The health impacts of climate change have been described as the single greatest threat to human health of the 21st century. In response health actors have been prominent in advocating for action on climate change, and some health services have pledged to reduce their emissions. For example, the United Kingdom’s National Health Service has pledged to be carbon neutral by 2045. Recently, editors of medical journals have united in calls for action on climate change, and health services have pledged to reduce their carbon emissions to take action towards preventing climate change and its health effects.
Although climate change is already impacting health, one of the reasons cited for the urgent need to act on climate is the catastrophic risk to health that it poses. Aside from climate change, there are other issues that also pose a catastrophic threat to health; such as nuclear war, and biological risks such as naturally emerging or bioengineered pandemic pathogens.
This raises the question of how the potential for catastrophic outcomes ought to influence our priorities for population health. To what extent should health care services prioritise reducing their carbon emissions? Should the health community concern itself with reducing the risk of nuclear war? And when considering how to protect societies from future pandemics, how much should we invest to prevent the very worst-case outcomes?
Although some catastrophic risks (such as nuclear war) pose a danger to presently existing people, other risks will become more salient in the future (such as catastrophic climate change). Much of the impetus to reduce catastrophic risks is protecting the health of future generations. This complicates how we consider the value of reducing global catastrophic risks, as it raises difficult questions of inter-generational justice, the moral standing of potential people, and how we value future health effects relative to health effects that we could produce now.
Catastrophes also raise the question of how we should collectively respond to risk, and whether the very worst-case scenarios should receive priority attention even when they have a low probability of occurring. In a world where there are urgent and pressing health issues, deviating resources to reduce risks necessarily carries some costs.
This panel will explore these questions and the implications of catastrophe for approaches to health priorities, using climate change as the primary example of a catastrophic risk to population health. It will consist of three linked talks:
• The first talk will provide the results of a review on catastrophic and existential risks to humanity and frameworks for prioritising actions to reduce risks. It considers how climate change may pose a catastrophic risk and how this ought to be considered against other catastrophic risks when it comes to determining priorities for action.
• The second talk will provide an argument for why reducing catastrophic risks ought to be a greater priority for those concerned with protecting and promoting health. It will also outline some of the philosophical uncertainties that complicate comparison with other health priorities.
• The third talk will consider approaches for comparing potential catastrophes with other priorities for population health. In particular it argues for the role of social welfare analysis, explores the details and ethical challenges for this approach, and applies this to the issue of comparing catastrophic climate impacts and health care.
As governments start planning how to invest to prevent future pandemics, and as pressure to act on climate change accelerates, there is a need to understand the implications of catastrophes for ethical macro-level resource allocations in health. This panel aims to advance that understanding, and prompt further discussion of the ethics of responding to the health risks of climate change and other catastrophic risks to health
Social welfare analysis, climate risks and priority setting in health
Dr. Maddalena Ferranna | Harvard University | United States
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Dr. Maddalena Ferranna | Harvard University | United States
Health-centric cost-effectiveness analysis (CEA) is the most common method to estimate the value of health interventions. CEA uses as objective function the sum of health outcomes (e.g., disability-adjusted life years), to be compared with the (net) costs of the intervention. Due to its exclusive focus on health outcomes, this method is not informative about the optimal size of the health care budget, i.e., whether limited resources should be invested in health interventions or in non-health interventions, e.g., limiting carbon emissions. In addition, since each unit of health is equally valued, CEA does not properly account for the broader environmental and socio-economic impacts of health improvements and for inequities in the distribution of these impacts. The paper argues for the use of social welfare analysis in the evaluation of both health and non-health interventions. Such an approach first estimates the impact of the intervention on individual well-being, and then aggregates well-being impacts through a social welfare function that captures distributional considerations. This approach is routinely adopted in the evaluation of climate policies. The paper discusses alternative concepts of well-being, the monetization of mortality and morbidity impacts, the timing and distribution of health and non-health impacts, and the set of admissible social welfare functions. The framework is applied to the issue of setting priorities between health care and preventing catastrophic climate risks.
Climate change – how might it rank in importance as a global catastrophic risk and an existential risk?
Prof. Nick Wilson | University of Otago | New Zealand
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Prof. Nick Wilson | University of Otago | New Zealand
Dr. Matt Boyd | Adapt Research | New Zealand
Humanity faces many major risks and needs to prioritise its response to them. A review on the literature on global catastrophic risks (GCR) and existential risks was conducted, along with frameworks for prioritising action to address them. Relevant factors included: probability of occurrence, potential impact, and tractability (including cost-effectiveness). This found that climate change is likely to be among the five greatest GCRs, where billions of people could be killed in this century (along with nuclear war, bio-engineered pandemics, ecosystem collapse and unaligned artificial intelligence [AI]). Although climate change seems unlikely to directly threaten human extinction, it could cause an unrecoverable collapse of civilisation. As such, it could meet a broad definition of existential risk “permanent destruction of humanity’s long-term potential” (Ord). However, some authors rank other existential risks as much more probable (eg, engineered pandemics and unaligned AI). Climate change could also increase the risk of other major risks (eg, great power conflict, global agricultural shortfall). Climate change may be more tractable than other major risks as there are cost-saving interventions (eg, ending fossil fuel subsidies or clean energy that reduces air pollution). But challenges include the high levels of international cooperation required, vested interests, and the short time horizon of many risk assessments. Climate change poses both a GCR and an existential risk and is therefore of great ethical importance. Action to address climate change should be very highly prioritised while also addressing other high priority risks, some of which could interact with climate change.
How much should the health community concern itself with catastrophic risks?
Dr. Bridget Williams | Rutgers University | United States
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Dr. Bridget Williams | Rutgers University | United States
Recently a joint statement was issued by the editors of over 200 health journals to call for action on climate change, citing the catastrophic risk to human health posed. This is not the first time that actors from the health community have concerned themselves with catastrophic risks. In 1985 International Physicians for the Prevention of Nuclear War was awarded the Nobel Peace Prize for their advocacy against nuclear weapons. Is it right for those tasked with protecting and promoting human health to put some of their attention and effort towards reducing the risk of catastrophe, rather than addressing existing and more predictable health issues? This paper addresses this question. I argue that health actors are justified in taking actions to reduce catastrophic risks, and that a utilitarian or prioritarian approach suggests such risks ought to receive greater attention than they do currently. I argue that the possibility of catastrophe, rather than near-term health concerns, justifies health services reducing their carbon emissions, and that health actors ought to take other actions to reduce catastrophic risks. This is particularly relevant when considering global catastrophic biological risks, such as a catastrophic pandemic, as many of the mitigation actions fall within the scope of the health community, including re-direction of research, investing in surveillance, and regulating some types of biomedical research. I also outline some of the philosophical uncertainties that complicate the question of how catastrophic risk reduction ought to be compared against near-term health concerns when determining priorities for health actors.