C JAMES HOSPEDALES C James Hospedales founded the EarthMedic and EarthNurse Foundation for Planetary Health to mobilise health professionals to address the climate crisis. He chairs the executive committee of the Defeat-NCD Partnership and is a climate and health adviser to the Healthy Caribbean Coalition. He was previously director of the Caribbean Public Health Agency, and coordinator of chronic disease prevention and control at the Pan American Health Organization. He played a key role in the 2007 CARICOM Heads of Government Summit on non- communicable diseases leading to the United Nations High Level Meeting on Non-Communicable Diseases in 2012, 2014 and 2018. X-TWITTER @earth_medic earthmedic.com
WHAT IS BEING DONE? In 2007, Caribbean countries held the first summit of heads of government on NCDs and issued the Port of Spain Declaration with 27 commitments on prevention and control. This was the forerunner to high-level meetings on NCDs at the United Nations in 2012, 2014 and 2018. The Healthy Caribbean Coalition was formed in 2012 with over 100 civil society organisations working to prevent and control NCDs. Governments in the region also worked on strengthening plans and programmes for preventing and controlling NCDs. Issues under the control of health ministries, such as policies and plans for treatment, showed positive movement. Issues requiring a multi-sector approach or subject to commercial influence hardly improved. Risk factors such as alcohol
consumption, unhealthy diets, physical inactivity and obesity increased in adults and children. In 2016–17, CARPHA developed a six-point policy package for healthier food environments to prevent childhood obesity, including front-of-pack labels, reduced marketing of unhealthy foods to children, product reformulation, food chain incentives for fruit and vegetables, and fiscal measures such as taxes on sugar-sweetened beverages. There was very limited progress, given forceful opposition from commercial interests. And little progress has been made on improving green spaces in urban areas or using alternative modes of transport. Similarly, at the global level the world is not on track to achieve the Sustainable Development Goals, including SDG 3 on health. Caribbean countries were at the forefront at the 2015 Paris Agreement with the cry of “1.5 to stay alive”. However, carbon dioxide levels continue to rise as burning of fossil fuels has steadily increased. The world is on track for 2.7°C of warming under current commitments. Fires, drought, floods worldwide in 2023 have led the UN to sound the alarm loudly. Yet the next UN climate conference will be chaired in November 2023 by an oil executive. With support from the World Health Organization and the European Union, many countries have developed health national adaptation plans for climate change, but health organisations and climate/environment interests largely operate in separate silos. At the regional level, the EarthMedic and EarthNurse Foundation for Planetary Health was founded in 2020 to mobilise health professionals to address the climate crisis. In July 2023, EarthMedic helped launch the Caribbean Health Alliance for Climate Action with five national medical associations and the HCC. In 2022, the Global Consortium on Climate and Health Education at Columbia University conducted climate and health courses in the Caribbean, to help address large knowledge-action gaps among healthcare professionals. These efforts are increasing the awareness of the impact of climate change on health and NCDs. WHAT STILL NEEDS TO HAPPEN? So much can be done. NCD prevention and control movements can join with climate action movements: the HCC, EarthMedic and environmental organisations can come together with the Caribbean Health Alliance for Climate Action.
A Caribbean hub for education could scale up training for health professionals, faculty, students and policymakers, with climate and health as a prerequisite. Governments should designate some of the divested sugar lands in all the Caribbean countries for community gardens and planting trees for food. This would address the threat of global food shortages caused by climate change and the worsening NCD epidemic, and reduce carbon footprints. Alternative transport, including biking, walking and rapid mass transport, and urban greening need public health and urban planners to come together. The existing built environment can be used, with co-benefits for public health, tourism and the environment. Practical measures such as painting roofs with heat-reflective paint and planting trees for shade in schools and homes for the elderly would reduce the risk of heat illness in these two vulnerable populations. NCDs should be included in national disaster risk reduction plans and responses including the pre-identification of people with NCDs and training for shelter managers. Commercial interests on health should be tackled head on, and the six-point policy package for healthier food environments should be implemented. If we can break down all the silos that exist within the silos, we can overcome the challenges caused by NCDs and climate change, and improve the health of the people and the planet on which we depend. ▪
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Health: A Political Choice – From Fragmentation to Integration
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