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Abstract

Climate change, a stochastic and cryptic global crunch, has been confronted through piecemeal rather than holistic approaches. It is a bioethics problem because it harms everyone and involves health, values, and responsibilities. Coupling and understanding the ethical concerns related to climate change and health are complex due to the inherent uncertainties and complexities. Compensation, responsibility, and justice as they relate to climate change and health raise ethical questions that require in-depth considerations while taking into account the diversity of stakeholders interested in them. The question on who is responsible for climate change and who should meet the costs of health challenges as a result of climate change eludes honest collective and shared responsibility responses. Considering the principle of common but differentiated responsibilities, those who have the ability to prevent or alleviate harm suffered by others and are in a position to do so without sacriﬁcing a greater value than what is rescued have a moral duty to act. It is ethically difﬁcult and complex to determine exactly what is unfair and unjust in the distribution of the negative consequences and the beneﬁts of actions that cause climate change. Issues of costs incurred on health raise fundamental ethical questions especially if the costs overburden vulnerable populations. A pro rata compensation scheme should be mooted so that those countries that contribute the least to climate change could be accorded the greatest share of compensation. The manner in which raw materials for biotechnological advancement are harvested or extracted from the environment and how this, though at a microscale, could have a far-reaching cumulative impact on climate change and health has not been quantiﬁed and raises ethical concerns. This could be a novel frontier for further consideration as questions arise on whether technologies applied in climate change adaptation and mitigation have any health impacts on the beneﬁciaries and the environment.

Introduction

Climate change has occurred over time in the past and continues to do so, making it one of the most challenging phenomena confronting human survival as a species (Moorthy et al. 2011). It is a slow and gradual cryptic global crunch which is a function of many factors, acting singly or in combination. Responses to its impacts have been through piecemeal rather than holistic approaches. To effectively deal with climate change, alertness and proactiveness are required to avoid responding to its symptoms which are exacerbated by some local and global stochastic events. Furthermore, efforts focusing on the major drawbacks of climate change have been very often thwarted and curtailed by political undertones and the abstract dimensions of climate change that are difﬁcult to discern. Several reports on climate change suggest that it cannot be stopped and will be with us for some time to come despite all the efforts to reduce the release of greenhouse gases into the atmosphere. This phenomenon has been partially driven by past and present human activities and poses a severe threat to human welfare, biodiversity and ecosystem integrity, and the life of present, future, and distant future generations. Lamentably, the least contributors to climate change are the most vulnerable.

Coupling climate change and health is complex due to intrinsic and extrinsic factors that drive both dimensions. It is further complicated by the existence of gaps in our understanding of the relationship between climate change, the environment, and human health due to scant information and data. Diseases are emerging and reemerging as a result of climate change, and data on disease incidence trends especially in the poor countries of the world are lacking. However, the majority of human health problems that can be linked to climate change are not solely created by changes in climate but by other extraneous factors. If the current rate of climate change is sustained, there will be an increase to critical levels of the risks of population health (McMichael et al. 2006). Currently, researchers are heavily disoriented in their focus, concentrating on, inter alia, the complexity of infectious disease and the multiplicity of drivers rather than on the ethical realities of climate change-health nexus. The ethical concerns of climate change and its impacts have mostly evaded the imaginations of stakeholders and have delayed justice, responsibility, and compensation to the most vulnerable who include young children, older adults, people with medical conditions, and the poor.

Climate Change And Health: A Background Synopsis

Climate change is not a new phenomenon and has, in recorded history, led to the collapse of entire civilizations and currently confronts us with a different set of ethical challenges. It poses a major threat to human health which subsequently impacts on the social and cultural dimensions of human existence, including diminishing the integrity of the biosphere as a whole. Its effects on health have been known since the time of Hippocrates (Ger 1978).

The impacts of weather and climate on human health are varied and diverse, making health the human face of climate change. Without an understanding of how diseases responded to climate in the past, it is impossible to predict how they might respond to climate in the future. In the late 1990s, scientists suggested that global warming might bring exotic tropical diseases to some developed countries and theorized that diseases such as malaria would reemerge in temperate areas, where they have long been controlled. This is not far from the truth as climate change continues; it is expected that diseases sensitive to climate will occur and the vectors expand their ranges and rate of transmission and could therefore introduce new pathogens into regions and countries. A changing climate impacts negatively on our health and well-being and is a critical public health problem. The spread of climate-sensitive diseases depends on both climate and non-climate factors, and the risks for the diseases can be much higher in poorer countries that have less capacity to prevent and treat illness. Vulnerable populations are the most affected by heat-related illness, infectious diseases related to changes in vector biology, allergic symptoms related to increased allergen production, and respiratory and cardiovascular disease related to worsening air pollution. In order to ameliorate the impacts of climate change, effective early warning systems and also the identiﬁcation of the susceptible, vulnerable, and displaced populations are needed. With the strong connection between a population’s health and economic and environmental health, the impact of climate change on each is one of the major ways in which climate change may impede development in the most vulnerable countries. Appropriate strategies for mitigating and adapting to climate change are therefore needed to prevent illness and death in people now, while also protecting the environment and health of future generations. This is an ethical consideration so that no harm is transferred to the next generation. The need for an ethical approach is compelling, and the formulation of an ethics response to climate change will have profound implications for the immediate and future wellbeing of a vast number of people who are the immediate victims of global climate change or fall into the vague category of those causing it.

Conceptual Clarification

There is no part of the world which has not tasted a dose of climate change, albeit with differing degrees of intensity and devastation. Climate change can directly and indirectly impact on human health. Its impacts on health were initially considered remotely, thus losing the ethical elements associated with it. Perhaps, the existence of limited data and the abstract dimensions of climate change endeared researchers to steer away from issues of health which were left to public health ofﬁcers. However, most of the health impacts of climate change are indirect. The emergence and reemergence of certain diseases as a result of climate change reawakened the need for coupling climate and health to address these concerns. Further, this could have presented an incentive for inclusion of ethical concerns. This was followed by a proliferation of documentation on climate change, health, and ethics without considering their interconnectivity. Perhaps, bioethics and its universal standard setting instruments exemplify the connectivity of climate change, health, and ethics better. Climate change, health, and ethics form a complex tripartite, and any attempt to decouple and exclude any one of them renders the whole exercise futile. The title of this paper on climate and health is therefore timely and appropriate especially when climate change and its impacts on human health including ethical considerations require an in-depth elaboration.

Ethical Dimensions

Over the last decade, several scientists, clinicians, and public health professionals have argued the need to examine climate change in terms of practical and ethical grounds (e.g., Menne and Bertollini 2005). Despite this, our understanding of the ethical dimensions related to climate is still in its infancy. This is not surprising since in most cases, ethical issues related to climate change are never given adequate weight in climate change forums. Further, uncertainties and complexities exist despite the existence of ethical principles to promote fundamental values that can act as reference to confronting climate change. In fact, there is no simple basis for ethical action in the face of the challenges of global climate change which directly follow from the complexity of global climate change as a phenomenon which is cryptic, stochastic, and unfolding in time.

The crisis of global warming is a moral as well as an ethical one. If we ignore ethical implications in responses to climate change, we are bound to be confronted with devastation of entire communities and creation of new paradigms of inequity and maldistribution and render more vulnerability to those peoples who have already found themselves uprooted by other man-made political and ideological struggles. Furthermore, to address the ethical question on climate change requires answers that are weighed against conﬂicting interests among different stakeholders. In this regard, different actions are required by different agents in different contexts to respond appropriately, humanely, and ethically to the challenges of climate change. These issues are complex and require some intricate, ingenuous, and complex approaches. In order to unravel these complexities, it is important that ethical questions on compensation, responsibility, justice, health cost, and biotechnological advancement be seriously addressed. These elements are considered in the subsections below.

Bioethical Considerations

The consideration and inclusion of bioethics in issues pertaining to climate change are noble because they are concerned with objectivity, fairness, morality, responsibility, health, and wellbeing. It is therefore not surprising that climate change is a bioethics problem because it harms everyone and also involves health, values, and responsibilities (Macpherson 2013). Climate change harms health everywhere, and allowing it to worsen is a choice involving values and responsibilities. Bioethics boosts understanding of the beneﬁts and harms, promotes transparency about actions and policies that allow climate change to worsen, exposes potential conﬂicts of interest that affect the conduct and interpretation of risk assessments, generates insights about sociocultural conditions that impinge on autonomy, and grounds new conceptions of social responsibility (Cook 2013). The present generation’s responsibility on the well-being of the future and distant future generations especially on the harm issue has been raised and considered as an ethical concern. Article 17 of the Universal Declaration on Bioethics and Human Rights (UDBHR) emphasizes the need to protect the environment, the biosphere, and the biodiversity which is fundamental in “protecting future generations” (Article 16). In this regard, the present generation may compromise the position of a next generation to such an extent that, in order to save itself, it may inﬂict even more harm on a succeeding generation. Thus, consideration of future generations is an essential element of the total ethical response to climate change. Therefore, bioethics has a responsibility to promote transparency and understanding about the actions and policies that allow climate change to worsen and to explore the associated conﬂicts. Furthermore, human-induced problems of the environment require ethical reasoning in their mitigation efforts, and bioethicists can explore the moral, philosophical, theological, and legal foundations of environmental policy (Resnik 2009). The public reacts especially positively to climate change messages framed in public health terms, and bioethicists are particularly well positioned to contribute their expertise to the process of carefully developing and communicating such messages (Valles 2015). At the very least, bioethics should inform and facilitate public and policy dialogue about how climate change threatens health.

Questions On Compensation, Responsibility, And Justice

Compensation, responsibility, and justice issues are pertinent especially when focused on human health including insurance costs that are incurred as a result of the impacts of climate change. These issues are addressed below to shed more light on their relevance and applicability.

Responsibility: The question on who is responsible for climate change and who should meet the costs of health challenges as a result of climate change still eludes in-depth collective and shared responsibility responses. This scenario is further exacerbated by the fact that climate change is a collective action involving many agents who should take responsibility and contribute toward reversing it. It can be easily said that each person, community, or country has a share in the responsibility for climate change and its impact on health. This assertion has very often been used to thwart responsibility efforts. Earlier generations are said to have had no clue whatsoever that their actions were impacting on climate and causing harm to the subsequent generations. Generally, it is known who the main contributors to climate change are, and none of them has morally and explicitly accepted responsibility for climate change and its consequent impacts on human health. At the turn of the twenty-ﬁrst century, it was realized that those most likely to suffer the consequences of climate change were primarily those who had least contributed to its cause. Currently, some people, groups, or states carry an unfair burden in suffering the negative consequences of climate change to the course of which they have made little or no contribution. This indicates that the health burden of climate change will rest disproportionately on the world’s poor and most vulnerable. The fact that no one has accepted responsibility for climate change means that Africa will continue carrying 25 % of the world’s disease burden and the 16–28 % in person-months of malarial infection rate by the year 2100 (Patz et al. 2005). Therefore, acceptance of responsibility does not in any way dilute status but makes one emerge as a hero among the poor and the most vulnerable, the “wretched of the Earth,” so to speak.

Justice: With regard to global climate change, it is difﬁcult to engage issues related to justice and human rights because they are intricately the most difﬁcult questions which focus mainly on how to recognize and respect other persons and in particular their vulnerability and personal integrity. In addition, it is difﬁcult and complex to determine exactly what is unfair and unjust in the distribution of the negative consequences and also the beneﬁts of actions that cause climate change. This notwithstanding, Article 10 of the Universal Declaration on Bioethics and Human Rights (UDBHR) demands that “The fundamental equality of all human beings in dignity and rights is to be respected so that they are treated justly and equitably” (UNESCO 2005). In this regard and considering the principle of “common but differentiated responsibilities,” those who have the ability to prevent or alleviate harm suffered by others, and are in a position to do so without sacriﬁcing a greater value than what is rescued, have a moral duty to act. Developed countries, therefore, have ethical and moral duty to support developing countries in strengthening their health systems and addressing threats to health caused by climate change.

Compensation: This question arises especially where people who suffer the consequences of climate change are not those who caused it. However, it is unclear how historical and current responsibility and compensation issues as they relate to climate change can be elucidated in the current academic and political debates and dialogues. It is morally and ethically prudent that those who have caused harm to others should be held accountable for it and even compensate those that have been harmed. Public health costs of global climate change are greatest in those parts of the world that have contributed least to the problem, posing a signiﬁcant ethical dilemma for the developed world. Perhaps, it is time for an agreed pro rata compensation scheme to be mooted so that those countries that contribute the least to climate change be accorded the greatest share of compensation. This, however, will require honest acceptance of responsibility and ingenuity in establishing a tiered global classiﬁcation of all countries based on their level of contribution to climate change.

Health Insurance Cost As An Ethical Issue

Insurance is often thought of as a tool to be brought into play only after a loss or harm has been sustained. The insurance industry helps society understand and adapt to emerging risks such as those associated with climate change. While a major segment of the global insurance industry is now engaged in the climate change discussion, most companies thus far have a very modest level of activity. A changing climate impacts on human health and well-being and also stresses health-care infrastructure and delivery systems, thus raising the ethical health-care question of whose responsibility it is to clear the incurred health costs. Issues of costs incurred on health raise fundamental ethical questions especially if the ailments are caused by climate change. However, teasing ailments arising from the effects of climate change from those caused by other extraneous factors is a daunting task. Intuitively, if acceptance of responsibility for climate change is as difﬁcult, then hard questions could arise from the demand for collective decisions to include subsidized health costs as a global agenda. The costs are a burden to the vulnerable populations, and an ethical approach is required to ameliorate this social risk.

Biotechnologies, Climate Change, And Health: A Nouvelle Ethical Reflection

Technological advancement for amelioration of human health could directly and/or indirectly contribute to climate change. Technology is considered here not only as referring to tools, equipment, and management but also information, knowledge, and activities involved in the physical transformation of inputs and outputs, with the outputs being products or services (Nilakant and Ramnarayan 1998). Today, we are witnessing rapid technological advancement that has resulted to a faster rate of human innovations in all spheres and activities of life. One of the areas advancing rapidly is the use of biotechnology. In this area, new ethical questions may be raised especially in the manner raw materials for its advancement are extracted from the environment and how this cumulatively impacts on climate change. This, though occurring in many parts of the world and on microscales, has so far not been quantiﬁed, the usual focus being on the macroscale activities. Although the microscale activities beneﬁt human beings through production of medicine and associated technologies, issues on vulnerability have not been addressed. Article 8 of the Universal Declaration on Bioethics and Human Rights (UDBHR) states that: “In applying and advancing scientiﬁc knowledge, medical practice and associated technologies, human vulnerability should be taken into account. .. ..” Furthermore, in Article 17, it is further stated that: “Due regard is to be given to the interconnection between human beings and other forms of life, to the importance of appropriate access and utilization of biological and genetic resources, to respect for traditional knowledge and to the role of human beings in the protection of the environment, the biosphere and biodiversity.” These two articles imply that each one of us has the responsibility to preserve the environment irrespective of whatever technology and/or activity is being undertaken.

Developments in biotechnologies and the understanding of genetics and related ﬁelds have meant that radical approaches and solutions are emerging in ﬁelds like pharmaceuticals, food processing, agriculture, and process engineering. Over a long time, traditional herbal medicine and modern medicine have been drawing some of their raw materials from vegetation, and the cumulative impact could have a role to play in climate change. Harvesting of vegetation for medicine production is directly linked with a decrease in plant biodiversity and loss of medicinal plants which provide the raw medicinal products. The use of plants for medicinal purposes is extensive, with 70–80 % of individuals worldwide relying solely on plant-based medicine as their primary source of health care (Hamilton 2006). Technologies and activities for extracting medicine and production of drugs from vegetation, though at minimized and localized levels, may cumulatively lead to death and/or no regeneration of forest cover over time. Removal of roots and stem for manufacture of medicine leads to death of the plant, barking dries up the plant, and use of seeds minimizes chances of forest regeneration. They are therefore “technologies of destruction and doom.” According to the preamble to the UDBHR, moral sensitivity and ethical reﬂections are emphasized as integral parts of the process of scientiﬁc and technological developments, and bioethics should play a predominant role in the choices that need to be made concerning issues arising from such developments. Furthermore, this should be intertwined with the desire of developing new approaches to social responsibility to ensure that progress in science and technology contributes to justice and equity and to the interest of humanity. Undoubtedly, the outcomes of these biotechnological developments are two-edged; the medicinal product is beneﬁcial for human health, and the consequent climate change and reduction of plant biodiversity have negative impact on humankind. This means that the more the biotechnological development, the more the vegetation is harvested for medicine and the more human health is improved. On the contrary, this leads to decimation of vegetation, climate change, and emergence and reemergence of diseases that impact on human health, thus creating an ethical dilemma on the applicability and suitability of these activities. This argument appears cyclical in nature, but it emphasizes the role biotechnologies and the usually underestimated small-scale activities could play in climate change.

Ethical Contributions Of Organizations To Climate Change And Health

The existence of climate change is not in doubt and is a reality that is universally acknowledged. It affects all corners of the world and has unleashed untold suffering to societies, thus prompting various organizations to harness their ethical if not political strengths to confront it. Given the nature of the challenges of climate change, ethics is an essential component of assessment of risks, vulnerabilities, and potential responses. With regard to analysis of the ethical implications of climate change, UNESCO has a clear comparative advantage and expertise. The push for a universal declaration of ethical principles by UNESCO would commit governments and societies to certain ethical standards of behavior in assessing options to respond to climate change. The World Meteorological Organization (WMO), the United Nations Environment Programme (UNEP), and others have also contributed to the elaboration of the impacts of climate change through production of several documents that address some aspects of climate change, health, and ethics. One of these documents is the Universal Declaration on Bioethics and Human Rights (UDBHR), 2005, a normative instrument by UNESCO, which offers ethical guidance on very fundamental issues on human beings and environment. Among its aims particularly relevant to the ethics of global climate change are to safeguard and promote the interests of the present and future generations and to underline the importance of biodiversity and its conservation as a common concern of humankind. Other documents that could be used to articulate the already existing international consensus on the ethical values that inform responses to global climate change include the Universal Declaration on Human Rights (UDHR), 1948, along with related covenants; the United Nations Convention on Biological Diversity, 1992; the Rio Declaration on the Environment and Development, 1992; the UNESCO Declaration on the Responsibilities of the Present Generations Towards Future Generations, 1997; the Kyoto Protocol, 1997; and the Earth Charter, 2000. The values and principles in these documents, though not exhaustive, could be explored further with a view to determining their relevance and applicability in addressing ethical questions related to global climate change and health. It will be expedient to identify where the gaps in these documents are and to focus future work on the ethics of climate change and health including elements of justice, compensation, and responsibility.

Conclusion

The existence of climate change is not in doubt and is a reality that is universally acknowledged. It affects all corners of the world and has unleashed untold suffering to societies, thus prompting international organizations to harness their ethical if not political strengths to confront it. Coupling or decoupling climate change and health is not only complex but also unnecessary. Climate change and health is a cause-effect affair especially when the ﬁne details of our societal consumptive economy and technological advancement are considered. Given the nature of the challenges of climate change, ethics is an essential component of assessment of risks, vulnerabilities, and potential responses. Ethical considerations on climate change and health raise responsibility, compensation, and justice questions which, presumably, could have led to reduced political thrust to formulate global climate change targets. The world is witnessing the emergence and reemergence of some diseases, with the vectors expanding their ecological ranges and victim populations especially in the most vulnerable countries. This calls for consideration of climate ﬁnance and the proposal made in this paper for a pro rata compensation to the most vulnerable countries. This would reduce the health and insurance cover costs which overburden these countries especially the least-developed countries (LDCs) and the small island developing states (SIDS). More ambitious and collective moral, ethical, and political decisions on climate change and human health are needed now, not tomorrow, for a sustainable future. The push for a Universal Declaration of Ethical Principles in Relation to Climate Change by UNESCO would commit governments and societies to certain ethical standards of behavior in assessing options to respond to climate change.

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