Why should nurses care about Climate Change and Nuclear War?

Climate Change and Nuclear War. Why is matters with Patricia Nayna Schwerdtle

• PhD Candidate, Heidelberg Institute of Global Health, Heidelberg University, Germany
• Adjunct Academic, Nursing & Midwifery, Monash University, Australia
• Vice President, Medecins Sans Frontieres, Australia

THIS IS PART 2 OF OUR INTERVIEW WITH PATRICIA. GO HERE FOR OUR INDEPTH Q&A PART 1

2020 was a rollercoaster of a year. There are several issues you are passionate about which Covid19 has taken the spotlight off in some sense.

Firstly, what is your position or views on President Donald Trump’s removal of funding to international NGOs and relationship with the WHO?

I’ll speak about MSF because it’s the Australian NGO I know best. MSF doesn’t accept government funding. This is so that MSF can remain independent and respond to humanitarian crises based purely on needs. This relates to a core humanitarian principle of ‘impartiality’- ensuring that the provision of humanitarian care is provided without discrimination on the basis of nationality, race, gender, religion, political opinion or class but based on need alone.

Almost all MSF funding is from private donors and in Australia, most of our income comes from individuals making regular monthly donations. MSF donors support the notion that everyone should have access to healthcare regardless of who or where they are. The pandemic has highlighted how critical universal healthcare is and the fact that no one is safe from COVID19, until we all are.

One of the first things Donald Trump did when he took the Presidency was re-instate the ‘global gag rule’, cuting off funding to all NGOs that provide safe abortion care services or related advocacy. The global gag rule means some vital NGOs were forced to reduce or close healthcare services that are often the only source of  reproductive healthcare for women. Some NGOs provide  the only point of medical contact for other primary healthcare services, such as cervical screening, HIV prevention, testing and counselling, STI prevention and treatment, pre and post-natal care and even newborn healthcare. So whilst this policy continues to be revived it is an extremely damaging policy that leads to more unsafe abortions and poorer health outcomes for women, families and communities.

It’s hard to overstate how damaging the potential withdrawal of the US from WHO and the Paris Agreement will be for global health and sustainable development. The Paris Agreement was a monumental achievement for human solidarity in the face of a common existential threat. It is truly amazing what the WHO achieves with their budget and teams. WHO’s entire global budget is about half what Nestle spends on advertising each year. Where are our priorities as human beings? The biggest threats to global health and stability are common threats: Climate Change, global pandemics, nuclear war. When protecting humans from these threats, governing bodies really have to rise above national interests and see the bigger picture. We owe it to past, current and future generations.

Why are nurses so important in the fight against global pandemics?

Indeed nurses and midwives are the largest group of health professionals and can be found in every single MSF project. Nurses and midwives provide the vast majority of healthcare worldwide particularly in low-income countries. This amounts to 80% of primary healthcare services, and 90% of maternal and child health care services (State of the world’s nursing report, WHO, 2020). Those numbers are overwhelming, I always have to double check them to be sure!

I don’t think nurses are being supported to reach their full capacity or extend to their full scope of practice in many settings in the global North and South. There are many reasons for this, but it is at least in part due to historical systems and a bias towards the biomedical (curative) model, both socially and financially. Nurses are the greatest investment in health and therefore have the biggest influence on patient outcomes. Acknowledging, supporting and investing in nurses will make the huge difference to our success in terms of attaining the ambitions of the Sustainable Development Goals and achieving universal healthcare for all.

How do we build the recognition and capacity of nurses?

With climate change and the degradation of natural systems and habitats, it is likely there will be more zoonotic diseases and the next one may be more infectious and more fatal. We could consider COVID19 a stress test of our health systems and consider what changes are necessary to improve future responses to shocks like global pandemics. The extent to which the world is connected means we all rely on eachothers health and health systems. Nurses are well known to be the lynchpin of these health systems.

Nurses need better representation at all levels of leadership, management and governance. They cannot be left without a seat at the assessment, planning, implementation or evaluation table on any matters pertaining to health or health determinants. Systems need to shift toward seeing the cost-benefits of investing in nurses and midwives – supporting them to achieve their full capacity and full scope of practice.

We will also need a great deal more nurses (6 million by 2030 – WHO State of the Worlds Nursing Report, 2020) in order to meet the needs of a growing and aging population. To meet that target, governments will need to invest more in nurse/midwifery training and development and improve working conditions. It would help if societies began to understand how much nursing and midwifery has and is changing and recognise it as a brilliant career opportunity. The COVID19 applause for health workers from frontyards will need to extend well beyond 2020 and translate into good strategy, concrete policy, supportive attitudes and adequate funding.

How does climate change adversely affect health by increasing human vulnerability and exposure to climate-related stresses?

Climate change is primarily a health issue. This is because human health depends on the health of natural systems. Just like all other organisms in our biosphere, if our habitat deteriorates, we get sick and can die. This happens directly, for example through extreme weather events and wildfires and indirectly, through changing patterns of infectious disease and compromised water and food security. Under some circumstances, climate change also acts as a threat multiplier of conflict and migration with consequences for human security, health and wellbeing. Although this is not always the case and climate change can also lead to increased solidarity, adaptation and reduced migration (trapped and immobile populations).

The huge injustice that we shouldn’t be able to stomach, is that climate change most significantly affects the people who are least responsible for the emissions that causes it – people living in low-income countries who are reliant on a stable climate for their livelihoods and survival. I’m passionate about addressing climate change because I think it’s the greatest issue of our time. Imagine your grandchildren rang you from the future and asked you what you did? Would it be enough with the knowledge and capacity we currently have to change this story today? We’ve inherited a planet that may be the only one with intelligent life on it in the universe, and we have a narrow window to protect the health and wellbeing of future generations and in the long term, the continuation of our species.

Why should nurses be engaged in the discourse around climate change?

Nurses, midwives and all health professionals play a key role in addressing climate change. We have developed good knowledge of the impact of climate change on health; we have the tools to address the problem; and we have proximity to the public who trust us and need to know about the threat and what to do about it.

Apart from preparing health systems for the impact of climate change we also have a key role in mitigating the impact. Every tenth of a degree of warming makes a difference. If the global health care sector were a country, it would be the fifth-largest greenhouse gas emitter on the planet (Health Care without Harm, 2019). Healthcare contributes significantly to climate change, so ethically, nurses and health professionals have a responsibility to ‘first do no harm’ – nurses are ideally placed to influence environmentally sustainable healthcare.

How do we improve engagement? At this critical point in time, health professions educators should be actively implementing, evaluating and improving education for sustainable healthcare also known as ‘planetary health education’. You don’t need to be an expert to do it – the tools are there, you just have to start the conversation, engage and persist.

The forgotten crises of nuclear war.

The doomsday clock has never been closer to midnight (yes, never – not even during the cold war) and we have never talked less about the threat of a nuclear incident. Why this is the case continues to baffle me but the expressions I get when I talk about it are even more baffled.

The truth is, there have never been more, nor bigger nuclear weapons on earth, as a result of nuclear proliferation. Other than the number and size, nuclear weapons are aging, geopolitics can be unpredictable and volatile and policies like ‘sole presidential authority’ and ‘mutually assured destruction’ are extremely concerning. We have inherited a system and international relations that make this a very ‘wicked problem’ indeed and so this definitely needs to be higher up on all government agendas.

The threat is not just all out nuclear war but also small scale conflict (enough to cause a nuclear winter) and also accidents. One just has to review the list of close calls to see how fallible creatures humans are: A flock of birds or a moon rising over Norway mistaken for incoming missiles, the story of Stanislav Petrov and the Cuban missile crisis.

It’s important to note there is no meaningful humanitarian response that can be planned to respond to a large scale nuclear incident – not even palliative care. With the size of nuclear weapons today this could potentially leave hundreds of millions of people affected. Imagine what that might look like. Perhaps that is why it is a forgotten crisis – because there is very little we could do however, this is exactly why we should be putting all our efforts into disarmament (ICAN).

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We hope you enjoyed these extra questions with Patricia! This was PART 2 of our interview. For our Part 1 indepth Q&A on a range of questions about her career GO HERE FOR OUR INDEPTH Q&A PART 1

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