Time to treat the climate and nature crisis as one indivisible global health emergency
Human health is damaged directly by both the climate crisis, as the journals have described in previous editorials, and by the nature crisis. This indivisible planetary crisis will have major effects on health as a result of the disruption of social and economic systems—shortages of land, shelter, food and water, exacerbating poverty, which in turn will lead to mass migration and conflict. Rising temperatures, extreme weather events, air pollution and the spread of infectious diseases are some of the major health threats exacerbated by climate change. “Without nature, we have nothing” was UN Secretary-General António Guterres’s blunt summary at the biodiversity COP in Montreal last year. Even if we could keep global warming below an increase of 1.5°C over preindustrial levels, we could still cause catastrophic harm to health by destroying nature. Access to clean water is fundamental to human health, and yet pollution has damaged water quality, causing a rise in waterborne diseases. Contamination of water on land can also have far-reaching effects on distant ecosystems when that water runs off into the ocean. Good nutrition is underpinned by diversity in the variety of foods, but there has been a striking loss of genetic diversity in the food system. Globally, about a fifth of people rely on wild species for food and their livelihoods. Declines in wildlife are a major challenge for these populations, particularly in low-income and middle-income countries. Fish provide more than half of dietary protein in many African, South Asian and small island nations, but ocean acidification has reduced the quality and quantity of seafood. Changes in land use have forced tens of thousands of species into closer contact, increasing the exchange of pathogens and the emergence of new diseases and pandemics. People losing contact with the natural environment and the declining biodiversity have both been linked to increases in non-communicable, autoimmune and inflammatory diseases, and metabolic, allergic and neuropsychiatric disorders. For Indigenous people, caring for and connecting with nature is especially important for their health. Nature has also been an important source of medicines, and thus reduced diversity also constrains the discovery of new medicines. Communities are healthier if they have access to high-quality green spaces that help filter air pollution, reduce air and ground temperatures, and provide opportunities for physical activity. Connection with nature reduces stress, loneliness and depression while promoting social interaction. These benefits are threatened by the continuing rise in urbanisation. Finally, the health impacts of climate change and biodiversity loss will be experienced unequally between and within countries, with the most vulnerable communities often bearing the highest burden. Linked to this, inequality is also arguably fuelling these environmental crises. Environmental challenges and social/health inequities are challenges that share drivers and there are potential co-benefits of addressing them. 

In December 2022 the biodiversity COP agreed on the effective conservation and management of at least 30% of the world’s land, coastal areas and oceans by 2030. Industrialised countries agreed to mobilise $30 billion per year to support developing nations to do so. These agreements echo promises made at climate COPs. Yet many commitments made at COPs have not been met. This has allowed ecosystems to be pushed further to the brink, greatly increasing the risk of arriving at ‘tipping points’, abrupt breakdowns in the functioning of nature. If these events were to occur, the impacts on health would be globally catastrophic. This risk, combined with the severe impacts on health already occurring, means that the WHO should declare the indivisible climate and nature crisis as a global health emergency. The three preconditions for the WHO to declare a situation to be a public health emergency of international concern are that it (1) is serious, sudden, unusual or unexpected; (2) carries implications for public health beyond the affected State’s national border; and (3) may require immediate international action. Climate change would appear to fulfil all of these conditions. While the accelerating climate change and loss of biodiversity are not sudden or unexpected, they are certainly serious and unusual. Hence we call for the WHO to make this declaration before or at the 77th World Health Assembly in May 2024. Tackling this emergency requires the COP processes to be harmonised. As a first step, the respective conventions must push for better integration of national climate plans with biodiversity equivalents. As the 2020 workshop that brought climate and nature scientists together concluded, ‘Critical leverage points include exploring alternative visions of good quality of life, rethinking consumption and waste, shifting values related to the human-nature relationship, reducing inequalities, and promoting education and learning’. All of these would benefit health. Health professionals must be powerful advocates for both restoring biodiversity and tackling climate change for the good of health. Political leaders must recognise both the severe threats to health from the planetary crisis as well as the benefits that can flow to health from tackling the crisis. But first, we must recognise this crisis for what it is: a global health emergency. List of Authors Kamran Abbasi, Editor-in-Chief, BMJ ; Parveen Ali, Editor-in-Chief, International Nursing Review ; Virginia Barbour, Editor-in-Chief, Medical Journal of Australia ; Thomas Benfield, Editor-in-Chief, Danish Medical Journal ; Kirsten Bibbins-Domingo, Editor-in-Chief, JAMA ; Stephen Hancocks, Editor-in-Chief, British Dental Journal ; Richard Horton, Editor-in-Chief, The Lancet ; Laurie Laybourn-Langton, University of Exeter; Robert Mash, Editor-in-Chief, African Journal of Primary Health Care & Family Medicine ; Peush Sahni, Editor-in-Chief, National Medical Journal of India ; Wadeia Mohammad Sharief, Editor-in-Chief, Dubai Medical Journal ; Paul Yonga, Editor-in-Chief, East African Medical Journal ; Chris Zielinski, University of Winchester. This Comment is being published simultaneously in multiple journals. For the full list of journals see: https://www.bmj.com/content/full-list-authors-and-signatories-climate-nature-emergency-editorial-october-2023 

Kamran Abbasi, Editor-in-Chief, BMJ ; Parveen Ali, Editor-in-Chief, International Nursing Review ; Virginia Barbour, Editor-in-Chief, Medical Journal of Australia ; Thomas Benfield, Editor-in-Chief, Danish Medical Journal ; Kirsten Bibbins-Domingo, Editor-in-Chief, JAMA ; Stephen Hancocks, Editor-in-Chief, British Dental Journal ; Richard Horton, Editor-in-Chief, The Lancet ; Laurie Laybourn-Langton, University of Exeter; Robert Mash, Editor-in-Chief, African Journal of Primary Health Care & Family Medicine ; Peush Sahni, Editor-in-Chief, National Medical Journal of India ; Wadeia Mohammad Sharief, Editor-in-Chief, Dubai Medical Journal ; Paul Yonga, Editor-in-Chief, East African Medical Journal ; Chris Zielinski, University of Winchester. This Comment is being published simultaneously in multiple journals. For the full list of journals see: https://www.bmj.com/content/full-list-authors-and-signatories-climate-nature-emergency-editorial-october-2023 

