National Emergency Briefing: Health

The main thrust of this talk was that the speaker knows from firsthand experience how to recognise an emergency, how to act in an emergency, and how to have those tough honest conversations that are sometimes needed at such times; and that the climate emergency IS an health emergency and needs to be responded to as such. At the same time, the actions we need to take because of this emergency are in themselves an opportunity to improve health outcomes, so why wouldn’t we just get on and do it?

As a doctor working in a north London intensive care unit, Professor Montgomery began by making the point that he knows what an emergency looks like and he knows how to respond to an emergency - you respond with genuine action. He is used to having what he calls ‘honest conversations’, those discussions about life and death and the difficult decisions people have to make along the way. His presentation is very much an honest conversation with us, his audience.

In an article in The Lancet in 2009 the statement was made that ‘climate change is the single biggest global health threat of the 21st century’. The risk, the chances of it happening, was being discussed back then but the hazards, the harm that might transpire as a result, were not, or at the very least, not enough. This is not about what might happen in some far distant time, ‘It’s about the survival, not of future generations, but of my son, who was 20 last Sunday.’

The Lancet Countdown maps 20 indicators of the health hazards of climate change annually. In 2025 12 of those 20 indicators broke records of hazard. They get worse every year because of the consequences of climate change eg heatwaves, higher rainfall, and then the impacts of those consequences eg fire, drought, flooding etc. Fire can cause respiratory disease, asthma, COPD but the really worrying consequences are the less direct ones. When crops fail and hunger ensues it is followed by social unrest and possibly migration, and even a breakdown of functional economy and thereby no functional health care. The real killer is the breakdown of our systems.

The economic consequences of climate change will be considerable over the decades to come. Professor Montgomery quoted the Institute and Faculty of Actuaries saying ‘At 3C or more of heating by 2050, there could be more than 4 billion deaths, significant sociopolitical fragmentation worldwide, failure of states (with resulting rapid, enduring, and significant loss of capital), and extinction events’. 

The same message is coming from so many sides, from scientists and academics, from actuaries, from ecologists, from the food industries. The last state of the climate report summarised it as ‘this is a global emergency beyond any doubt’.

At the end of his presentation Professor Montgomery returned to where he had started, reminding us that he can recognise an emergency, that this is one and we must treat it as one. We need transformational change now if we are going to survive.

By contrast, taking action will bring health benefits. Increasing active travel will reduce particulate pollution and increase physical fitness. Getting rid of gas boilers also reduces particulate pollution. A plant based diet brings health benefits.  These obvious wins simply make sense. With these changes ‘we get longer lives, lower emissions and enormous cash savings’. Fixing obesity alone would save the country £126 billion a year. Taking action on climate change is the biggest health opportunity of our lifetime, cutting emissions and disease together.

‘This is no longer a risk. Without action, these impacts are certainties and the hazards are catastrophic.’

Those who end up having an ‘honest conversation’ with Professor Montgomery in his work at the hospital undoubtedly find those conversations just as difficult to hear, but sometimes there are things that you simply need to hear.

Professor Hugh Montgomery

Director of the Centre for Human Health at University College London

Hugh Montgomery is a Professor of Intensive Care Medicine at UCL and co-leads the Lancet Countdown on Health and Climate Change. A clinician, researcher, author, and environmental advocate, he founded UCL’s MSc in Climate & Health and health-sector non-profit Real Zero.