COP28 Series: Climate Change and Health, Non-Communicable Diseases (NCDs)
According to the World Health Organization (WHO), non-communicable diseases (NCDs) kill 41 million people each year, which is equivalent to 74% of all deaths globally. Of these, the biggest killers are cardiovascular disease, cancers, chronic respiratory diseases and diabetes. The United Nations Sustainable Development Goal 3 includes an ambitious target of reducing premature deaths from NCDs by one third from 2015 levels to 2030. In order to achieve this, significant developments will be needed both in tackling the causes of NCDs and improving treatments.
According to Our World in Data, as well as the latest report from NCD Countdown 2030, the rate at which the death rate from non-communicable diseases has been declining has slowed down in recent years. At this stage, few countries are on track to achieve the UN goal of reducing premature deaths from NCDs by a third by 2030. With climate change putting increasing pressure on health systems around the world, it is clear that technological advancements, both in treating and preventing NCDs, will be vital if the world is to get back on track to meeting the UN goals.
The links between climate change, rising incidence of NCDs and declining outcomes are becoming ever clearer. For example, the link between declining air quality and chronic respiratory diseases such as asthma has been known for decades.
However, extreme weather events, which are becoming ever more frequent, can also have long term impacts on our health. Heat waves increase the risk of cardiovascular diseases, such as strokes. Drought and floods can affect supplies of fresh food and water. A recent study has also linked particulate pollution from wildfires to an increase in lung cancer globally in recent decades. Extreme weather events can also affect primary healthcare infrastructure and healthcare supply lines, disrupting treatment plans and reducing access to healthcare. This article from the American National Cancer Institute (NCI) highlights the long-term lower survival rates in cancer patients in areas affected by hurricanes due to delayed diagnoses and interruptions in care. Treatment options which are more effective as well as offering reduced hospitalisation time and increased flexibility are needed to combat these impending changes.
New technologies to combat NCDs
The EPO highlights the problem of rising incidence of NCDs in its recently released study on patents and innovations against cancer. It is predicted that, by the age of 75, 31% of men and 25% of women will be diagnosed with cancer in the EU alone. However, it is not all doom and gloom. Innovation relating to cancer diagnosis and treatment continues to boom. The EPO’s patent trends act as a proxy for innovation in the cancer space; patenting in this area increased by 70% between 2015 and 2021, showing the importance of technological advances in this area.
The EPO has also launched a platform (“Technologies combatting cancer”) dedicated to improving access to the technological know-how in patents for cancer researchers and innovators. This is the fourth knowledge-sharing platform launched by the EPO, following similar initiatives focussed on coronavirus, clean energy technologies, and firefighting. The platform underlines the importance of the patent “bargain”: making inventions public in exchange for commercial protection. The platform aims to allow innovators to make the most out of any inventions given patent protection, to the benefit of the wider public. The scheme also highlights how the patent system can work together with innovators to further future research and development to the benefit of the public as a whole and the EPO championing initiatives like this aims to boost innovation in key target areas for public benefit. This is likely to be increasingly important in addressing climate-driven NCDs.
The EPO’s cancer innovation study highlights specific areas such as AI, gene therapy, and immunotherapy which are driving a particular rise in patent filings and are set to play a big role in the cancer treatments of tomorrow. Another area likely to transform the future of cancer diagnosis and treatment is personalised medicine. The field of personalised medicine has been born out of the increasing power of bioinformatics to build accurate models of cancer. By taking into account genetics, environmental and lifestyle factors, it is possible to determine the risk of a particular individual of developing a particular cancer with ever increasing precision. This will allow for earlier cancer diagnoses, which are associated with improved outcomes.
Personalised medicine can also be used to inform cancer treatment. By profiling the genetic markers of a given patient’s cancer, as well as their own genetics, models can predict whether the patient needs, or is likely to respond to, a particular course of treatment. This allows practitioners to select the most effective treatment on a patient-by-patient basis, improving outcomes and survival rates.
According to the EPO, between 2002 and 2021, over 50% of international patent families in the area of personalised medicine list universities, hospitals, and public research organisations as applicants. The EPO highlights the success story of OncoMark, a spin out of University College Dublin which commercialised their diagnostic assay for early-stage breast cancer and was later acquired by Cepheid, a US molecular diagnostics company. This assay was able to determine those at high risk and low risk of cancer recurrence after surgery, meaning that only those patients who needed it would receive a course of chemotherapy, which often comes with negative side effects.
Strengthening the climate resilience and environmental sustainability of health systems and facilities
Improving the efficiency of NCD treatment through innovations like personalised medicine will also help to drive down the carbon emissions of the healthcare system (which is thought to be responsible for almost 5% of global greenhouse gas emissions). For example, the provision of medicines and chemicals is the single largest source of greenhouse gas emissions in the NHS. Through earlier diagnoses and better targeting of therapies, personalised medicine has the potential to significantly reduce the overall amount of drugs needed for cancer treatment (and other treatments), which would result in reduced emissions from the pharmaceutical industry.
Reducing greenhouse emissions of the healthcare industry was a key focus of COP28, and formed one of the commitments of the Declaration on Climate and Health. Signatories of the declaration also commit to better integrate health considerations into climate action plans such as the Paris Agreement. COP28’s dedicated “Health Day” presented case studies which showcase how new technologies and innovations can mitigate the effects of climate change on our health across three main areas, as discussed below. Some of these are technological solutions, while others are social initiatives, and it’s clear that both technological and social solutions will need to be leveraged in a complementary way in order to address the aims of COP28 in the most impactful way.
Emvolio portable solar-powered refrigerator
An example of technological innovation showcased at COP28 is the development of a portable, medical-grade refrigerator equipped with a battery powered by a 100 W solar panel. The device is known as the “Emvolio” and is described in patent application WO2020/201868. The product has been deployed in both India and Kenya to maintain primary healthcare during periods of intermittent power supply, such as extreme weather events. It has also been used to increase the reach of vaccination programs (e.g. COVID-19) to remote areas, such as the Himalayas in North East India, with doctors reporting that twice as many children can now be reached in these areas. It is hoped that this technology can be rolled out to increase the reach of vaccine programs worldwide, as well as increasing the resilience of healthcare systems to extreme weather events.
Delivering a Net Zero NHS
Decreasing the carbon emissions of healthcare systems will be vital to tackling climate change. One case study focussed on NHS England, which has invested almost one billion dollars in decarbonisation projects on its estates and facilities. As the first national health service to pledge to reach net zero by 2050 at COP26, NHS England is leading the way in reducing the greenhouse gas emissions of the health industry in developed nations.
NHS England has committed to decarbonise its estates by 2040, which includes eliminating 3.1 megatonnes of greenhouse gas emissions from NHS building energy and water use. Diving a little deeper into the details of NHS England’s plan, it is clear that the introduction of greener technologies will play a key role in decarbonisation.
As highlighted at COP28, reducing emissions from the NHS estates includes significant investment into renewable energy, notably the installation of ground-source heat pumps, solar panels and LEDs in hospitals across the country. NHS England also contributed to the development of the world’s first hydrogen/electric hybrid ambulance in partnership with ULEMCo (first debuted at COP26).
As mentioned above, a significant proportion of the NHS carbon footprint comes from the medicines and chemicals needed for the health service. One key contributor is metered-dose inhalers (MDIs), which accounts for 3% of the total greenhouse gas emissions of the NHS. This is primarily due to the accelerants used in MDIs. Many MDIs use hydrofluorocarbons (HFCs) as accelerants, which have a much higher global warming potential (GWP) than CO2. Progress in this area is already being made; for example patent application WO2012156711 describes an HFC with a GWP up to 90% lower than HFCs currently in use, with the first MDIs utilising this propellant expected to be launched in 2025. With climate change seemingly driving an increase in respiratory diseases such as asthma, the use of inhalers looks likely to increase in coming years. It is therefore vital that technological innovations continue to be made, for example reformulating pharmaceutical compositions for use with low-GWP propellants or in dry powder inhalers (DPIs), to reduce the environmental impact of inhalers if the NHS is to meet its net zero goal.
Addressing the health impacts of climate change
The case studies presented at the COP28 Health Day also included schemes designed to improve the climate resilience of healthcare systems around the world. For example, one study focussed on a project launched by the Green Climate Fund to provide training and resources to the Lao People’s Democratic Republic to equip their health system to cope with a predicted average temperature rise of 2-3 degrees and a 10-30% increase in rainfall by 2050.
Other case studies focus on direct action which can simultaneously reduce carbon emissions and improve health, such as the EcoBici cycling scheme in Buenos Aires. The scheme allows citizens to rent bicycles for free, available 24 hours a day, every day. Since 2009, 286 kilometres of cycle lanes have been built throughout Buenos Aires, linking schools, universities, and hospitals across the city. The impact of the scheme is clear, since 2013 there has been a 131% increase in the number of bicycle trips made in Buenos Aires. In 2020, cycling accounted for 10% of all trips made in the city. Along with a reduction in greenhouse gas emissions, choosing to cycle can also substantially improve cardiovascular health, reduce metabolic disease, and improve fitness.
The future of climate and health
The prominence of health as a topic at COP28 served to highlight how our wellbeing is inextricably linked to climate change. Extreme weather events and declining air quality not only contribute to a rise in the incidence of NCDs, but also to declining patient outcomes by interrupting access to healthcare. Accordingly, it seems ever more likely that, if the UN goal of reducing premature deaths from NCDs by a third by 2030 is to be met, new technologies will be vital, not only to mitigate the impacts of global warming and climate change which are driving a rise in NCDs, but also to develop new treatments to improve survivability rates.
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