Carsons Syndrome- Non accidental injury to the Planet

Carsons Syndrome--A major threat to the publics health in the 21^st Century

This outline does not attempt to craft a new definition of health, an anyway unneccesary folly as definitions do not alter our understanding of the factors which contribute to our health.

We already know that our collective and individual health is crucially dependent on the social circumstances in which we live, our relationships with our fellow humans, and on the way we humans interact with our physical environment, with nature and with our planet. Furthermore it is becoming increasingly clear that current methods of social, political and economic organisation, including those orientated towards health, will inevitably produce serious environmental barriers to our collective well being.

In the UK public health act of 1848, the need for clean air, clean water, nourishing unadulterated food and appropriate housing and insulation were identified as being essential for good health. Over the years the relative importance attached to these goods has changed, and we have added others such as effective transport to the list. We also have a clearer idea of the role that the environment has in supporting our health

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Our environment provides:

• A source for energy and materials
• A sink for pollution and other wastes
• A service for water, nutrients and carbon recycling
• A space for living, working and aesthetics

What is new for us is the realisation that in building our healthy societies we have been creating environmental problems which are endangering our health and the health of our planet. We need to understand the problems which environmental degradation pose for health. Indeed for health professionals who are interested in the public health, THE task for the 21^st century is to create a health promoting social and physical environment in a way which does not inflict long-term damage on the planet.

To achieve this task we need to find and use new concepts and new tools, as well as to alert health workers and the public to the new dangers. My contribution is to unveil a new syndrome, Carsons syndrome, whose health manifestations are likely to dominate the next half century.

1 have called this new syndrome Carson's syndrome, after the remarkable Rachel Carson, who in 1962 published the Silent Spring, recording the environmental impact of the insecticide DDT Although she wasn't the first person to recognise the environmental problems associated with DDT, her passionate advocacy triggered the environmental movement.

Carson's syndrome describes the damage done to the environment by the non sustainable actions of individuals. The syndrome has been increasing in prevalence for years, but until recently hasn't been recognised, and until today has not been named. There are well known precedents for the emergence of a syndrome whose recognition requires insight rather than science. How many people knew of baby bashing before this was described with its radiological features by Caffey and others in the late 40's?

Now childhood abuse and Non Accidental Injury are recognised to be common causes of paediatric pathology Even a cursory knowledge of literature makes it clear that these problems are age old; indeed radiologists say that characteristic fractures have been found in Egyptian mummies. It just needed the right culture for the syndrome to be defined, and so properly investigated .Carsons syndrome is in the same category.

As I shall show, the non sustainable environmental impact of human behaviour is already causing significant health problems and if we don't take appropriate action now the consequences for our individual and collective health will be catastrophic. Adapting the terminology of childhood abuse syndromes, the ways that humans adversely affect the planet might in the vernacular be called planet bashing or planetary abuse. Drawing a further parallel with baby bashing, the eponym Carson's syndrome describes the severest form of planetary abuse, Non accidental Injury to the Planet.

So what are the elements of planetary abuse, and what has it got to do with health in the next millennium? When Einstein was asked to define relativity he is reported to have said. 'When a man sits with a pretty girl for an hour, it seems like a minute. But let him sit on hot stove for a minute-and it's longer than any hour---that's relativity.

1 can't hope to so elegantly define planetary abuse, but will try to use compelling metaphors wherever possible.

The first metaphor is the idea of environmental space. Most of our global resources, with the long-term exception of sunshine, are finite. In the case of fossil fuels, contrary to earlier predictions, catastrophic environmental damage would result well before available resources ran dry. Nonetheless, the necessity of respecting consumption limits remains clear with regard to the use or disposal of most commodities. For humanities long term survival, we need to leave our

globe and its resources in as good a state as we find them. To care for our planet, on which with our children and our future depends, we have to be careful about how we use and abuse resources of all kinds.

Being careful means individual human beings can only take a limited number of fish from the sea, or trees from a forest or dispose of a limited amount of waste into the atmosphere. The measure of these amounts defines our environmental space. As an example, the globe has a finite capacity to absorb C02, the gas responsible for about 60% of the anthropogenically induced global climate change. This absorptive capacity is estimated to be 12 billion tons per year.

Given the world, population is six billion, and assuming an equal share for each person, an individuals annual allowance of C02 is 2 tons. So, for carbon dioxide, two tons per year defines our allowable environmental space. This space can be diagrammatically represented as a footprint, and an allowable space can be characterised by an appropriately sized footprint. Thus if I was responsible for only 2 tons off CO2 emission/year, I would be treading lightly on the planet, and my contribution to CO2 emission would not be creating any environmental damage.

The actual amount of any specific substance which is allowable will of course vary considerably. For some particularly noxious substances, such as plutonium, CFCs and many fat soluble organic substances like dioxin, even minute amounts cause planetary damage which cannot be repaired within one human life span. They have no allowable space, and their footprint is zero. The size of other footprints, such as that for organic waste, have yet to be accurately determined, and part of the research needed in this field is to calculate allowable footprints for as many substances as possible.

Anyone who puts more than the allowable amount of a specific substance into the environment creates a footprint that is too large. A footprint that is too large through malice rather than ignorance and custom causes non accidental injury to the planet, Carson's syndrome

Many overlarge footprints cause ill health. In this paper I am going to focus on just one, Carbon Dioxide. Most of us backed by the 2,500 scientists who work with the International Panel on Climate Change recognise that anthropogenic global warming is for real.. Most health workers are aware of the global consequences to health of Global warming, namely:

• Exposure to thermal extremes, with the increasing frequency and severity

of extreme weather events

• The rise in sea level, with its devastating effect on low lying areas
• Climate change with problems for food growing in the already

marginalised parts of the world

• Spread of vector borne diseases outside their present range

• Biological effects of pollutants--eg PM10 levels

• Social economic demographics dislocation as a result of all the above.

1 am not going to explore these problems, which will effect mainly the already underprivileged. Instead, I will examine the impact of climate change on the health of people living in

the Rich North. The very people who carry prime responsibility for provoking climate change.

So its those living in the Rich North, people like me, that I now want to focus on. Whilst we are the main perpetrators of planetary abuse both accidental and non accidental, we also suffer its health consequences

What is it about our life in the Rich North, which provokes both climate change and ill health?

Global warming and climate change are largely due to excess C02 production. CO2 production results from the complete burning of fossil fuel, the motor for our consumer societies, and it is our consumer societies that provoke global climate change. For instance the US, with 4% of the world's population, produces 22% of the global C02 output. The situation is similar for many other materials. So our consumer societies clearly provoke global warming. And the self same activities which provoke global warming also underlie the main causes of illness and death in the Rich North.

Although cancer is seen by many of the public to be our main health problem, it is not the major killer. It is the narrowing of our arteries by atheroma leading to coronary heart disease and thrombotic stroke which is the leading killer in all rich societies, and an increasing number of middle income ones. And the risk factors for atheroma, outlined below, are in large part a product of the social reorganisation which has evolved in parallel to our increasing consumption.

Thus the same process that provokes global warming creates the circumstances in which the leading killer of our time flourishes. Treading on the world with overlarge footprints gives rise to both accidental, as well the increasingly common non-accidental planetary abuse- Carson's syndrome. And treading on the world with overlarge C02 footprints is both a marker for climate change and for atheroma.

How can understanding Carsons syndrome help us?

I want to finish by showing how we can use the concepts of footprints to help reorientate our societies, to help create social and environmental circumstances in which good health will flourish within sustainable environmental limits, and so help address the challenge of public health in the next century.

If we look in detail at the main causes of C02 production in our Societies and the risk factors for atheroma. its easy to see the links. For an individual in the UK the three big generators of C02 are:

• Personal travel --- particularly car and air travel--40%

• Domestic heat regulation---25%

• Food grown in the agribusiness, which is additive and resource intensive, and may travel a long way to reach us (food miles)- 15%

To reduce our responsibility for the production of C02, we need to take action in all three of these areas.

The risk factors for atheroma

• Lack of exercise
• High cholesterol diets --- more meat and less vegetables and fruit
• Hypertension - a disease virtually unknown in pre-industrial societies.
• Diabetes-primarily a disease of the non exercising obese
• Smoking --- most common in marginalised communities.
• Disadvantage and lack of social engagement --- lack of employment, lack of control over your life, leading to stress
• Family history

Each of these risk factors is much more common in modern consumer societies. To reduce the prevalence of atheroma we need to reverse as many of these risk factors as possible. In the same way that the societal changes of the last 100 years provoked both climate change and atheroma, there are many action we can take over the next 50 years which will reduce our excess C02 production, diminish the risk factors of atheroma and enhance our social and physical environment. As an example , I will explore one of these in detail. Reducing the 40% of C02 production related to transport will have major health and environment benefits.

How can we best reduce the 40% of C02 production related to transport? We need to encourage walking and bicycling, and given that around 50% of journeys in the UK are under 2 miles, and 75% under five, this shouldn't be difficult. If we succeeded, we would dramatically increase our exercise levels a key requirement in reducing atheroma. Giving Priority to cyclists and pedestrians, by separating them from cars, and traffic calming would increase the number of people on the streets, and enhance the safety of all. Population surveys suggest that children would walk to school again, with the health benefits that would bring. This is indeed what is happening on the continent.

In Holland for instance 25% of all journeys are by bicycle. The perception that deserted car-bound streets are threatening is one reason for people not engaging in society, but instead staying behind closed doors. Reclaiming the streets for people would improve the perception if not the reality of safety, and help restore the sense of identity and community which is in itself a strong antidote to atheroma. 25% of the poorest people don't have cars, and a switch to effective public transport would decrease their sense of marginalisation, again helpful for preventing atheroma.

And of course the research and development needed to ensure that public transport and any residual essential private transport is powered by renewable energy will help compensate for jobs lost in car production.

This example illustrates the health benefits we would get from implementing just one measure to reduce C02 production. The generation of local jobs through a programme of energy conservation in houses and public buildings is another example of health benefit coming from measures which will also reduce global warming. So also is a programme to increase the amount of energy generated through renewable sources.

But how easy is any of this to do?

One other important new perception in public health is the necessity of motivating and engaging the public. Giving people helpful information about their footprints may well be helpful.

For instance, we can measure our own contribution to C02 emissions using a simple form, and so assess our own individual footprints for C02. The average Briton produces 10 tons each year 5 times our allowable amount. An American is responsible for 19 tons, whereas an Indian is only responsible for 1 ton each year. So 1, and 1 suspect any of my readers living in the rich north, instead of treading on the world lightly, in my case with size eight shoes, trample on the earth with feet five times my size, size 40 feet. As far as I personally am concerned any footprint over size eight constitutes planetary abuse and I leave it to you to judge whether any of my size 40 footprint is due to non-accidental injury, or Carson's syndrome.

With our own measurements to hand, we can change our own lives to enhance both our health and the global climate, and record encouraging changes in our footprint. In this way we can improve our health whilst reversing planetary abuse.

However as our societies are presently constructed it is virtually impossible for those of us living in the Rich North to live within our allowable environmental space, to reduce our footprint to an appropriate size. To reduce the enormously oversized footprints of modern industrial societies requires much more than individual effort. Co-ordinated national

and international action is essential. A synopsis of the necessary actions is detailed below.Transport. First we must reduce the need to travel. And when we do travel we should wherever possible walk or bicycle, both of which should be pleasurable and easy. As should public transport for longer journeys. There must be rigorous control of private transport

Industry. Industrial pollution is a major contributer to environmental damage, but it need not be. There needs to be inculcation of responsible attitudes in industry. One way of achieving this is by requiring firms to run environmental and social audits, as some are now doing. Macro fiscal policy, moving towards a taxation system which not only raises revenue , but reorientates the economy towards sustainability is essential..Human settlements. We must ensure that there is universal access to family planning, and an increasing awareness of environmental problems.Agriculture. There are enormous social and environmental advantages to local non additive production and consumption, to which organic farming can contribute.Energy There is now sufficient technical knowledge for the rapid uptake of renewable non polluting energy. There is similar understanding of how we can efficiently use energy. Only the will to implement these is lacking.Forestry. Moves to plant trees and stop deforestation. Already vigorous, must be sustained.

As health workers and responsible citizens we have a key role in getting these messages across. Given the size of the problems, individual effort and example while certainly important is not sufficient. We have an additional role and responsibility. We need to educate ourselves, the public and politicians, and exert pressure on government to make environmental issues central to their policies. For instance the tax system must be changed not just to generate money but also to steer the economy towards greater sustainability. Taxation is therefore a public health issue. We need to think widely about these matters, change personally to show how modifying our life styles can be life and environment enhancing, and campaign to put pressure on governments and Trans Nationals to take environmental matters much more seriously than any presently do.

By suggesting a name for the problem, offering some ideas for personal and public solutions, my contribution will I trust stimulate all of you readers to action. Planetary abuse, now that we have recognised and defined it, should become as unacceptable to us as child abuse. When this happened, the health benefits to both individuals and the planet will be immense.