Exiting the Paris climate accord: Trump administration misses the rising tide
Authors: Shilu Tong, Kristie Ebi, Jørn Olsen
Journal: The Lancet Planetary Health (2017)

On June 1, 2017, US President Donald Trump announced that he had decided to withdraw his country from the 2015 Paris climate accord.1Tollefson J Trump pulls United States out of Paris climate agreement.Nature. 2017; 546: 198Crossref PubMed Scopus (16) Google Scholar The central aim of the Paris Agreement is to keep any global temperature rise this century well below 2°C above preindustrial levels.2UN Framework Convention on Climate ChangeThe Paris Agreement.http://unfccc.int/paris_agreement/items/9485.phpGoogle Scholar The international community is concerned that an eventual US withdrawal from the Paris accord, if it happens, will hurt international collaborative efforts to avoid dangerous climate change. Not only would exiting the Paris climate accord harm human and planetary health, but also the Trump administration will miss the rising tide of innovation and transformation of the next industrial revolution—renewable energy and zero-emission vehicles are among the best economic opportunities of our time. The good news from the USA is that several states (eg, California and Washington), cities, and companies are moving ahead with development and deployment of mitigation technology, incentivised by emission reduction goals and by commitment to moving towards sustainability. Further efforts could be made, including targeting of zero emission goals to take into account that the world will continue to warm for decades once carbon emissions stop; development of institutional support for work across government agencies (eg, public health, urban planning, transport, education and tourism), given that risks posed by climate change cut across sectors and regions; increasing of investment in research and technology development (eg, early warning and response systems for extreme weather events); and testing the efficacy and efficiency of implemented policies and programmes, to provide the evidence base for informed policy making. One motivation for these efforts is to promote and protect population health from the increasing risks of a changing climate. Weather and climate are negatively affecting population health at a global scale, with risks projected to increase with additional climate change.3IPCCClimate change 2014 synthesis report—summary for policymakers. Cambridge University Press, Cambridge, UK, and New York, NY2014Google Scholar, 4Patz JA Frumkin H Holloway T Vimont DJ Haines A Climate change: challenges and opportunities for global health.JAMA. 2014; 312: 1565-1580Crossref PubMed Scopus (281) Google Scholar, 5McMichael AJ Globalization, climate change, and human health.N Engl J Med. 2013; 368: 1335-1343Crossref PubMed Scopus (328) Google Scholar, 6Watts N Adger WN Agnolucci P et al.Health and climate change: policy responses to protect public health.Lancet. 2015; 386: 1861-1914Summary Full Text Full Text PDF PubMed Scopus (1017) Google Scholar Anthropogenic greenhouse gases emissions are primarily driven by population size, economic activity, lifestyle, energy use, land use patterns, technology, and climate policy. Cumulative greenhouse gases emissions will largely determine global mean surface warming by the late 21st century and beyond. Scientific evidence for human-induced global warming is convincing. The fifth assessment report of the Intergovernmental Panel on Climate Change concluded that average temperatures are rising, precipitation patterns are changing, ice sheets are melting, sea levels are rising, and ocean acidification is worsening.3IPCCClimate change 2014 synthesis report—summary for policymakers. Cambridge University Press, Cambridge, UK, and New York, NY2014Google Scholar These changes are affecting the availability and quality of water supplies, how and where food is grown, and even all the components of ecosystems. Additional climate change is expected to increase the likelihood of extreme weather events such as heatwaves, droughts, floods, and bushfires.3IPCCClimate change 2014 synthesis report—summary for policymakers. Cambridge University Press, Cambridge, UK, and New York, NY2014Google Scholar, 4Patz JA Frumkin H Holloway T Vimont DJ Haines A Climate change: challenges and opportunities for global health.JAMA. 2014; 312: 1565-1580Crossref PubMed Scopus (281) Google Scholar, 5McMichael AJ Globalization, climate change, and human health.N Engl J Med. 2013; 368: 1335-1343Crossref PubMed Scopus (328) Google Scholar, 6Watts N Adger WN Agnolucci P et al.Health and climate change: policy responses to protect public health.Lancet. 2015; 386: 1861-1914Summary Full Text Full Text PDF PubMed Scopus (1017) Google Scholar All of these events can have devastating health effects. Health effects arise from increases in heat-related mortality, infectious diseases, aeroallegens, air pollution, limited food and water supplies, mental illnesses related to floods and droughts, human and property losses caused by bushfires, and conflict and migration.7Guo Y Gasparrini A Armstrong B et al.Heatwave and mortality: a multi-country multi-community study.Environ Health Perspect. 2017; (published online Aug 14.)DOI:10.1289/EHP1026Crossref Scopus (229) Google Scholar, 8Tong S Confalonieri U Ebi K Olsen J Managing and mitigating the health risks of climate change: calling for evidence-informed policy and action.Environ Health Perspect. 2016; 124: A176-A179Crossref PubMed Scopus (22) Google Scholar, 9McMichael C Barnett J McMichael AJ An ill wind? Climate change, migration, and health.Environ Health Perspect. 2012; 120: 646-654Crossref PubMed Scopus (167) Google Scholar, 10Gasparrini A Guo Y Hashizume M et al.Mortality risk attributable to high and low ambient temperature: a multi-country study.Lancet. 2015; 386: 69-75Summary Full Text Full Text PDF Scopus (20) Google Scholar, 11Hunter DJ Frumkin H Jha A Preventive medicine for the planet and its peoples.N Engl J Med. 2017; 376: 1605-1607Crossref PubMed Scopus (21) Google Scholar, 12WHOQuantitative risk assessment of the effects of climate change on selected causes of death, 2030s and 2050s. World Health Organization, Geneva, Switzerland2014Google Scholar It will be important to estimate the direct effects of climate change on temperature-related mortality and morbidity. A 2017 international study found that heatwaves significantly increased mortality across all countries studied, but the magnitude of the impacts varied with region and exposure intensity.7Guo Y Gasparrini A Armstrong B et al.Heatwave and mortality: a multi-country multi-community study.Environ Health Perspect. 2017; (published online Aug 14.)DOI:10.1289/EHP1026Crossref Scopus (229) Google Scholar As climate change will increase the frequency, intensity, and duration of heatwaves, health authorities need to prepare for the increased burden of heat-related mortality. Another important area of research is to project the future risks of malaria and other diseases associated with climate change to support effective policy making and intervention activity. Accruing evidence converges on a single point: the direct effect of climate change on future malaria transmission results in an increase of the simulated length of the malaria transmission season over the tropical highlands.8Tong S Confalonieri U Ebi K Olsen J Managing and mitigating the health risks of climate change: calling for evidence-informed policy and action.Environ Health Perspect. 2016; 124: A176-A179Crossref PubMed Scopus (22) Google Scholar Climate change will likely expand the distribution of disease vectors to non-endemic areas, increase the length of the disease-transmission season, and facilitate host–vector–environment interactions in many regions. Additionally, climate change is projected to cause substantial increases in population movement in coming decades. Climate-change-related migration is likely to result in adverse health outcomes, both for displaced and for host populations, particularly in situations of forced migration.9McMichael C Barnett J McMichael AJ An ill wind? Climate change, migration, and health.Environ Health Perspect. 2012; 120: 646-654Crossref PubMed Scopus (167) Google Scholar WHO concluded that climate change is expected to cause about 250 000 additional deaths per year between 2030 and 2050; of these, 38 000 will be due to heat exposure among the elderly, 48 000 to diarrhoeal disease, 60 000 to malaria, and 95 000 to undernourishment in children.12WHOQuantitative risk assessment of the effects of climate change on selected causes of death, 2030s and 2050s. World Health Organization, Geneva, Switzerland2014Google Scholar Although these risk estimates are uncertain due to the low number of studies on the health impacts of climate change, particularly from low-income countries, they are broadly indicative of substantial public health consequences of climate change. The medical community has been at the forefront of research evaluating the impacts of climate change on population health and promoting mitigation strategies. We need to promote the concept of global stewardship and strengthen our collaboration with other sectors and disciplines to actively facilitate and develop policies (including the effective implementation of the Paris accord) that will reduce and prevent the devastating consequences of climate change. Health research and economic development can work together to ensure that all human beings and our children live in a healthy and sustainable planet. We declare no competing interests.