus on the ways in which flows of finance and economic incentives are developing to accelerate progress on health and climate change. Indicators for this working group will fall into three broad themes: investment in a low-carbon economy; valuing the health co-benefits of climate change mitigation; and

5: Political and broader engagement

The fifth working group will focus on the broader context within which progress on health and climate change is being made. These indicator domains will track the implementation of political commitments within the UNFCCC, alongside analysis of scientific and public engagement with health and climate change, which provide both background and context for policy implementation.

Conclusion

The Lancet Countdown is an international, multidisciplinary research collaboration dedicated to tracking progress on health and climate change from 2016 to 2030. It will be governed by a board comprising the research leads for each working group, and coordinated by a smaller executive team responsible for supporting the working groups to deliver and communicate the academic content. Over the coming months, the Countdown will work to establish an international advisory board, to provide

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