In an open email to CAHA, responding to CAHA’s comments on McKeon review, Professor Tony McMichael provides another critique of the McKeon review’s narrow approach to health and medical research.
This McKeon Review ‘consultation paper’ contains, for the wider social enterprise of public health research, a dismal but predictable set of recommendations. The name ‘NHMRC’ incorporates the words ‘Health and Medical’, but the McKeon Review panel membership comprised ‘medical’ rather than ‘health’ persons — eminent researchers in laboratory and clinical science — along with a strong representation of the private for-profit business (including biotech) sector.
Of course, it’s easy to rail against this McKeon Review output and the restricted, orthodox, and somewhat closed-shop NHMRC mentality. However, the document also provides a sobering reminder of the fundamental problem that societies face today in their need to expand their concern, research effort, resources and policy to abating the big, and unprecedented, systemic threats to population health and survival from human-caused climate change and other extraordinary global environmental changes. These threats to health are of a kind not previously faced, and a broad and distinctive genre of research in relation to them is required.
The committee members are very able people who, variously, have great intellectual, reputational and financial investments in the status quo; they are at the top of their professional pyramids; and they probably cannot imagine a different world in the near future with a radically different spectrum of health-risk issues.
History has seen it all before. As prolonged droughts closed in on the Maya civilisation in the ninth century, contributing greatly to the weakening of the agricultural base (already stretched by a population that had expanded substantially), the rulers and opinion-leaders opted for ever larger edifices and grander ceremonies. They had, presumably, little understanding or interest in the increasingly precarious longer-term prospects of their society. Hay was to be made while the sun shined. It was business as usual, but always with a growing appetite for ever-more resources.
Dubai today is following suit, in a region of the world where they have had to give up trying to grow their own grains, now that their once-only aquifer supplies have been depleted. Meanwhile, the sheikhs and financiers opt for world-tallest buildings and creating (and selling) artificial island ‘nations’ in the Gulf that have been built to a mere couple of metres above the (rising) sea level.
The McKeon Review perspective is of a kind with these assumptions of business-as-usual (in a stable world). It is not surprising that the Chief Executive of Medicines Australia, Brendan Shaw, has been quoted as saying this week: “We are encouraged by the McKeon Review’s recognition of the importance of clinical research both as generator of economic benefit, but more importantly as a generator of health benefits for Australian patients, and the recognition of the important role the medicines industry plays in this.
For more detail on this issue, see the following excerpt from the Climate and Health Alliance’s submission to the McKeon Review:
The Australian and global population face the most serious threat to global public health in human history, with global mean temperatures now predicted to rise by three degrees by the middle of this century. Yet little research has been conducted to understand the implications of a temperature rise of this magnitude on the Australian community.
There is little research on the links between anticipated population growth and population health, and almost no research on the likely impacts of climate change, ecosystem disruption, or energy and resource scarcity on births and deaths.
While there have been laudable efforts to investigate strategies for adaptation from unavoidable climate change, a focus on mitigation has been demonstrably absent from the climate and health research agenda in Australia.
Climate change threatens natural and built systems that protect and preserve health, ranging from direct infrastructure damage to disruption of the social and organisational structures required for community resilience.
Research is needed to support the health care sector respond to the risks from climate change and to commence the necessary transition to becoming a low emissions industry. This includes identifying risks to existing infrastructure as well assisting the sector to transition to low carbon operations, through the identification of effective strategies to cut emissions and minimise the environmental footprints of health care service providers and healthcare institutions.
Australian policymakers, the health sector, and the Australian community are seriously underprepared for the predicted approaching environmental crisis, which will likely have severe implications for economic and social stability, and pose unprecedented risks for health and wellbeing.
There is an important role for health and medical research to make more explicit the relationship between human health and broader determinants of population health in relation such as healthy ecosystems, biodiversity, energy production, waste, transport, food and agriculture, industrial practices, water use, and citizen engagement, for example.
The Climate and Health Alliance recommendation to the review were:
1. The establishment of a national health priority related to environmental protection, given the current and predicted threats to natural ecosystems and biodiversity, the essential underpinnings of human health and wellbeing
2. A substantial increase in the funding available for climate and health research in Australia, including a specific emphasis on mitigation research to evaluate the health consequences of unmitigated climate change as well as evaluating the health benefits of effective action for mitigation
3. The establishment of an international catalogue of climate change impacts, research needs and projects and outcomes, as well as existing national and international collaborations to help improve coordination and dissemination of findings and research outcomes
4. Increased research on climate change communication to support translation of evidence into policy action
5. Expanding health and medical research programs to support interdisciplinary research in developing nations to support adaptation and climate change response strategies.
Prof Tony (AJ) McMichael, AO, is a medical graduate and epidemiologist at the Australian National University. He heads a research program on the health risks of climate and environmental change, present and future and is a member of the Science Advisory Panel to the Australian Government’s Commission on Climate Change (2011-2012).
The Climate and Health Alliance was established in August 2010 and is a coalition of health care stakeholders who wish to see the threat to human health from climate change and ecological degradation addressed through prompt policy action. This commitment is based on the understanding that further global warming poses grave risks to human health and biodiversity and if left unchecked, threatens the future of human civilisation.