Nuclear war, climate change, and medical activism
Authors: Jack Williamson
Journal: The Lancet Planetary Health (2020)

Throughout the latter half of the 20th century, the world seemed poised between two outcomes: nuclear disarmament or global annihilation. As we face new threats to human health, what role does the medical community have to prevent these? “Do critics doubt that this is a medical issue?”Sidney Alexander, president of Physicians for Social Responsibility, on nuclear disarmament You must take prompt action if you think that patient safety, dignity, or comfort could be compromised. You must make sure that your conduct justifies your patients' trust in you and the public's trust in the profession. These two statements (listed in the Good Medical Practice guidelines) were used by Doctors for Extinction Rebellion in September, 2019, to justify the neglect of their normal patient duties as they lay on the ground outside the governmental Department for Business, Energy and Industrial Strategy in London (UK). In capital letters, a fluorescent orange banner read Government Inaction Will Cost Countless Lives. Their bodies lay in unity against the inaction on climate issues that they, as guardians of health, felt obligated to oppose. The connection between environment and health is now a key concern of many medical professionals, perhaps best vocalised by WHO's declaration that “Climate change is the greatest threat to global health in the 21st century.” The climate crisis is not, however, the first issue that has compelled doctors to break the law to safeguard patient safety, dignity, and comfort. From spearheading illegal needle exchange programmes, using their bodies as blockades to stop the detention of asylum seekers, and illegally occupying government buildings to ensure continued access to medicines for people with HIV, the past century holds many examples of how the medical community can use activism—and the large moral trust the public places on them—to help confront governmental neglect on major global issues and help to abate catastrophic health outcomes. But how justified are these actions? Should nurses working in India, for example, be allowed to use their working hours and social standing to voice their concerns against destructive air pollution that, in 2017, led to 1·24 million preventable deaths in their country alone? To this day, one of the starkest risks to public health comes from the threat of nuclear warfare. Realising this connection, cardiologists Bernhard Lown (a US-born developer of the direct current defibrillator for cardiac resuscitation) and Evgeny Chazov (a Russian-born director of the Moscow Cardiological Center and a physician to former general secretaries to the communist party, such as Mikhail Gorbachev) began an unlikely collaboration. Overcoming their political differences to form International Physicians for the Prevention of Nuclear War (IPPNW) in 1980, their exhaustive efforts to communicate the health impact of nuclear warfare—thereby reframing nuclear war as a medical issue—culminated in an unprecedented satellite teleconference between two live audiences in Moscow (Russia) and San Francisco (US). Addressing the US itself, Chazov forewarned that “If there is a nuclear war, 2 billion [people] will perish on the Earth. Civilisation will perish… the climate will be changed and there will even be the question as to whether life itself could survive… either we will live together on our beautiful planet or we will die together in the flames of a nuclear war.” In 1985, a mere 5 years after its formation, the IPPNW had over 135 000 members in 40 countries, was awarded the Nobel Peace Prize, and had accelerated its agenda to the scope of global concern. On the ground in the UK, the Medical Campaign Against Nuclear Weapons (MCANW) and The Medical Association for the Prevention of War (MAPW)—both UK affiliates of the IPPNW—rallied together in their thousands to stage protests, organise appeals, lobby political and military leaders, and host international conferences. Through campaigns such as Treatment not Trident in 1985 and Beds not Bombs in 1987, the aim of both organisations was to call attention to the dire medical consequences of nuclear war, the unconscionable high cost of building, testing, and maintaining nuclear warheads, and the incapacity of the National Health Service to cope with the unprecedented demand of a nuclear blast. Taras Young, author of Nuclear War in the UK, believed that medic-led activist groups, because of their medical expertise, were well positioned to argue against the use of nuclear weapons. Adopting an evidence-based approach to communicating the health dangers of nuclear weapons, as well as using their prestigious and trusted status in society, their message was clear and irrefutable, striking the core of society. “Taking a medical standpoint against nuclear weapons became a problem for the government, who could easily write off movements like the CND [Campaign for Nuclear Disarmament] as unwashed hippies”, Taras said, “but when you have a doctor saying the same thing and backing it up with a medical argument, it's much more difficult for the government to discredit.” Medic-led movements also played a corrective role in countering the unrealistic government messaging found in widely distributed public information series, such as the much derided 1980 Protect and Survive series. Discussing the accuracy of the data used in this series, Taras emphasised that “it's very likely that they [the estimated figures] were much too high in terms of how many people would survive”. Exercise Hard Rock (a simulation done by the UK Government in 1982 to estimate the impact of a nuclear blast) is another example of the government's underestimation of the damage to public health caused by nuclear warheads, which concluded that a maximum of 7·5 million people would die. Replicating the government model themselves, scientists found that the true number of deaths would be closer to 39 million deaths if the scenario was more comprehensive. As custodians of health, medical professionals were acutely aware of the potential impact on public health that a nuclear blast would have and, as such, produced pamphlets that were far more pessimistic about the effects of nuclear war than those produced by the government. The Medical Consequences of Nuclear Weapons, a 40-page pamphlet produced by MCANW and MAPW in 1982, concluded that “An examination of the facts leads to one inescapable conclusion. If for none other than purely medical reasons, nuclear warfare must never be allowed to happen.” The message could not be clearer: prevention is our only hope. The damage that is being done through climate change is, like the potential of nuclear arms, a serious threat to our planet, our people, and future. And while the bushfires that ravaged Australia between November, 2019, and January, 2020, might not have inspired the same level of fear or urgency as that of a nuclear blast, to public health officials, they were a chilling indication of the health ramifications that climate change will bring. “We are currently dealing with an enormous public health challenge”, says John McMillan, professor of bioethics at the University of Otago (Dunedin, New Zealand). “Even with the best, clearest examples of where climate change has caused harm, it's very difficult to get the evidence based public health message across.” Health professionals are once more needed, it seems, to address the failure of global leaders to properly examine the causes of, for example, Australia's so-called Black Summer and initiate serious discussions about how to address the immediate consequences of climate change on health that are unfolding at an alarming rate. Civil disobedience against the political interests stopping effective climate policy—a Treatment not Trident for our times—could represent one of the last remaining options. “Why are they [medical professionals] resorting to civil disobedience? The reason is because the conventional methods of communication on public health people use aren't getting the message across.” The immediacy of this measure reflects the immediacy of the problem, says Alex Macmillan, associate professor of environmental health at the University of Otago. “As health professionals take action, civil disobedient action included, they're communicating very clearly about the co-benefits of climate action for health and health equity.” As Lown and Chazov discovered, issues that pose catastrophic risks to health and the future of our survival are often met—paradoxically—with political and public inertia, possibly because the short-term gains of confronting these issues are hard to see and are, therefore, politically undesirable. “Our communication around [medical professionals] taking action needs to focus on shifting the framing of climate change as a remote issue (for example, about polar bears and ice caps) to being able to show the public the immediate health impacts of climate change on their lives now.” Lown and Chazov, aged 98 and 90 years, are both still alive. Unfortunately, as with all whose life's work has been dedicated to preventing apocalyptic scenarios, we cannot know for sure how much their accomplishments contributed to diverting the course of a more violent, darker history. The absolute nature of nuclear warfare means that there are no scenarios with half consequences, no half dropping of bombs—either they fall or they do not. The climate crisis is different to this. The damage we are doing to the planet, and consequently human health, is more incremental in nature. Like a cancer spreading through the body, it's happening all the time and we could make the mistake of denying it's there until it's too late. The medical community is duty-bound to act in good conscience to help avert this human calamity.