The BMJ Today: Paying people to live healthier lives and tackling climate change

This week, the Intergovernmental Panel on Climate Change (IPCC) released its Fifth Assessment Report. The scientists who wrote it warn of the serious impact that climate change—unequivocally influenced by human activity—will have on humans and other species in the planet. The IPCC calls for world leaders and policy makers to promote adaptation strategies to mitigate the implications of climate change for future generations. Climate change may be the greatest challenge we face as a species yet many people have difficulty grasping its implications. The changes are abstract, will occur in the future, and mitigation strategies have economic costs and limited short term benefits. In addition, several institutions, corporations, and individuals with vested interests refute the claims of mainstream scientists and promote the fallacious view that there is great uncertainty around the predictions of the IPCC and that many in the scientific community are skeptical about the impact of human activity on climate change.

In an essay published in the BMJ, Eric Chivian, founder and former director of the Center for Health and the Global Environment at the Harvard Medical School argues that physicians are ideally placed to educate the public and policy makers on the consequences of climate change in at least two ways. On the one hand, physicians can make climate change real for people by using jargon free language and concrete examples of the impact of global warming on health. On the other hand, physicians can combat the disinformation generated by climate change deniers (often with economic ties to industries that benefit from fossil fuel based economic activities) and promulgated by the media. Those who cast doubt on the effect of human activity on climate change base their arguments on the uncertainty of the effect estimates—an unavoidable uncertainty at the root of all scientific activities. But physicians can reframe the debate and show how in medicine, inaction in the face of uncertainty may be fatal, and decisions must be made in light of the available evidence, even if uncertainties persist.

Motivating people to make healthy changes, rather than mandating them, is the theme of an article published by Sarah Strickland that explores the impact of economic incentives to promote healthy behaviours. She asks whether concrete economic rewards for healthy activities can stem the rise of chronic diseases, an epidemic that has not been stopped by education about the long term (and abstract) benefits of diet and exercise. In the article, she discusses several efforts from rich and poor countries to use incentives, and uses Finland’s approach to promote the production of healthier grains and lower fat diary alternatives as a successful example of the use of economic incentives for health promotion.

While chronic diseases have become prevalent in most countries, infectious diseases still exert a toll in many parts of the world, often as a result of war and other human conflicts. Such is the case of polio in the Middle East, where local strife has led the tragic resurgence and spread of polio. In a news article, Sophie Arie explores the dramatic spread of this cause of flaccid paralysis from Syria to Iraq. Civil and military conflicts also lead to traumatic injuries.

The BMJ has also just published a review of the management of splenic injury. These injuries also occur in other settings, and splenic injury can also be caused by malignancies and even medical procedures. The review focuses on the diagnosis and treatment of the condition, and includes a discussion of surgical and non-operative approaches.

Jose G. Merino is US clinical research editor, BMJ.