Interview with Chris Zielinski, Visiting Research Fellow and Faculty of Health and Wellbeing at the University of Winchester, UK, James Kigera, Editor-in-Chief, Annals of African Surgery, and James Tumwine, Editor-in-Chief, African Health Sciences, authors of COP27 Climate Change Conference—Urgent Action Needed for Africa and the World. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD.
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From the JAMA Network, this is JAMA Author Interviews, conversations with authors exploring the latest clinical research, reviews, and opinion featured in JAMA.
Dr Kirsten Bibbins-Domingo:
Hello, and welcome to this edition of the JAMA Author Interview podcast. I'm Dr Kirsten Bibbins-Domingo. I'm the Editor in Chief of JAMA and the JAMA Network. JAMA and other journals of the JAMA Network recently published an editorial written by our fellow editors from journals on the African continent. The editorial is entitled "COP27 Climate Change Conference, Urgent Action Needed for Africa and the World."
In the first line, the authors highlight that wealthy nations must step up support for Africa and vulnerable countries in addressing past, present, and future impacts of climate change. JAMA and the JAMA Network joined more than 200 health journals across the world in publishing this editorial to coincide with COP27. I'm pleased to be joined today by three authors of this editorial.
Dr James Kigera is the Editor in Chief of Annals of African Surgery, and is based in Kenya. Professor James Tumwine is the Editor in Chief of African Health Sciences, and is based in Uganda. Dr Chris Zielinski is from the Center for Global Health at the University of Winchester in the UK.
I'm going to begin with Dr Kigera. Perhaps you can begin by helping us to understand the impacts of climate change that are specific to Africa. I think we're all understanding the effects of the climate crisis, but Africa disproportionately. What types of things have you highlighted in this editorial?
Dr James Kigera:
Thanks for the question, and thanks for having me on the podcast. I think Africa is bearing the brunt of what's happening as far as climate change is concerned. If you just look at the rising temperatures that are causing zoonotic diseases to spread across the continent, we've had three or four Ebola outbreaks on the continent in the last few years. Malaria, yellow fever, dengue fever, Rift Valley fever, are becoming more and more common, and this is because of the rising temperatures.
When you look at the coastal communities, the rising of sea water is making it difficult to control previously-controlled waterborne diseases. And when you add that onto infrastructure that is not well-equipped to handle these rapid changes in the environment, then the devastating effects of this is borne by the people who are living in the African continent. So I think we are least to blame for what's going on, but probably we are receiving the shortest end of the stick, so to speak.
Dr Tumwine, what other health effects would you highlight that are the consequence of the climate crisis in countries on the African continent?
My home is at 6,500 feet above sea level at the Uganda-Congo-Rwanda border. That's where the famous gorillas live, and it's always cold. But recently there's been a resurgence of mosquitoes. Even as I talk to you now, that's where I am, and I keep chasing away the mosquitoes. But because the Earth has become so hot, now we have mountain malaria. And as you know, of course in Uganda right now we are struggling with an Ebola outbreak. So we are not in theory, we are in practice, and yet we are only contributing very little to the greenhouse gases.
The other health problem we are facing is increased numbers of mentally ill people, the mental health problem. We have a resurgence of depression and anxiety, particularly in the east of Uganda at the Kenya-Uganda border where one of our big mountains, Mount Elgon, every single rainy season we have terrible landslides, and huge large communities they lose their homes and they become homeless with no food, et cetera. So we have malnutrition, we have the mental health problem, apart from the infectious diseases that my namesake has mentioned.
Dr Zielinski, you organized the journals in putting together this editorial. Why did you want to do this and, what is the significance of the timing?
Yes, I've engaged in this process, which is in fact the second year that the organization I've been working with has carried out such a project. It's the UK Health Alliance on Climate Change, UKHACC. And last year in the run-up to the United Nations Climate Change Conference that was held in Glasgow, COP26, they got together around 200 journals to publish an editorial. This year, because of the focus on Africa, COP27, there was a need to focus more on the African continent, and so we got together a group of editors of leading journals published on the continent. Altogether I think 18 different journal editors participated in drafting this editorial that's now gone out to the world really.
Some 260 biomedical journals will publish this editorial. We're very happy to see the take-up, which is really an unprecedented consortium of journals. Over 50 journals are African journals as well. It's a project which a group of us did. I'm the sort of administrative edge of it if you like. I've been in touch with the journals thanks to my prior connections with the African journals particularly, but through projects that I've led in the past. That's really the background to my participation in this and to how the project is working.
Thanks so much. One of the points that is highlighted so nicely in this editorial, and I'd like to ask Dr Kigera to speak on this because he mentioned it at the outset, is that the climate crisis is clearly having devastating effects in Africa. But the issue is made even more compelling by the fact that as a relative contribution to the causes of the climate crisis, countries in Africa, the populations in Africa, have contributed least. Would you just help us to understand that point a little bit more Dr Kigera?
If you look at the Eastern African region, for example, so we look at the region from the Indian Ocean all the way to where James Tumwine is living, and as far north as the Red Sea, that region has not had a proper rainy season for the last four years, and 70 to 85% of the agriculture in that area is rain fed. So that means we've been having dwindling nutrition for close to 250 million people in that area. When you look at the contribution of the citizens of that region to global warming, probably the most that would happen would be the carbon dioxide from burning biomass for fuel.
The level of industrialization in that region is not that high. Motoring for transportation is not as dense as you would imagine say in Europe or other Western parts of the world. Yet the rising sea temperatures that are causing drought will affect this region severely. If you look at the levels of malnutrition, we are now seeing levels of infant mortality that we haven't seen since the '60s when the countries in this region were gaining their independence.
So just as a percentage of what they contribute to greenhouse gases and to other forms of climate change, that region is definitely receiving far much more in return than it should be. The greatest contributors of these are probably in areas where there's lots of rapid unchecked industrialization. For example, in China, in parts of Europe, and the United States, yet the citizens of those countries are unlikely to feel the heat the way the citizens of Africa are.
Another point that is made so clearly in the editorial is that there's a call to appeal to the moral responsibility of the globe, and particularly wealthy nations, to provide resources to countries without the means to deal with the devastating effects. But you also highlight that it's not just a moral imperative. In fact, you make the point that for wealthy countries it is in their self-interest to engage and really fully address the devastating health effects in Africa. Give us an example, Dr Tumwine, if you would about how something that might take place in Africa has an impact on other parts of the globe.
I as saying that 30% of our population lives on less than $2 a day. Levels of poverty are extremely high. The subsistence workers own the land, they grow a little food that they survive on. Now, when there's climate change, their food production is compromised. The area that my namesake was mentioning, people are unable to grow food. Now, when you have disease outbreaks, it is not rocket science to know that a serious infectious disease anywhere in the world like COVID-19, it started in China, but within a couple of weeks it was in the United States, it was in Europe.
In fact, I was in Denmark when COVID-19 arrived in Europe. So when you have Ebola and other diseases breaking out, this little village that we live in, village Earth, the diseases will spread like wildfire unless of course we stay in our little hamlets like America, like Africa. But this is an area of international travel, the diseases will come, they'll spread all over the place.
That's really well said. This is a global crisis and the implications even when they're felt more significantly and disproportionately on the African continent certainly have implications for the entire globe. We see that, we all have the experience of that in the COVID-19 pandemic. Certainly more recently with monkeypox, and have experienced that certainly not to the same extent, but have significant impacts of the Ebola crisis as well. So what does this editorial call for? What would you want the people attending COP27 to know? What would you want wealthy nations to know? What is the editorial calling for in the focus and turning our attention to Africa? Dr Zielinski?
Well, the editorial really is a call to nations to respect their own promises, things that they've already asserted that they're going to do but haven't done. The data coming out of the research around climate change is most concerning. And I think it's clear that there has to be some change. We can't continue with business as usual. So the real bottom line is to look at the bottom line, to look at the financial consequences, and the financial requirements to combat this crisis.
And I think this means really that nations which have the resources have to supply resources and support to countries that don't. Africa, as the editorial stresses, has done the least to cause the climate crisis and is going to be bearing the brunt of it and earliest unless something is done, and that something has financial consequences. So I think that's really the central call and the editorial is for all signatories, all those who are responding to this discussion to meet their own commitments.
Thank you. Dr Kigera, what is the significance for you? We're physicians, we're scientists, we're editors in chief. What's the significance of us taking a united stand in publishing this editorial together across more than well over 200 journals across the globe in helping to amplify this statement?
The first thing to recognize is that the world is not little cocoons like we would like to see it. I think we need to recognize that everything is interlinked. I'm an orthopedic surgeon, and if I decide that I should only be interested in fractures of the femur or osteoarthritis of the hip, I will have missed the bigger picture because a hip does not walk into my consultation room, a person does, and this person is a product of the environment that we are talking about. And if the environment is being affected by different factors, including climate change, then my patient will be affected.
The sooner we realize how interconnected everything is, the quicker we might run to find solutions that are beyond our comfort zones. So I think the coming together of people of different backgrounds, different trainings, but all of us looking at where the overwhelming science is pointing us to, and all of us agreeing that this overwhelming science needs to be something that we respond to and respond to urgently, I think that is a great step for humanity. Maybe if you allow me to highlight one other aspect in addition to what James was talking about.
Other than the pandemics that look like they'll become more and more prevalent if we are not careful about climate change going into the future, the other thing that might happen is the breakdown in societies, uncontrolled migration, and also security risks, because people will find ways of leaving the places where they think habitation is no longer possible. This will end up causing civil strife both in the places where they want to leave, but also in the places where they intend to go to. So all countries in the world are best served if the changes we are seeing are mitigated, and mitigated early, so that any potential crises are averted before they become full-blown crises.
Dr Tumwine, I'm going to pose the same question to you. What is the significance of us as physicians, as scientists, as editors of journals, coming together to amplify the particular statement made by the editors in chief of the health journals on the African continent?
It is so important, very important. It does not matter anymore whether you are rich, you are living in a rich country like America, or a very poor country like Uganda. We breathe the same air. So when there is poison going into the air in Boston, for example, that air will be breathed by somebody in Nairobi or in Copenhagen. I wish we had boundaries. We don't have boundaries anymore, so it is extremely important that we educate our populations about the danger of this tragedy. The tragedy that the Earth is burning. We're on fire, and it doesn't matter where you are. We must educate our population that we are in this catastrophe together.
I want to draw this podcast to an end. I wanted to give each of you the opportunity for a final reflection, anything you want our listeners to know as they read your editorial that we hope to amplify along with journals across the network. Dr Zielinski, any parting words or thoughts?
I'd like to just stress that one of the purposes of this editorial has been not just to talk to the public, but also to talk to the medical profession. Because on the whole, biomedical journals have been slow to respond to the impact of climate change on health. We're carrying out research currently at the London School of Hygiene and Tropical Medicine on this question. Why have journals not particularly considered this topic?
One reason is that many of them think it may not be particularly relevant. And as the person responsible for putting together the consortium, I frequently had to answer the question, "Why should we publish your editorial? What's the impact of climate on dermatology, or veterinary science, or palliative care, or tuberculosis?" Indeed, these are questions that are important to ask, and the editorial is causing those questions to be asked. Our solution has been to suggest that the journal editors write a companion editorial to detail the impact of climate change in their specialist area, and a number of them have done so.
I think this is quite important, that the whole climate question can only be addressed by concerted action and knowledge spreading throughout the population, and that includes both the general public and the medical profession. So I think one of the important results of this editorial effort will be to raise the question of how climate change will affect particular parts of the whole biomedical world, and to try to come up with answers for that.
Thank you so much for making that point. I think it's a really important one, particularly because the industry of modern health care is an important contributor of course to many of the forces that underlie our current climate crisis. And so I think a really important point to underscore, as well as the issue of the clear impacts on health, which is the domain of health journals certainly. Dr Kigera, any final thoughts you'd like to leave us with?
I think my take-home message that I want listeners to have is, we are all in this together. Whether you're a shoe shiner in Nairobi, or a large-scale farmer in Australia, or a factory worker in the Midwest of the US, climate change is affecting all of us. And if we all do not do something about it, we are all going to sink together.
Dr Tumwine, you have the last words for today.
Oh, thank you. This is addressed to our fellow doctors, pharmacists, editor journals, et cetera, who are relatively aware of, they have not strictly felt the climate crunch like the majority of our poor people. You have comfort, but there is nowhere to escape to. Let us urge our communities, our governments, and of course in our countries, to try and meet our commitments. And if we work together, we shall manage. Thank you.
Thank you very much, and thanks to all three of you for joining us today for this important conversation. I've been speaking with Dr James Kigera from Annals of African Surgery. He's the Editor in Chief based in Kenya. Professor James Tumwine, the Editor in Chief of African Health Sciences based in Uganda, and Dr Chris Zielinski from the Center for Global Health at the University of Winchester in the UK.
They are authors on an editorial published by JAMA and across the JAMA Network really underscoring the effects of the climate crisis on the African continent and on the importance of wealthy nations really doing their part both because of the moral imperative as well as the impact of the climate crisis on the entire world. Thank you so much for being with me today, and thank you for listening to this podcast.
This episode was produced by Jesse McQuarters at the JAMA Network. The audio team here also includes Daniel Morrow, Shelly Steffens, Lisa Hardin, Audrey Forman, and Mary Lynn Ferkaluk. To follow this and other JAMA Network podcasts, please visit us online at jamanetworkaudio.com. Thanks for listening.
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