 Good afternoon everyone and a very warm welcome to the annual Gordon Goodman Memorial Lecture, that we at the Stockholm Environment Institute are very proud to co-organize with the Stockholm University and the Royal Swedish Academy of Sciences. The topic this year and this afternoon is climate change and health, developing evidence for action. We have a fantastic keynote speaker, a really high-powered panel and an excellent moderator. For this annual memorial lecture in Gordon Goodman's name we'd like to think that we always identify really important topics, but I think this year climate change and health feels incredibly important and urgent. We have of course in the last one and a half years felt health impacts and noticed changes to our daily lives from a large looming global threat, pandemic. Climate change is the ultimate threat, an existential threat, but it's not really so abstract anymore. We are starting to experience climate change and see the health impacts for example from heat waves, but the good news here is of course that there are lots of solutions to both climate change and ill health. Smart systemic solutions that address not just the negative threats that we want to avoid, but also tap into positive goals and aspirations of societies and of people for economic development, good health, human well-being, etc. At the Stockholm Environment Institute we try to work on these co-benefits, quantify them, understand them, persuade policymakers to take action, particularly looking at health and climate co-benefits from tackling air pollution, both short-lived climate pollutants and how we can include those in national climate plans and disease for example, and also increasingly looking at methane and how our agricultural production systems must change. Another area for us is sanitation, smart sustainable sanitation and how that can improve noticed health and safety of users, but also promote resource recovery and reduce emissions. So with that introduction here is the agenda for today, the coming 90 minutes. You will hear a short welcome also from our partner institutions, followed by a keynote lecture by Professor Sir Andy Haynes, and then we will have a very promising, very exciting panel discussion, moderated by Anders Nordstrom from the Ministry of Foreign Affairs of Sweden. And then we'll wrap up and there will be a media briefing after for any journalists joining this lecture. So without further ado I'd like to hand over to Astrid Söderberg-Vitting of Stockholm University and Don Lahrheim, my Royal Swedish Academy of Sciences. Okay, it seems we have unfortunately a problem with the connections. This still happens, but I think I can say on behalf of the Royal Swedish Academy of Sciences that they are also very much looking forward to the lecture and of course lots of work also from members of that academy on this important topic. And SEI shares a history with the Royal Swedish Academy of Sciences in how our institute was established. So let's see if we can hear them from our Stockholm University partners. Dear colleagues, as president of Stockholm University, one of the partner institutions presenting the Gordon Goodman Memorial lecture, it is with great pleasure that I take part in today's introduction, looking forward to this year's lecture by Sir Andy Haynes. We three partners, commonly arranging the lecture, complement each other with different profiles, but with research as our common denominator. Research may both explore wicked problems, such as today's important topic of climate change and its impacts on human health, and find solutions of benefit both to human health and to the environment. Whereas fundamental research is a necessary foundation for applications, the urgent need to find research-based solutions and to turn them into policy and action has indeed been accelerated by the climate crisis. If the Royal Swedish Academy of Sciences is primarily devoted to promoting research, an admission for Stockholm Environment Institute is bridging science and policy. Stockholm University, just like any research university, has, I would say, as its main mission to offer higher education based on and closely connected to research. Research and higher education must go hand in hand. In offering courses and programs where researchers communicate to students their new findings on, say, climate change, on health, on sustainability in food systems, in urban systems, or sustainable development, in any sense of the word, universities may become real drivers for change. Higher education is by far the university's most important task in contributing to societal development. But without strong research as its base, higher education risks to lose its value. I'm convinced that today's lecture will inspire not only researchers and policymakers, but also students at all levels in our universities. In today's societies, much is at stake to actually turn the threatening visions of climate and health into realising a sustainable vision for the future. Here, we have a common role to play together from our different perspectives, with research, higher education and policy making being developed into action. Thank you. Thank you very much. I'll start by reading of Stockholm University. So, let's dig into the programme for today. I will introduce our esteemed keynote speaker, Professor Andy Hain, who is Professor of Environmental Change and Public Health at the Centre on Climate Change and Planetary Health at the Lana School of Hygiene and Tropical Medicine. He has a very impressive CV and have been on basically all the important commissions and working group establishing this field of research around climate change and health. Now, co-chairing the interacademic partnership, he's been working in the Lancet Commission on Planetary Health, working with the WHO as a scientific advisor and also being part of the IPCC assessments. And interestingly, also working directly with patients and people as a primary care physician, and then eventually later in his career developed this field of climate change and health impacts. So, with that, we're very pleased and honoured to have you with us. Andy and Floris, yours. Well, thank you so much for the kind introduction. I hope you can hear me. Good. So, it's a great honour, a pleasure and a privilege for me to give the Gordon Goodman lecture today. In fact, I did share some experience with Gordon Goodman. When I looked at his CV, I found that he'd started his career in South Wales, and as a young doctor, I worked in a coal mining community in South Wales, our next coal mining community. And I really saw at first hand the health effects, both the health effects of mining coal, but also the health effects of abandoning communities once their energy source no longer became essential for society. So, we have to remember when we're transitioning to the zero carbon economy that there are human costs of doing so, and we need to plan that transition in a way which recognises the need for healthy and fulfilling employment and to maintain the social fabric of communities. So, what I'm going to do today is briefly outline the effects of climate change on health. Let's have the first slide, please. And then to say something about the potential actions that we need to take. Now, this first slide will be very familiar to many, many of you. You can see on the left the undoubted fact that human activities have warmed the climate. I don't like the term global warming. I find it too reassuring. If you're going to use the term at all, perhaps global heating is a better term. But climate change also encompasses other changes besides changing temperatures. So, there's no doubt now that there has been an increase in temperature due to the emissions of greenhouse gases from human activities, notably from the burning of fossil fuels. Obviously, carbon dioxide shown in the right side of this slide shows you that the current level is now well over 400 parts per million. And, of course, before human activities had their impact, the levels were much, much lower than that around about under 300 anyway. So, you can see that we're now in a really abnormal and unusual point as a result of these greenhouse gas emissions. So, CO2 stays up in the atmosphere for a long time. So, it's a legacy that we leave future generations, unfortunately, a negative legacy. Next slide. But because it's not just carbon dioxide from the burning of fossil fuels, there are also the short-lived climate pollutants. I think we'll hear a bit more about those also in the Q&A session. There's black carbon, which is a fine particle, which is emitted, for example, from cook stoves, from old diesel engines, and so on. It has a variety of local regional effects. Obviously, when it's deposited on ice and snow, it accelerates the melting of those. Methane, we've already heard about the importance of methane. It's emitted from natural gas, livestock, landfills, rice paddies, and of course, it's a major greenhouse gas on a global scale, and it's increasing in the atmosphere just as CO2 is, and we need to tackle it urgently. Tropospheric ozone is a secondary pollutant formed from complex interactions between methane, carbon monoxide, nitrogen oxides, volatile organic compounds, and it's important because it has adverse effects on human health. And again, we'll explore those more later and also in the Q&A. So these short-lived climate pollutants are also very important, not just from a climate change point of view, but also because of their health implications as well. Hydrofluorocarbons at the bottom, they're human-made. Of course, they are in air-conditioning refrigeration and hopefully will be limited by the new Kikari amendment to the Montreal Protocol. Next slide. So what are the effects of climate change on human health? Well, often they're divided into direct and indirect. There's the direct effects, of course, of extreme heat on human health, which are fairly well understood, but some effects are still emerging and still some work needed to understand them better. There's the effects from disruption of ecosystems, including allergies, food, water, and insect-borne illnesses, and then there are the effects from disruptions in social systems. Reduced crop yield, for example, can push more people into poverty. Reduced ability to work because of extreme heat will likewise push more people back into poverty. There may be increases in conflict as a result of climate change. And of course, we know that the effects are not just physical health, they're also on mental health as well. And there are vulnerable populations. Some populations are more vulnerable than others. Of course, we're all affected in the end and even now, but some populations are more vulnerable than others. Older people, pregnant women, young, very young children, for example, those in certain occupational groups or on low incomes would be other examples. And of course, it's very notable that the GHG emissions, greenhouse gas emissions, the sources are concentrated in high income and increasingly in emerging economies. The impacts are likely to be concentrated in low and middle income countries, but of course, as I've already said, the whole world is being impacted on by climate change and no community can be insulated from the effects of climate change. Next slide. So what sort of evidence do we need in order to take appropriate action to prevent some of these effects of climate change on health? Well, we can perhaps broadly divide them into two broad categories. One is more scientific discovery. And it has to be transdisciplinary because it's very clear that just the narrow public health disciplines of the past will not be sufficient to understand the complex relationships between climate change, the interactions between climate change and other global environmental changes and their impacts on human health. So we need to realise that it's complex. We're dealing with complexity here. We need to think in terms of systems approaches rather than just linear cause and effect relationships. And we need to marshal a whole range of disciplines well beyond the traditional public health discipline. So increasingly, we're working with obviously social sciences, anthropologists, health economists, sociologists, psychologists, but also climate scientists, earth system scientists, soil scientists, agricultural scientists and so on. So it's a different kind of research environment than it was perhaps 10 or 20 years ago. And I think it's a very exciting time actually to see these different scientific disciplines working together and learning of each other. The problem is that the research funders haven't caught up with this. So much of our research funding still comes in little silos linked to particular disciplines, which is not the way we need to tackle some of these complex problems. It's going to be very important to assess tipping points beyond which sudden state shifts can occur, posing risks to health. So for example, if we get melting of ice caps, of course you get rapid increase in sea level, and that will inundate some coastal communities, just one example. But then we need another category of research as well, not just observational research to try and understand these complex changes, but also research to enable to support action and to evaluate actions to make sure that they have the desired impacts. So for example, we need research to help us to get better early warning of impending threats to human health, whether they be heatwaves, disasters, disease outbreaks, or whatever. We also need research to evaluate the effects of adaptation and mitigation actions on health, because they don't always have the desired impacts that we hope they will have. And we need better research to summarize, to give us an overview of progress towards nationally and internationally agreed targets. And this will help to foster greater transparency and accountability, because there's an awful lot of rhetoric out there at the moment of various political leaders talking about what they're going to do, the policies they're going to put in place, but still the actions are lagging far behind what we require in order to keep within the safe limits well under two degrees. And certainly 1.5 degrees is sadly really vanishing from our grasp very rapidly, unfortunately. Next. So one of the potential pieces of evidence that I think is going to be increasingly important is the science of detection and attribution. So rather than just talking generally about the effects of heat on health, for example, as we used to do, we can now speak more confidently about the human influences, the causation of the excessive heat that's impacting on health. So for example, the Siberian event of 2020, the heat and fires in Siberia, the estimates are that would have been a one in 80,000 year event without climate change. And there's a 600 fold increase in the probability of such events as a result of human induced climate change so far. So the science of detection attribution is rapidly advancing. Much of that has been applied to climate events themselves, not very much to health, but that is beginning to change next, please. And this one example of that is this recent paper in Nature Climate Change just a few weeks ago, using data from over 730 sites in 43 countries that by some of my colleagues at London School, but many collaborators around the world. And what they did was to show that more than 30%, in fact, more around about 37% of the total heat deaths over the last few decades could be attributed to human induced climate change. So it didn't just occur as a result of natural fluctuations in climate. They occurred as a result of human induced climate change. But as you can see from the map, the gray areas, there's big gaps in the evidence. So we don't really know what's happening in much of Africa and Asia because we don't have the robust data collection systems to do that research. And that's an urgent research gap, an urgent evidence gap that needs to be filled in. But I think detection and attribution will play an important role in holding decision makers to account. I think it will probably also support a number of legal cases. And it's going to be a really important area of science to watch out for over coming years. We're going to see a lot more events that have had impacts on human health attributed to climate change, human induced climate change with increasing confidence. Next. We're also seeing that climate change doesn't just have an effect on death rates of elderly people. It has effects, for example, on pregnant women. This is some work that's done by Anna Bernel, a PhD student working in West Africa in the Gambia. She's working on studying the extreme heat exposure in pregnant women's subsistence farmers. Now these are low income families. They don't have a choice of whether to work or not when they're pregnant. They have to work in order to support their families. And what's striking about this slide is it shows you the wet bulb globe temperature. And you can see the category, which is the red dots, which is the most extreme category of exposure. You can see that many of these women already are working at levels of heat exposure. If they were, for example, US military, they would be given very strict information and told that they were unable to exercise for much of the time and be given a lot of advice and support about adequate hydration. But these women are working in the open, sometimes in advanced stages of pregnancy, unable to take rest or shade exposed to extremely high levels of heat. And we have some evidence already. It's a small study. So it's a preliminary study showing that this is causing fetal distress and it's probably affecting, almost certainly affecting birth outcomes as well. So that's just one example of a vulnerable group. And the evidence is still accumulating, but I think there's no doubt that we're seeing the effects already and only going to get worse in the future. Next. We know that wildfires are also becoming more common in many parts of the world as a result of climate change. And this slide on the top on the right side, you can see the change in the length of the fire weather season over recent decades as a result of climate change, a recent review summarized some of these impacts. And you can see that the climate change has increasing the length of the fire weather season. Now wildfires have many effects on human health, obviously the direct effects of burning and so on, but also the effects of inhaling smoke. And we're also beginning to understand that these wildfire particles are smaller than those in the particulate matter from urban sources. They have a higher proportion of PMPM 2.5, the smallest particles. They contain more oxidative components that will like to be much more damaging for human health and they can accelerate inflammation in the human body. So we believe that there are pervasive and wide-ranging effects of wildfires, not just on biodiversity and on ecosystems and on greenhouse gas emissions, of course, but also directly on human health, physical effects and mental health effects as well. Next slide. Climate change has some multiplicity effects on infectious diseases and I don't have time to go into all of them. Clearly it has implications for vector-borne diseases, so mosquitoes, ticks and other vectors are likely to transmit diseases more frequently, more intensely in many parts of the world. On food-borne diseases, food poisoning and so on goes up. Sometimes bacterial food poisoning increase with increasing temperatures and, of course, on water-borne diseases through a variety of different pathways. Could be schistosomiasis, could be cholera, could be a range of water-borne diseases that are influenced by climate change. And a wide variety of pathogens have their transmission and ecology affected by climate and we're still understanding, we're still, the understanding is still evolving of these complex relationships. And the right side of the slide summarizes how climate change can affect infectious diseases directly through impacts on the pathogen, disease vectors, but also on the host can reduce host ability to deal with infection, host immunity and so on through changes in nutrition, for example. Next slide. This is just one example, dengue, obviously very, very common vector-borne disease. Climate change is expected to increase the proportion of the global population exposed to dengue from about 35 percent as of a decade or so back to 56 to 60 percent by mid to late century, something of that order, depending on the decisions that we take about greenhouse gas emissions, of course, and the map shows you that expansion. And we're seeing, of course, the dengue vectors already having arrived in southern Europe as a result of a trade in used tyres and now those vectors are they're expanding northwards, so we can expect dengue to expand its range of transmission in Europe. There are many other diseases too, that's Nile virus, a range of others, tick boiling, kephalitis and so on, that are and will increasingly be affected by climate change. So that will pose challenges to disease control systems. Next slide. I mentioned the potential effects of climate change on nutrition and the right side of the slide shows you where climate change is likely to have a negative impact on the productivity of food crops over coming decades. You can see the red area is where crop yields are projected to decline. You can see that the green areas, there may be increases in some temperate regions, but we don't know how long that will last for and we don't know whether populations in low middle income countries will be able to forward to buy food on what will presumably be an increasingly competitive global market. So this indeed poses serious challenges for the future of nutrition, particularly those populations already suffering from under nutrition and on the left you can see a summary of the modelling studies looking at climate change impacts on crop yields which show that within a couple of decades there'll be very clearly negative as we move towards mid-century, then there'll be really substantial reductions of 10% greater than 10% in crop yields. They're really significant reductions in stable crops. It's not just stable crops, it's also fruit and vegetables of course which are also very important for public health. We know that adequate consumption of fruit and vegetables protects us against non-communical diseases like diabetes, like heart disease, stroke and others. Next slide. So this is an example of the effects on vegetables and legumes, a systematic review that my colleagues at the Holland School led by Pauline Schildbeg did some years ago. You can see on balance many of these environmental effects are negative. Carbon dioxide can stimulate the growth of some crops, but it doesn't offset the negative effects of the other global environmental changes, so the effects are still negative and of course as you put more CO2 into the atmosphere it also reduces the nutrient quality of crops, so it reduces the level of micronutrients in many of the stable crops like zinc and iron and already about 2 billion people have micronutrient deficiencies. So it isn't just declining stable crops, it's also fruit and vegetable, but also declining nutritional quality of crops and all of these like to impact on human health. Next. Drought can have complex effects on human health and this is summarized in this slide and they show you how a drought can impact through water shortages, through its effects on livelihoods, through increased food prices and migration displacement of populations, how it can have a range of indirect health effects, not just those related to nutrition but also mental health effects, vector-borne diseases, airborne dust and smoke and of course water-related diseases of course and many other health outcomes also affected. So this is just one example of how extreme events such as droughts can have complex far-reaching effects on human health, physical and mental. Next. And this summarizes the mental health effects of environmental change, this concept of solastalgia, the distress caused by environmental change, some people call it the grief, grief that people experience when their familiar environment changes before their eyes and it's a concept which has to be developed by Glenn Albrecht and his colleagues. It seems to be, it's been described in Australian farmers experiencing drought for example or arctic villagers displaced when their melting ice forces them to move their communities. And many studies have shown an increase in common mental disorders from considerable periods after floods for example, floods, droughts, wildfires and so on. And there also seem to be relations, relationships shown on the slide between temperature changes and suicide rates in some countries. The mechanisms we can discuss it may be due to changes in livelihoods, crop yields and so on but there does seem to be a relationship between temperature and suicide rates in a number of studies. Next. So that's a quick run through of all the effects of climate change and health and it's a rather worrying concerning picture it's only going to get worse of course and these effects many of them will be non-linear so things could get quite suddenly worse. But there's a lot of actions that we can take and so we need to address now the evidence gaps for action. We need to act in two different ways. One is to adapt to climate change which is to manage the climate change that we can't prevent because we're already at 1.1 degrees and we're going to be at 1.5 unfortunately all too soon. So we'll have to adapt and we can adapt up to a point but adaptation will have limits and when we reach the limits of the adaptation things will get worse I fear rather quickly and rather seriously. So adaptation for sure we need to invest in and we need to understand more about but we also need to mitigate so we need to cut emissions very quickly very urgently and we need to integrate mitigation and adaptation as far as possible. The evidence base for some of these actions are still quite weak. A recent systematic review also led by my colleague Pauline Schildbeek of over 1500 papers found only two studies that were ex-anti-formal evaluations of climate change adaptation responses in low middle-income countries. So there may be some activities going on but we still don't know whether these actions have the desired impacts. There are a range of potential strategies that we can take next slide and these include for example community heat action plans which are summarized here from a very recent paper in the last just in the last few weeks which summarizes the kind of actions that we could take to reduce the impact direct effects of extreme heat on human health and what you can see from this summary slide is that these actions include a range of different components obviously health sector leadership but engagement of other partners and other sectors communication to vulnerable groups and to the healthcare sector integrated surveillance in any warning systems heat warnings syndromic surveillance new technologies that may come on stream to help us to withstand extreme heat better community response plan cooling centers for example distribution of clean water and the targeting of vulnerable groups such as the very elderly and the creation of course of climate resilient health systems which have supply chains that can withstand climate shocks but we need to see adaptations beyond the healthcare system itself it has to be intersectoral and in the urban situation you can see three levels of sustainable cooling strategies those involving the landscape and urban planning for example increasing green space in cities those involving buildings using passive ventilation rather than just putting in lots of air conditioning which requires a lot of energy powered by greenhouse gases of course and increases air pollution and increases the urban heat island effect an individual level actions as well which individuals can take in their own homes for example putting shutters on the windows keeping well hydrated and so on so there's a lot that can be done even if the evidence base is still a bit fragmentary about how effective those actions are next we know that water and sanitation this has been mentioned in the introduction is a really key a key sector for adapting to climate change but also mitigating as well because we can reduce for example methane through capturing methane from water treatment plants but this slide just summarizes the water and sanitation resilience under intense on the left side and decreased rainfall on the right you can see under intense rainfall which is going to occur in parts of the world of course something like pittler trains would have low adaptability at high vulnerability under decreased rainfall pittler trains might have lower vulnerability but still high lower adaptability but also low vulnerability so you can see that there will be different effects of on water and sanitation depending on where we are in the world depending whether we're in an area which has extreme intense rainfall or increasing drought one strategy of course is deep wells you can see on the slide now the thing about deep wells it comes quite well quite strongly out of this analysis but the problem with deep wells is in many countries these depend on finite sources of water so they depend on aquifers which are being depleted at a very rapid rate and as we deplete aquifers we have to go deeper and deeper to get the water we suck up more and more toxic compounds like fluorine and so on and that can have adverse of health effects so water sanitation and resilience is crucial to withstand climate change but also to mitigate climate change next slide please so we have a lot of public support for our climate friendly recovery as we come out of covid and you can see that in this opinion poll which was done last year you can see that the majority of the population in most countries support a climate friendly recovery ranging from over 80% in India to 57% in the US unfortunately however the announced stimulus packages stimulus packages amounting to over 17 trillion dollars at least according to a whole range of analyses are likely to have a net negative environmental impact this one's from vivid economics showing that in 15 of the G20 economies the stimulus packages will have a net negative effect on the environment increasing greenhouse gas emissions because they're not being targeted at climate change mitigations so although there's public support policymakers are not really implementing these policies at the right scale next so how can health contribute to transformative action this is a nice illustration from a paper from Eleanor Otto and her colleagues shows you in a diagrammatic way how identifying key tipping points can help us to accelerate rapid social change we believe that emphasizing the opportunities and benefits of change as well as the hazards of not reacting can help to accelerate and increase ambition catalyzing and evaluating the uptake of policies technologies and interventions you can see from the slide it may not be a smooth transition there may be lots of bumps on the road but by in harnessing the health argument that by mitigating climate change and adapting to climate change we can improve human health we believe that that can also accelerate the scale of ambition next let me give you just a few examples one of them is an obvious one if we phase out fossil fuels we not we're not only reduced greenhouse gas emissions we also ever millions of death annually from reduced ambient air pollution a recent estimate suggesting perhaps 3.6 million a year from fossil fuel burning alone so as we move towards a zero carbon economy based on clean renewable energy we reduce greenhouse gas emissions dramatically but we also reduce the health damaging air pollutants that are killing many millions of people around the world right now and those benefits could occur quite rapidly the obviously the benefits of reducing dangerous climate change rolled out over decades and centuries but the benefits of reducing air pollution are really quite rapid over years so that these can reduce the incidence of heart disease stroke and a range of other non-communical diseases you can see from the map that the benefits the dark coloring is over east asia india much of europe and us as well less so over the africa and latin america because on average they burn less fossil fuels next slide please but it also and i want i emphasize this at the beginning it's not just of course the burning of fossil fuels and carbon dioxide it's also reducing the short-lived climate pollutants like black carbon ozone and methane an analysis some years ago at yoan is very very familiar with suggested that perhaps 2.4 million premature deaths could be reduced by 14 strategists that reduce the short-lived climate pollutants particularly through the reduction in black carbon which is a toxic highly damaging pollutant but also as we've heard methane is a precursor for tropospheric ozone and tropospheric ozone is also a pollutant which is dangerous to crops and dangerous to humans so these interventions are also improved crop yields as well as improving human health we can't just add the two together from the two slides that i've shown because there's overlap between the pathways but it does show that many millions of premature deaths could at least in theory be prevented by these clean development strategies as well as taking us onto a much safer climate climate pathway next in cities too there's big opportunities for action and this recent report from the the cdp eclae unified reporting system based on data from over 800 cities around the world showed that about over 60 of cities were implementing climate mitigation actions those cities which reported co-benefits of their mitigation actions whether they be co-benefits on health or other aspects of the economy were more likely to take mitigation actions and they were more likely to take ambitious mitigation actions so there is some evidence some emerging evidence that these co-benefits can help to accelerate ambition and maybe make it an easier sell to the public for decarbonisation strategies in the city context there are a number of approaches that don't have time to go into detail but obviously clean transport systems more sustainable buildings more green space and some would all be parts of such strategies next this is one example our colleagues in basal owner at is global have been reviewing the health benefits of natural spaces on the left you can see the evidence for benefits in the dark letters where there's strong evidence and the gray letter where there's emerging evidence you can see that there's growing evidence around improved life expectancy from exposure to green space better general mental and physical health and possibly benefits in children as well but the evidence is still evolving so what they proposed is this approach of the super blocks approach which is about amalgamating city blocks into very one large block they're not going nine blocks into one block they stop through traffic plant more trees have more green space and make it easier to walk and cycle and they've estimated that if that approach could be scaled up to the city of basal owner then they have benefits from improved physical activity reduced air pollution and perhaps reduce urban heat exposure as well could be really quite substantial so that's just one example of these kind of strategies next but we're also increasingly aware that nature based solutions are important in terms of climate change mitigation they're not an alternative to cutting fossil fuel emissions but they need to be undertaken in addition to these other mitigation actions one estimate suggests that they could provide over one third of the cost effective climate mitigation needed between over the next decade or so and we do know that there are implications of nature based relations for human health forest conservation for example can improve health through decreased malaria transmission reduced air pollution cleaner water for example restoring mangroves and wetlands can protect populations against storm surges can provide nurseries for fish improving nutrition and can improve freshwater quantity and quality and farmer managed natural regeneration also offers a range of potential opportunities for health including reduced disease transmission and improved nutrition but again a very active area for research because not much evidence is available as yet next we also know the food system is a major contributor 30 of the greenhouse gas emissions come from the food system of course a lot of that comes from livestock producing methane but also land use change as well this is a study we did in the UK showing that if we could optimize the UK diet to meet WHO nutritional guidelines we could reduce emissions by nearly 20% and that would increase life expectancy by about eight months or so something of that order as a result of decreased currently heart disease in particular so there are again big win-win opportunities here but of course we need to make these diets affordable many low income countries many low income people cannot necessarily afford to eat a healthy and sustainable diet and next the Eat Lancet Commission is well known I think to many of you next slide and that shows us that really I think a great piece of work shows us really the dramatic health benefits that could accrue from what the commission calls a planetary health diet which again is more fruits and vegetables great reduction in in red meat dairy products more whole grain carbohydrates more nuts and seeds and so on so a healthy diet of this kind could help to keep us within planetary boundaries but also greatly benefit human health many millions of premature deaths about it next and finally optimizing biomass use for for health so biomass is also being promoted for energy and there's a competition between food feed and fuel and so it's going to be really important to optimize the use of biomass to prioritize food first rather than than fuel rather than biomass crops for energy because obviously we have to feed the world population in the first instance when we can do that in a safe and secure way then we can maybe exploit the potential of biomass for biofuels but we have to recognize that in burning biofuels we also create air pollution so there's a trade-off there this is going to be an important balance to get right and research evidence is going to play an important role in that next well the healthcare system of course is increasingly recognizing that we as healthcare professionals are playing an important role in all this not always a virtuous one either because the healthcare system if it was a country would be the fifth largest greenhouse gas emitter on the planet so in trying to treat our patients we're also contributing to climate change and the healthcare system needs to show leadership in reducing emissions NHS England for example has recently committed to net zero by 2040 the right side of the slide shows you the different scope emissions the direct emissions from the national health service facilities indirect from electricity and then the scope three emissions from the supply chains from medical devices the embodied carbon from pharmaceuticals and other products so there's a great deal that can be done both within the healthcare system reduce it to reduce its emissions but also working with the suppliers with procurement of pharmaceuticals medical equipment to decarbonize their supply chains as well and we're going to see increasing action around the world as healthcare systems take the lead in moving towards net zero resilient net zero emission resilient healthcare systems next so in conclusion there are a whole range of pathways to climate action i've emphasized the importance of both adapting to the climate change we cannot prevent mitigating cutting emissions rapidly and integrating adaptation and mitigation as far as is possible there are many pathways by which we can do that policy pathways i mean there's the nationally determined contributions under the paris agreement that governments make under the paris agreement when they agree to cut their greenhouse gas emissions traditionally those haven't said much about health but thanks for the work of WHO and i'm sure maria will mention that in the q and a and the discussion uh WHO is doing great work in supporting countries to make sure that health is given a much higher profile in these nationally determined contributions and the health code benefits of decarbonizing economy is mentioned and used as a rationale for rapid decarbonization as well as the needs to reduce dangerous climate change many countries have national adaptation plans in many cases they don't put enough emphasis on protecting health so there's a real need to strengthen these adaptation plans to ensure that they protect the health particularly if the vulnerable climate finance is often inadequate particularly for the protection of health and there's very little climate finance from for example the green climate fund doesn't really emphasize very much the health benefits of the investments they make nor do they systematically assess the investments they make for the health impacts of the mitigation actions that they're funding there's a lot as i say that can be done through these net zero emission resilient health systems and i think we'll see an increasing number of countries and health professional organizations urging action on this front i mentioned the importance of legislation we've seen over a thousand cases on climate change litigation increasing increasingly our legal colleagues are looking towards the health community to help them with these legal cases to quantify the impacts to make the case that climate change is having effects on health now which will get worse in the future and finally of course we should shouldn't ignore we should work with the subnational players as well city and local government planners and in many cases we're seeing more action at the city level or at the regional level than we are at the national level so we need to work closely with our colleagues public health colleagues but also city leaders around the world to support their activities both to adapt to and to mitigate climate change so last slide in conclusion i hope what i've tried to do really is to illustrate and to really emphasize the importance of urgent action to prevent these dangerous impacts on climate change but to end on a note of optimism because i firmly believe that the solutions are within reach we do know what we have to do in many cases we're not doing it at sufficient speed i think research evidence can help to inform and make sure that we do have the desired beneficial effects of policies they can help to support legal cases they can help to support the kind of urgent policy action that we all want to see and of course COP26 in Glasgow will really be an opportunity to showcase the importance of health although it's not an official theme it will underpin and cut across many of the themes that we're going to be hearing about in Glasgow and of course following that COP27 in Africa where we hope there'll be an even greater emphasis on health so i'll stop there because i know we've got some great panellists coming up and hand over to them thank you very much for giving me the opportunity to speak to you today thank you thank you very much andi i wish we could give you an applause but with technology and interacting in this way it's not possible but you shared really with us what are the key challenges that we are facing what can we do but also some reflections about what our potential the impact both positive and negative impact of also some of those actions there is a question to you andi from the audience about what actually authorities both at the national and local level how they can access the technical guidance in terms of what to do both in terms of where they face more concrete threats from changes in climate that have an impact on people's health we are a bit too short of time supposedly if you could just follow up on that questions as we are speaking because i would like to move now into both engaging the full audience with some q and a sense a mentimeter question but also getting to the panel my name is Anders Nordstrom i'm the swedish ambassador for global health right now i've been on a leave now for a year and i've been heading the secretariat for the independent panel on prepare pandemic preparedness and response chaired by presidents early for helen clock and i won't go into that now but it's crystal clear that this crisis that we are facing right now is not just about the virus and the solution is not just about the vaccine this crisis has really disclosed that what we have in societies is a lack of resilience i think what we will hear we will hear the world resilience many times and i think what we are seeing now is again is not just about an infectious diseases it's about how people and societies have not been able to cope with that and i think the world for that is about resilience and sustainability so with those few words i would like then to pull in the audience please use the chat if you have some specific questions directed to some of the panelists that i will introduce in a second or just to interact with each other the panel that you will now have a possibility to listen to it's a great group of people we have maria naira a colleague and friend from WHO she's the director for public health and environment at WHO in Geneva we will have andi coming back we also have omnia omnari who is coming from msf the international federation of medical students association very good to see you we have sarah dickens from the stock and environment institute who is leading on sanitation issues there then we have brahna khanom who is an associate professor from cote voe with us from africa directly and finally joan kylen kjärna who is the research lead at the stock and environment institute before we move into listening to them they will be giving three minutes each to provide some reflections of what they heard from andi and then we will have some questions to them i would like to ask you to pose the questions to all of you and if you can then use what is called the many many many many meter i think all of you are quite used to that now after quite a few video conferences and zoom seminars so if we can have that instruction and question on the screen please yes so you use the mentor so you go to um on to that address w w do menti dot com you will find this in the chat as well and the code for this question is as you can read here and again you'll find that in the chat where you can use the the code here so the question is then what do you think is the most important climate related factor that will have an impact on human health and you will have a number of options and the options are coming here and you need to pick just one so we'll see where you why people feel that will have most of an impact on people's health can we have the options for the answers please no such a slide okay so i will then give the options okay so the options are um weather related conditions is that what is mostly impacting people's health changes in weather is it air pollution is it infectious diseases as we see right now is it food and food security that are mainly impacting people's health that are coming sort of from the negative climate impact or is it access to clean drinking water now we got them there please put your vote in and we look at the answer at the end of this seminar with those few words i would like to invite maria to provide your um introduction sort of comments on what you heard from andro and some key messages from you and maria over to you please thank you thank you very much Anders and Bravo and the brilliant and articulate and very well as social so a pleasure to to work with you to hear from you and a pleasure to see as well this very holistic presentation quick reaction since we have very little time one uh i see all the time when you were talking a kind of balance and i was putting myself the weight in one side or another side of the balance first the first unbalance is about the sources of emissions that's your right to present it versus the other part of the balance those who will suffer the impact i think this inequity factor is fundamental on your presentation and i think it should even motivate more action the other unbalance i see and i hope that we will be able to put that right soon is that the weight of the scientific evidence that is getting really now i mean never at the level we would like to see that the scientific evidence but we have a very strong weight of scientific evidence and the little action in the other part of the balance so i hope we will be able to moderate that and soon accelerate another thing i would like to react is you mentioned the complexity of this issue how many science different sectors and then parts of our knowledge as human beings needs to contribute to that but i see as well on this new public health approach new global public health the role of the health professionals at large the public health professionals is changing now a public health professional cannot use epidemiology cannot just give data cannot just make a very technical good presentation is a person that needs to be able to influence the energy sector is a person that needs to try to convince others that we need to stop the use of fossil fuels because this is bad for health and this might represent a revolution on the way the public health community will be now influencing all all of these chains that we need and we need to all be prepared for that role because clearly although this is a very complex issue if we summarize if we put the focus on health if we use this particularly sensitive moment where everybody's dealing with the pandemic and feel very much exposed and vulnerable they want to reduce that vulnerability to their health and i'm sure that we might be able to attract them to understand that if you tackle the causes of climate change what you are doing above everything or as a most important thing is to generate public health enormous public health benefits on the action and you you you summarize this extremely well and of course for WHO this is where we want to put now all the weight on this balance for us to accelerate now we need to make sure that the health argument is very well understood by everyone and we will be able hopefully at the COP to present this report that will be called the health argument for for for climate action where we will refocus around the lungs of the people the brain of the people the the cardiovascular system of the people hoping that this will motivate more action and ambition for those transitions that we need to do i think we need to lead several transitions obviously the energy transition you mentioned the issue of air pollution caused by the type of fossil fuels we are using or other type of pollution that we are generating the urban health transition how we need to change our cities this is a critical transition we need to ensure and obviously the food system transition that we need to try to lead and the public health community at large will be forced somehow and will be engaged in taking such an incredible leadership and of course Maria Maria Maria thank thank you just so that we stick to the timing and also that we can allow sure so that everybody can come in but i had a question to you about the trends and as you say that of course you're representing double air show and what we see from double air show now in the media basically every day it's about the virus it's about how do we increase coverage for vaccination how can we ensure that the words also get the message including from double air show that this crisis is not only about the virus and the need for a vaccine it's crystal clear for all of us here but what can we do collectively to ensure that we are not missing what are really the biggest issues here you are absolutely right we need to insist on the preparedness and response but we need to go as well at the sources of this vulnerability and then what it makes us so vulnerable vis-à-vis climate change or the next crisis whatever it will be what can we do have a look at the manifesto for a healthy and green recovery last year already in the most critical moment of the pandemic we issue those six prescriptions with no regrets investments because we are talking about water sanitation agricultural practices energy transition stop destroying ecosystems and stop giving fossil fuel subsidies I mean subsidies to fossil fuels so I will invite everyone to look at those prescriptions look at the companion of environmental interventions that we just the issue as well 500 actions all of them are common sense pragmatic non-regrets investments and will generate the basis for a better public health and reducing the vulnerability that will better prepare us or make us more resilient for a next pandemic or a next crisis whatever the crisis is coming from so fully agree with you very very very good very good so I'm looking forward to see you Maria sitting next to Tedros instead of Mike Brian at the next press conference talking about this excellent we're looking forward to that let us now move to Omni please very pleased to have you here I had the background in high FMSA myself very many years ago so delighted to see you with us here today so what are your reflections on what you heard from Andy yes so thank you so much for having me to begin with the friend my own personal reflections would be two questions the first question I ask myself am I as a young medical doctor prepared to face the implications that Andy has mentioned am I prepared to treat a patient who would present with an asthma due to air pollution would present with malnourishment because of the increasing food insecurity or echo anxiety because of the climate crisis the answer that comes to my mind is no the second question I have is what can I do about it and this is what FMC has been giving me as a young member there part of a network that represents over 1.3 many medical students what we do is we advocate and we educate we have the opportunity to look at our education as medical students we have just recently launched an online course that focuses on climate change and nutrition having over 1200 medical students participate in that and for them to understand their role in advocating for climate change and for sustainable food patterns and dietary change at the same time we advocate we have been doing that for more than 10 years by attending every year the climate change conference with the delegation of medical students advocating both with WHO with the health community but also with our own country delegates highlighting the importance of placing human health at the heart of the climate negotiations and discussions but our actions go beyond that we advocate on a global level but we also advocate on a national and a country level by building the awareness of our own communities by doing our own capacity building within the communities within our students but also addressing our national leaders to take action and I've seen that in by many students through our network and through our map of activities where students either do their own advocacy where they do their own awareness where they simply do activities like planting trees to see to acknowledge that as students coming from a health background we are also concerned about the health of our environment as being the most impacted by working with youth from different disciplines and this brings us to the importance of looking at planetary health as a whole and then finally we're also looking at our education that comes to our own curriculum so we do online courses for students on the side but also looking at the education and the importance of integrating climate change in our own curriculum we saw that less than 12 percent had a mention of that and we're changing this by creating a climate change curriculum that addresses both how as students we can advocate within our own clinical practice but also how we can advocate within our own with our own national leaders thank you very impressive and very encouraged to listen to what you are doing with a lot of passion excellent I mean the climate issues but also the health issues are really about in some way the future and it's also an issue in terms of how we work across generations if I may say so and Andy and myself we are at one end of that spectrum and you are at the other end do you have any concrete suggestions how we can work more across generations because you work a lot with young people and unfortunately I work mostly with older people how can we make this something that we do jointly because this is really about your future and we're all keen to do something better for the future for you yes I think I have two concrete suggestions the first one is for young people as well as for leaders is to always look for creating an intergenerational dialogue whenever there is an issue we're talking about climate change which is an issue that's an intergenerational equity issue it's a social justice issue and at the same time having a dialogue between young people and ministers for example in a way that is not just a one-time event but more of a sustainable mechanism for young people to be continuously involved we don't want to just be there attending we want to be co-creating solutions and this is for example what we have been doing with WHO as I from say we are part of the WHO civil society waking group as a young member and we're able to voice our opinions and share with them and look at the solutions that are being changed this is done on a global level but it needs to be done on a country level as young people we can be proactive and we have to be persistent when it comes to our demands and we can do that by having these dialogues these conversations and these conversations they must have an outcome an outcome that can be implemented that can be monitored and asked for the transparency when it comes to its implementation very good so intergenerational dialogues and not just as a one-off and with concrete outcomes excellent thank you so much should we then move to sarah you are leading on issues around sanitation at the stock and environment institute hope it's you sarah your reflections on what you heard from Andy great thank you I hope you can hear me so I first want to thank you for the insightful lecture and there are two points that I wanted to reflect on today the first is to emphasize the message that we heard from Andy and also Maria about the fact that the health impacts of climate change are very uneven and they disproportionately affect certain groups we heard a bit today about the biological vulnerabilities but I also want to touch on some of the the social vulnerabilities behind this and in connection to that I also want to touch on ways we can better track monitor and track who is being left behind so that we can actually target those groups and I was happy to hear some examples on water and sanitation and I will touch on those as well so we didn't hear so much today but climate change has many gendered health impacts and it's important to note that these are driven by systemic and structural inequalities and they can often intersect with other types of exclusions or marginalizations this could be due to race class class ethnicity disability and so on depending on the context and in my own research I work on water and sanitation so we see that in many countries women have the unfair burden of collecting water and this is worsens during periods of droughts with warming temperatures with variability where we don't know if there's going to be enough water and so you can't plan your time as well as when there's poor quality water and these are all exacerbated by climate change and this is just one example there are many gender disparities related to climate change but I think there's been less effort put into actually tracking this so there aren't that many gender specific indicators to track the uneven impacts of climate change so it's not enough to just describe these as challenges and recognize them I think that this has been actually pretty clear through the COVID-19 pandemic the importance of understanding the gendered impacts both the direct and indirect has actually come up quite often but in terms of how we're tracking climate change I think there's quite a lot of gender blindness in terms of the impacts as well as tracking what kind of solutions work or don't work so one example is actually the lands at countdown many of you have probably heard of this it's a major initiative to track progress on climate change and health and they have a number of indicators around 40 indicators on climate change and health but we see that these aren't actually disaggregated for example by sex or they're not specific to gender so they deal with issues on a very coarse level and I think it's important to have this information disaggregated so that we can really understand the differential impacts of climate change. Sarah can I just ask one very specific question now I mean we I think we all recognize the importance of inequalities and that those needs to be addressed but also these are big political issues how to really just make structure changes in societies but if you look at now the climate crisis and in some way the health crisis that we're living now do you see any specific opportunities really also to get in some way the political attention on the inequalities and to deal with them in order to really to get that impact can you say something concretely what do you see any opportunities for that right now? Yeah so I guess that that really comes to the point that I'm trying to make that we we do really need good data and evidence on this to make it clear because before we can motivate action on that topic we need we need to be able to show who is being most left behind and really put that black and white onto paper because things that aren't properly measured we can't manage them and so we really need evidence-based approaches. Okay very good and I think let's thank you very much Sarah let's then move to Brahma because I think this is something that is of great interest for you as well as far as I understood that data access to data lack of data and then specifically then when it comes to the African continent but Brahma some more general reflections on what you heard from Andy as well please first. Great thank you so much thank you to Andy for this great presentation and I saw to a garden lecture team for inviting me. What I may emphasize on based on Andy's presentation and what I heard from his presentation is that to build good adaptation and mitigation strategies we need strong scientific evidence and those strong scientific evidence of course are based on good science but not whatever good science. The challenge is that to build those strong evidence for adaptation and mitigation we need to work with transdisciplinarity we need to work with multidisciplinarity and we need to use that in a context of institutionalized disciplinary training and capacity building at our universities mainly in developing countries and I will even say in all other universities we grow in a disciplinary training and capacity building process and we are now facing complex situations that need transdisciplinary methodologies and I will say that methodologies like ecosystem approach to health and one health approach is need to be emphasizes in our universities and in our training institutions to face the complexity of socio-ecological system in which climate whether human and diseases are connected and are interacting and I think some examples are around the world we just need to build on those ones do the HOTDR program actually is coordinating a training on one health that can be a usual to follow up and to encourage. Canadian RDRC has been working for decades on the eco health methodology that are also processed we need to learn on and to see how we can encourage a follow-up and how we can continue working with such methodologies because they can help focus they can help better understand the complex socio-ecological system we are facing in tackling climate change and health problems. Thank you very much Rama Sarah was already pointing to that we lack gender desegregated data on the climate side but from your perspective you might agree with her on that but are there any specific pieces of information data where you feel that we have big gaps today because we have a lot of data but I mean from your you as a researcher what would you prioritize in terms of getting more information about? Yeah thank you so much I think the issue of data availability is the second issue I want to stress on for building strong scientific evidence if you want to make a good science you need good data but unfortunately the data mainly in developing countries have been missing so far good climate and weather data have been missing so far but in the last decade we got a quite used improvement for weather and climate data by using satellite reanalysis data unfortunately the challenge remains for health data how to get good health data mainly in developing countries when the data are existing how to access freely those data for research purpose this is I think a huge challenge we need to tackle we need to face and luckily we are not starting everything at zero we have pioneers the institute of health metrics and evaluation at the University of Washington for example with the global health data exchange catalog this is a kind of fantastic opportunity we need to emphasize on to learn from and to see how we can improve such opportunities how we can implement such opportunities in other contexts with other institutions and mainly for developing less developed countries researchers in order for them to get good data for good science thank you very much brahman I also have been asked to ask or let don laura hammer the president of the royal academy of science to provide the comments but I would do that they at the very end together with ossa perfect so thank you very much brahman you also now have joan your reflections on what you heard from andy this is something that I think is quite familiar to you and you've heard andy speaking about those issues before but some reflections from your side what you heard key message or something new that you heard that you like to point to uh and to share with all of us joan please you're still muted let's see whether you can come back in in in a second and try to reconnect and I will see whether you can come back in I have also a question then as I said andy would be part of this uh this discussion as well so andy if you would like to come back in I want to ask you to comment on your own presentation I don't think that would be appropriate but rather a question to you then um if you look ahead now six months there's a lot that is going to happen it's going to be the cop yes but there are other events and major political meetings or scientific gatherings etc where are the priorities I mean you have a now we have more than 300 people here in the audience where should we focus what can we actually do what would you like to see us to do now during the next six months andy well well thanks yes of course that's that's a very big question and we have as you say a number of opportunities we have the world's focus will be on climate change with cop26 and we really have to try and capitalize that on that not just really to get more fine statements from political leaders but really to put in place better systems to monitor and assess whether the changes are in fact being achieved because what concerns me at the moment is not just kind of climate change denial and people saying they don't want to do anything but also we are seeing quite a lot of statements about aspirations to cut greenhouse gas emissions but is that really being followed by action and this often the case is often the answer to that is not sufficient action so I think we need to build systems of accountability in terms of the opportunities we have over coming months we have in addition to cop we have of course the g20 the g20 meeting we have the planning for cop 27 in Africa which I think we should think about even now because I think there's opportunities particularly because of the concerns in Africa around climate change adaptation resilience inadequate funding to really raise the issues of ensuring that high income countries actually live up to their commitments that they there are commitments for a hundred billion dollars as you may remember on an annual basis for climate funding is that really coming through I don't think so and if it is it's probably not being spent adequately so I think we need to raise issues of accountability we need to raise issues of better data and monitoring of impact so we can get beyond the kind of rhetoric the green rhetoric that we often see from our political leaders and the health community itself I think has big opportunities over coming months omnia Maria summarize some of those but I think increasingly we'd like to see major world world conferences on health issues should be foreground in climate change and they should be integrating climate change into their activities and we should ensure that all health care systems have the same objective of moving towards net zero emissions resilient climate resilient health systems within the next few decades so there's a lot the health care sector can do I think to advance this agenda thank you thank you very much I don't know whether you want us yeah yes I'm working great please come in but time is short just sort of two three minutes just comments from you okay so I really want to say that I really enjoyed Andy's lecture and it's quite clear from that there is no aspect of our lives that will not be impacted by climate change or the measures that we need to address it but it also means though that there are multiple benefits that can be realized through the transformations that we need and the measures that are needed to be implemented that will reduce the emissions so Andy has provided a very nice framework to be able to assess the health benefits I think is vital that all countries take a more integrated approach and be in a position to themselves quantify or at least list the different benefits of taking action and importantly describe a positive future development that limits climate change so it's not only related to the fact that there are measures or policies reducing CO2 and other GHG emissions and not only how these measures may reduce air pollution but the benefits that they can have on other development priorities including the ways by which health and well-being food supply and security can be enhanced and and how the policies affect jobs so we have a clear link between fossil fuels and air pollution and of course with the greenhouse gases. The third of all deaths from air pollution are associated with fossil fuels about a million premature deaths a year from fossil fuels related to air pollution so as Andy has said clearly a shift away from fossil fuels will improve air pollution and climate change and shifting away to renewable energy will have huge benefits but we also have a recent report involving Nicholas Stern showing that three times as many jobs can be developed by having by by building new renewable energy infrastructure rather than fossil based infrastructure so and if we take another example of electric mobility if it's fueled by this renewable renewable electricity then of course it will create jobs addressing both climate change and air pollution but but just doing that won't address congestion or traffic accidents but promoting walking and cycling as Andy also mentioned will reduce these emissions and impacts but also reduce congestionally to a health population so essentially planners need the tools that can be used to assess and quantify the effects of different strategies and identify the multiple benefits of the different policy options and increase policy coherence and help drive ambition but I don't know Anders if if I have a chance to say something about methane. I don't think so unfortunately Johan we're coming it's coming close to the end and we're both going to go back to the mentimeter and I have a couple of questions from the audience and I would just like to get three of you to give a one-minute answer to three questions. The first question is about what can we do in terms of training citizens about how to deal with heat waves and do we need to redesign our infrastructure because of what we see now in terms of a warmer if not say hotter climate. The second question is around the vulnerable groups people that are specifically at risk what can we do to reach them and the final question is there really is there a link why we have COVID-19 today that we can go back to climate change and explain that question goes to Andy at the end but the first question then do we need to do more training of people to deal with heat waves and also redesign infrastructure do we still have Maria with us because I'd like you to give a one-minute answer to that question and the next question then to Sarah. Yes I'm here I'm here. So Maria training for people on heat waves to deal with them and do we need to redesign infrastructure because of we have a warmer climate now. So the question is I think we have a very good recommendations for how our health system can be more resilient more adaptable to adapted to climate change impacts and I would recommend everyone to have a look at that and to start to incorporate it on your interventions. This was a much more practical question in terms of do we actually now investing training of people of citizens in terms of how do you deal with increased temperature when we have warmer weather and the same thing do we need different kinds of infrastructure to deal with this in terms of transport etc and I suppose your answer will be yes we need to do that. Sarah what specific vulnerable group people have been asking also about I suppose the answer is that yes we need to reach them do you have any reflection in terms of how we can do that? Well that's a pretty big question so I won't get into all of it but maybe I'll just focus on sanitation because this isn't something that most people think of when they think of climate change. So people who don't have sanitation are often also the most vulnerable groups and this could be people in very rural areas people experiencing homelessness the poorest groups but I think sanitation is a good example where there's many co-benefits so we can address gender inequalities other types of marginalizations but we can also with safely manage sanitation systems reduce methane emissions from anaerobic processes in poorly managed pit latrines for example we can protect the environment from contamination and also protect from spread of disease that's also exacerbated by warmer temperatures so I think that's a good example of addressing vulnerable groups with the solution very good very good and Andy then the question about do we have COVID because of the changes we have seen in climate during the last last post decades? Well a simple answer would be I don't think climate change is causing COVID-19 but of course zoonotic infections of which COVID is one are related to interactions between domestic animals, wild animals and humans so any activity which increases those interactions will increase the probability of transmission there are many other changes occurring in the world changes in land use for example changes in food systems farming practices and that's why we use this broader framing of planetary health and for those of you who are interested I'll just push the book we launched yesterday on planetary health which tries to describe some of the interactions between these various environmental changes and human health and one of those of course is zoonotic diseases so it's an important lesson to us as a kind of disease that will probably get more frequent and there are important implications as we emerge from COVID whether we merge from it on a high emission or high greenhouse gas emission trajectory or a low greenhouse gas emission trajectory at the moment unfortunately going in the wrong direction. Thank you I mean if you have a more of interest in that very specific topic on the 27th of September the Swedish Minister for International Development Corporation will be in a debate about the importance of folk biodiversity and if we invest more in that can we then prevent more zoonotic diseases in the future or not that will be a debate in the afternoon of the 27th of September so I would like to thank you all short sharp thank you very much we will look at the answers to the question do we have that on the screen for everyone Jan it's there thank you very much and as expected possibly or not quite diverse views some people believe that drinking water is the most important other that the weather is the most important factor that will have an impact on people's health food security, air pollution less on infectious diseases interesting I suppose the bottom line here is that all of those factors matters and when we think about how climate is actually impacting people's health we need to think about a broader sort of approach to this before giving now the word then back to Osa and to Don who should be giving one or two minutes to Osa before we conclude I would just like to say from my side that very interesting I think we have a huge task in front of us we have big challenges not just with the virus that we are facing right now but with the bigger agenda about how can we improve people's health and the planet's health and we have heard a lot about the challenges here but I've got one big message is that look for the positive impact look for the possible the positive possibilities what is good for people's health is also good for the planet and the other way around and those are not negative aspects in terms of how your life will become worse the contrary if you do if you make choices and if the society is enabling you to make those choices to have cleaner air to have better food to have more active transportation instead of using the cars etc etc I mean this is something that is positive for you as a human being and it will have huge impact also on our climate in the long run so those positive co-benefits and something which has not been mentioned here today it's really not the the concrete direct impact of the warmer weather etc but it's on the non-communal diseases what is killing people today are what is called non-communal diseases heart diseases cancers strokes etc 40 million people are dying every year 40 million 15 million before the age of 70 premature mortality those people should not die 15 million compared to four millions now of covid we could save lives and the planet at the same time those are the co-benefits that I think we should focus much more on and recovery good that people prioritize that it should be green but it should be healthy as well also and don over to you also you decide if you go first thank you very much thank you so very much Anders and all the panelists let me see if Don is with us now and want to make a comment yes can you hear me we can all right well first of all thank you very much sir Andrew for a fantastic lecture an excellent overview and also thanks to you Anders for leading the discussion in such a vivid way and I must apologize that I wasn't able to connect right from the start because Microsoft Teams was not on speaking terms with my laptop and when I realized that for the fifth time I am sure you are all very happy that you could not hear me speak at the very end I think it would be appropriate to say a few words about Gordon Goodman who we acknowledge today Gordon Goodman was a Welsh ecologist he was born in 1926 and he worked for many years in Swansea and then moved to London in the mid 1970s and that's where he wrote a document for an international network of scientists and this document made political leaders think globally about environment Goodman got to visit Sweden a few times and when the Bayer Institute was formed here in 1977 at the Royal Swedish Academy of Sciences he became the Institute's founding director the Institute focused on energy systems and human ecology and was supported by the Shell and Matta Bayer Foundation a few years later a Gordon Goodman was elected a foreign member of the Swedish Academy of Sciences in the mid 1980s he and professor Bert Brolin also an academy member by the way initiated the IPCC that was officially formed in 1988 with Brolin as the precedent for the first 10 years and in 89 the Swedish government set up the Stockholm Environment Institute and Gordon Goodman became its first director and servant until the year after focusing on sustainable agriculture biotechnology and many other factors and after retirement he moved back to England and he passed away in 2008 incidentally just a few months after Bert Brolin passed away so let me end by saying that the Academy of Sciences here in Sweden has a strong and deep interest in global sustainability it would have been wonderful to welcome you to our building and our newly designed lecture hall but you all know why this could not be so I hope to see you here next year instead and now I will look forward to watching and this lecture once again in peace and quiet and soak it all in thank you very much thank you very much Don and we look forward to rejoining physically hopefully next year or hybrid shall I say to continue have this virtual participation from colleagues around the world I just wanted to end with a few takeaways from my side it's been a complete pleasure to listen to you but as always we feel that we are just scratching the surface and we want to continue the conversation but I think as a research director I always try to listen in on what are the evidence gaps what gaps can we as scientists help fill and you did mention a few there about gendered impacts for example mourning for multidisciplinary work mourning for data particularly in lower income settings however I think we also heard from Andy that there is evidence abundance so the question is really why is that evidence not really translating into action and I think a real wake-up call there was what we heard that scientific evidence is now being used as legal evidence that really says something about what kind of society we are moving into unless we take more preventative action it was also really interesting to hear from Omnia El Omrani also having a voice and a face of these future professionals who are going to work in the climate changed world basically and who will have to deal with it so thank you particularly for joining us today and I think some of these insights we can also take with us as SCI starting to prepare for Stockholm plus 50 so next year we will commemorate the first UN conference on the human dimensions of the environment there will be a UN meeting in June and I think some of the things you said there are really important for making that not just a sort of commemoration but really the first day of the next 50 years where evidence needs to translate much faster into action we heard about the need for greater accountability more tracking and also providing this positive future which I think where I think science can also contribute a lot what are the contours of that kind of positive future so with us I want to thank you all again warmly Professor Andy Hayes all the panelists our excellent moderator and the organizing team of course and everyone listening in today so thank you and Arrivederci