Thread by @wormmaps

If - like me - you sometimes feel a bit lost when you hear climate experts talk about "transformative social change," I have a bit of a theory about why. Heartfelt thoughts from a scientist who worked on the new #ipcc report 🧵

Let's start with the basics. The @IPCC_CH report released yesterday is clear about the need for transformative change - like the Special Report on 1.5C was before, like the @IPBES transformative change assessment will be. There are no half solutions to a planetary emergency.

I'm really grateful to other climate activists on Twitter and offline, who give me faith that we have both the courage to make those changes and the power to center them around ideas of justice and kindness.

But - you probably know this if we've met - I'm not the biggest "vague positive feelings" guy. I care about justice, and I care about change, but I constantly find myself grasping for specifics. I'm ready for transformative change, now give me the bullet point agenda, let's go.

Solving the climate crisis starts with transformative change to phase out fossil fuels. @EricHolthaus is right: net zero isn't transformative enough. It's not safe enough. Zero. Fossil. Fuels.

https://twitter.com/EricHolthaus/status/1498534282851237892

But - even though my work revolves around climate change - I don't really have a huge hand on that steering wheel as a scientist working in global health. And that's where I start to get frustrated - because so often we limit our imagination of transformation to mitigation.

For context: mitigation means "put less greenhouse gasses in the atmosphere, stop climate change." That's what November's #ipcc report was about, and another part will come out in April. But yesterday's report is more about adaptation: learning to live in a warmer world.

Yesterday's #ipcc report tells us that we face a planetary-scale crisis of adaptation. We have to learn to live in a world that's already a degree warmer and will probably pass 1.5 before we "win the fight."

Hundreds of scientists are telling you: we can adapt.

When people reply to my tweets talking about how this is the "end of the world," I get a bit sad - not because I think they're right, but because I think we haven't done enough to give people hope for transformative change through adaptation. I think they need specifics.

So let me talk your ear off as someone who studies health. I think health and healthcare are the most personal way we imagine climate change - it's part of why we default to saying things like climate change will "kill us all" when we're feeling despair. (It won't kill us all.)

Transformative adaptation also starts with zero: we deserve to live in a society where climate change causes zero preventable deaths.

The #ipcc report tells us that climate change will cause more heat sickness, more diarrheal disease, more dengue fever, more Lyme disease, worse mental health. How do we take that seriously and keep sickness from becoming death?

Weirdly, I think Covid shows us some specifics.

I was already working on the #ipcc report when the pandemic started, and pandemic response (+@viralemergence) pulled me away from it for about a year. I've got no fond memories of that point in time, but we learned a lot of specifics about what's broken in global health.

In particular, we learned that the U.S. itself is just absolutely broken. Our healthcare system was supposed to be the best prepared for an epidemic. But folks like @edyong209 have helped us understand why we were uniquely at risk of this exact crisis.
theatlantic.com/magazine/archi…

What went wrong?
🚨 the panic-neglect cycle
🚨 incompetent or malicious govt response
🚨 underfunded hospitals & health depts
🚨 discrimination and inequity in healthcare
🚨 vaccine inequity

Some of those give us obvious starting points for health sector planning: governments need to implement health adaptation plans now that are future-proofed. We need elected officials who prioritize climate change, and we need to hold them accountable.

There's also opportunities to fix policy at higher levels of multilateralism. Revising the International Health Regulations, and a #PandemicTreaty that puts health system strengthening first, could stop future epidemics in their tracks. And we'll need to:
biorxiv.org/content/10.110…

Pandemic ideas like breaking biomedical patents will also probably be relevant again soon. Big Pharma is planning to make billions off of vaccines needed because of climate change. They'll profit from the wealthy and withhold vaccines where they're needed.

https://twitter.com/wormmaps/status/1498370162583609348

All of that gives us a starting point based on what went wrong everywhere during Covid-19. But what about the United States? How do we deal with the fact that we failed so uniquely? What can we do with our healthcare system?

We need to talk about universal health coverage.

You might not know that UHC is about a kind of *outcome*, not a particular kind of approach. It just means that everyone can get the care they need - quality care, including specialist care (e.g., for disabilities, women's health, etc.) - without financial hardship.

The new #ipcc report is explicit: universal health coverage has to be a global goal. It especially matters at the frontlines of climate change impacts, like in African nations strategizing their pandemic recovery.

Like our measures of epidemic preparedness, we usually say that African and Asian countries are furthest from UHC, while the United States scores pretty high. If the cognitive dissonance feels familiar, it should.
thelancet.com/journals/lance…

It's hard to pin down the problem, because most Americans have "access" to health insurance and healthcare. But a third of Americans are underinsured, and a third of Americans have medical debt, even if they have insurance. If you're not one of them, you're one unlucky day away.

There are problems with access, like rural hospital closures, and limited specialist services, particularly covered by in-network care. And there are problems with quality: discrimination is at the heart of racialized healthcare gaps.

Here's the crux of it: because we tolerate for-profit healthcare and private insurance, many Americans don't have access to quality healthcare without a risk of financial hardship. With climate change, that's untenable. The transformative change is imagining something better.

My work led me to my politics here, rather than the other way around. I've never been a big universal healthcare guy; hell, I'll admit it - I was the guy heckling his Bernie supporter friends about "how will you pay for it!" in 2016. But two things have changed my mind.

The first is that before the pandemic, I read Health Justice Now by @crulge, and learned the history of modern private health insurance - a system our country invented, much to our own detriment - and the specifics of what we could do instead.

healthjusticenow.com

@crulge The second is this study in The Lancet - yes, that Lancet, where you get your Covid news, the top medical journal in the world - by @Alison_Galvani and colleagues, which shows that the Medicare for All Act would have saved our country $450 BILLION A YEAR.

thelancet.com/article/S0140-…

@crulge @Alison_Galvani We're at a weird moment politically - the Biden administration and especially the CDC doesn't seem keen on a competent pandemic response, let alone something sweeping and ambitious. We're struggling to handle new variants and make it from week to week.

@crulge @Alison_Galvani But the reason we're here is the same reason we're not ready for climate change. We've let something fester in our healthcare system, and it's gone systemic. You don't trust that you can get sick safely in our country today. You can't trust it in a warmer future.

@crulge @Alison_Galvani So I'm telling you, as a scientist, as someone who has been sick in this country, who has struggled with medical debt, who wants to survive a century of climate change as badly as you do: we have to take universal health coverage seriously in the U.S.

@crulge @Alison_Galvani UHC is the goal. Climate adaptation is the goal. Transformative change is the means, and if you want specifics about what that transformative change looks like, here it is: like re-setting a bone that healed wrong, we have to break what's here now.

@crulge @Alison_Galvani We should dare to imagine something as ambitious and transformative and *specific* as not being beholden to Pfizer and Morgan Stanley and Kaiser Permanente for whether we live or die through heat waves and viral epidemics. That's transformative. It's doable.

@crulge @Alison_Galvani I'm a believer in transformative change. I believe we can build a healthcare system that's kind and just in the United States. I think that's part of solving the climate crisis. That's all I want to say today. Thanks for reading.

@crulge @Alison_Galvani Quick corrigendum #1: I want to talk about the response that we have to go further and talk about capitalism. It's a driver of the problem, and on balance it's a blocker for both kinds of solution - mitigation and adaptation.

https://twitter.com/OmanReagan/status/1498729731159588864

The data are pretty unambiguous here too. Take this graph, which might be the most obvious example of how capitalism shapes health in a warming world:

https://twitter.com/wormmaps/status/1498452581127008258

But - and this *is* my personal politics, not my work politics - I find it overwhelming, even unproductive, that all roads lead here. Yes, that's capitalism's fault, not the people raising the point. But so many of our conversations dead end here.

"Beating capitalism" is like "solving the climate crisis" or "transformative change": it's big, it's all-encompassing, and I think it needs specifics. So my 2 cents: don't think of healthcare reform as a non-starter unless we "deal with capitalism". Think of it as a tangible step

Pharmaceutical companies and for-profit healthcare are part of how capitalism entrenches itself in American society - the basic power over life or death forces us to play the game. It changes how we think: when I switched from United to Kaiser, I was *gushing* about a corporation

So doing something about this part of the problem is doing something towards the whole. It's a piece of how we deal with the capitalist roots of the climate crisis. Divide, operationalize, conquer.