Time to treat the climate and nature crisis as one indivisible global health emergency

Over 200 health journals call on the United Nations, politi- cal leaders, and health professionals to recognize that climate change and biodiversity loss are one indivisible crisis and must be tackled together to preserve health and avoid catastrophe. This overall environmental crisis is now so severe as to be a global health emergency. The world is currently responding to the climate crisis and the nature crisis as if they were separate challenges. This is a dangerous mistake. The 28th Conference of Parties (COP) on climate change is about to be held in Dubai while the 16th COP on biodiversity is due to be held in Turkey in 2024. Read more in the PDF.

unfortunately largely separate, but they were brought together for a workshop in 2020 when they concluded that "Only by considering climate and biodiversity as parts of the same complex problem…can solutions be developed that avoid maladaptation and maximize the beneficial outcomes." 1 As the health world has recognized with the development of the concept of planetary health, the natural world is made up of one overall interdependent system.Damage to one subsystem can create feedback that damages another-for example, drought, wildfires, floods, and the other effects of rising global temperatures destroy plant life and lead to soil erosion and so inhibit carbon storage, which means more global warming. 2 Climate change is set to overtake deforestation and other land-use change as the primary driver of nature loss. 3ture has a remarkable power to restore.For example, deforested land can revert to forest through natural regeneration, and marine phytoplankton, which act as natural carbon stores, turn over 1 billion tons of photosynthesizing biomass every 8 days. 4Indigenous land and sea management has a particularly important role to play in regeneration and continuing care. 5storing one subsystem can help another-for example, replenishing soil could help remove greenhouse gases from the atmosphere on a vast scale. 6But actions that may benefit one subsystem can harm another-for example, planting forests with one type of tree can remove carbon dioxide from the air but can damage the biodiversity that is fundamental to healthy ecosystems. 7

The Impacts on Health
Human health is damaged directly by both the climate crisis, as the journals have described in previous editorials, 8,9 and by the nature crisis. 10This 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. 11"Without nature, we have nothing," was UN Secretary-General António Guterres' blunt summary at the biodiversity COP in Montreal last year. 12Even 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 water-borne diseases. 13Contamination of water on land can also have far-reaching effects on distant ecosystems when that water runs off into the ocean. 14Good 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. 15Declines in wildlife are a major challenge for these populations, particularly in low-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. 16anges 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. 17People losing contact with the natural environment and the declining loss in biodiversity have both been linked to increases in noncommunicable, autoimmune, and inflammatory diseases and metabolic, allergic, and neuropsychiatric disorders. 10,18For Indigenous people, caring for and connecting with nature is especially important for their health. 19Nature 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. 20nnection with nature reduces stress, loneliness, and depression while promoting social interaction. 21These benefits are threatened by the continuing rise in urbanization. 22nally, 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. 10Linked to this, inequality is also arguably fueling these environmental crises.
Environmental challenges and social/health inequities are challenges that share drivers and there are potential co-benefits of addressing them. 10

A Global Health Emergency
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. 23Industrialized countries agreed to mobilize $30 billion per year to support developing nations to do so. 23These 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. 2,24If these events were to occur, the impacts on health would be globally catastrophic.

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Author affiliations and article information are listed at the end of this article.OpenAccess.This is an open access article distributed under the terms of the CC-BY License.JAMA Network Open.2023;6(10):e2344081. doi:10.1001/jamanetworkopen.2023.44081(Reprinted) October 25, 2023 1/Downloaded From: https://jamanetwork.com/ on 10/29/2023 1his risk, combined with the severe impacts on health already occurring, means that the World Health Organization should declare the indivisible climate and nature crisis as a global health emergency.The 3 preconditions for WHO to declare a situation to be a Public Health Emergency of 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."1All 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 recognize both the severe threats toJAMA Network Open | EditorialTreating Climate and Nature Crisis as a Global Health Emergency JAMA Network Open.2023;6(10):e2344081. doi:10.1001/jamanetworkopen.2023.44081(Reprinted) October 25, 2023 2/4