Richard Smith reflects on a recent webinar on Climate Justice, Health Inequalities and the Climate Crisis hosted by the UK Health Alliance on Climate Change

The world is warming rapidly, and, as the Intergovernmental Panel on Climate Change keeps telling us, we are running out of time to avoid catastrophe and the possible extinction of humans. We seem to be unable to make the great changes we need at every level from the global to the individual. We can probably all agree that action is better than despair, but what action should we take?

Presently our main aim is for countries and the organisations within them, including health systems, to reach carbon net zero in order to keep the increase in global temperature as low as possible—preferably below a 1.5C increase over pre-industrial levels. Those from the health community working on climate change tend to divide into those campaigning to get the whole economy to net zero by, for example, stopping any new exploration for fossil fuels, and those who work within the health system by, for example, encouraging the use of low-carbon inhalers. We need both lines of work, but are they enough and are they the best approach?

Avoid tunnel vision and work for climate justice

They are needed but are not enough and are not the best approach, said Abi Deinvanayagam, a clinical fellow in public health, at a webinar organized by the UK Health Alliance on Climate Change (UKHACC), which I chair.   Concentrating on reducing carbon emissions means that we are suffering from tunnel vision and not seeing the linked factors of inequality, the water crisis, biodiversity loss, poverty, and other factors. A better approach to the planetary crisis is to pursue climate justice.

Since the beginning of the industrial revolution North America and Europe have produced nearly two thirds of greenhouse gases and Africa only 3%,  yet Africa is already suffering more from the planetary crisis and will suffer more than countries in the North. The richest 10% of people, most of them in high income countries, produce half of the greenhouse gases while the poorest 50% produce only 10%.

Rich people can protect themselves from extreme temperatures with air conditioning (making the problem worse), while poor people working in fields are the most exposed.

In addition, pointed out Deinvanayagam, it is injustice over centuries that has led to these differences. Colonialism meant that countries like Britain and France built empires and exploited the people and land of countries in the South, growing rich in the process. Those speaking in the webinar used the word “extractavism,” which “describes economic activities that remove large amounts of a nation’s natural commons for sale on the world market with little or no processing.” In the webinar the term was extended to mean extracting labour from people, many of them slaves or very poorly paid. Racism meant that the colonial powers could justify their unjust behaviour by arguing that they were helping an inferior people.

Think in systems and move from an extractive to a living economy

Instead of simply concentrating on reducing carbon emissions we need to “think in systems” and move from an extractive to a living economy, said Guppi Bola, author of Reimagining Public Health and chair of the Joint Council for the Welfare of Immigrants. She shared a diagram that she carries in her head and explains what is meant by moving from an extractive to a living economy and how it can be achieved. 

We must move from a consumerist and colonial worldview to one of caring and sacredness. Instead of extracting, digging, burning, and dumping we need regeneration. Our purpose should not be the enclosure of wealth and power but ecological and social wellbeing, and our system of governance should not be militarism but “deep democracy.” We shift from exploitation to cooperation.

The transition from the extractive to the living economy is achieved in essence by moving power and resources from one to the other. Economic control must lie with communities. Wealth and the workplace are democratised. Ecology is restored, and production and consumption are localized. Racial and social justice are central as is retaining and restoring cultures and traditions.

Move beyond the “white, Western, European imagination”

An important step in moving to a better world will be to recognise that there are many realities, not simply one, said Araceli Camargo, a neuroscientist of indigenous American descent in ‘Turtle Island’ (the Indigenous American name for North America). The “white, Western, European imagination” has spread across the world and “taken away our languages.” This Western imagination “takes away our beingness,” a river becomes a transport system. We should connect with other less exploitative ways of imaging the world.

This was all heady stuff, inspiring to many of the people attending the webinar. I am attracted by the idea of reimagining the world and moving from an extractive to a living economy, and in the Lancet Commission on the Value of Death that I cochaired we emphasised the importance of systems thinking, created a realistic utopia, and called for major changes in values and the restoration of traditions.

 And a major influence on my thinking has been Ivan Illich, a critic of industrial society who advocated in the 60s and 70s much of what was advocated in the webinar. I also reviewed favourably a book Plenitude by the economist Juliet B Schor that argued for something very like the living economy.

But is this the right way to go?

But at the same time I was left with severe doubts about what was being advocated, particularly about its practicality. Why? I felt the need to try and explore and explain my doubts, the origin of this blog.

Language is a problem, people may not be persuaded

The first and most unimportant reason is language. Justice is a positive word, and the injustice of the planetary crisis is clear. Colonialism and racism are causes of the crisis, but they are words that unnerve some. Extractivism is a new word to most and must be explained, and it’s meaning seems to be extending beyond extracting from the earth to extracting from people. The extended word brings its meaning close to the meaning of capitalism, a word that divides people. There might need to be more thought put into the language used if it is to bring people.

The right language is needed to persuade people of the necessity of change, but I fear that persuading people to give up out-of-control consumption will be hard, analogous in my mind to the difficulty of mobbing away from a system of overtreatment at the end of life. We will, of course, need to move away from excessive consumption to achieve net zero. This will not mostly be a matter of persuasion but of political change, but that change is going to be hard without a population that not only accepts the change but calls for it.

Have we left it too late with such a populated world?

My second anxiety is that we may have left it too late to make the move, which brings to a very sensitive subject, population. Indigenous people like Aboriginals of Australia lived in harmony with the earth for tens of thousands of years, whereas the Europeans who arrived some 200 years ago have adopted an economy that has led to Australia suffering severe damage already with much more to come. But there were considerably fewer than a million Aboriginals and they lived as hunter gatherers. Few survived into old age. 

For some 200 000 years Homo Sapiens lived without damaging the planet, but the appearance of farming led to cities, pandemics, specialisation of professions, inequalities, the growth of knowledge and population, and eventually the industrial revolution and an atmosphere filled with greenhouse gases. It is not entirely fanciful to see a parallel with the fall of man, Adam and Eve being expelled from the Garden of Eden after tasting of the Tree of Knowledge.

In the 80s I heard Paul Ehrlich, a Stanford professor and author of The Population Bomb, describe how because of overpopulation millions would die from starvation within a few decades. He was wrong. Famines have become less common. And the anxiety about overpopulation led to some abusive practices liked forced sterilisations in India and the one-child policy in China.

Ehrlich’s apocalyptic warnings have led people to be sceptical of all such warnings, including in relation to the planetary crisis, but his warning may have been right—but in a different way from how he predicted. People have not died in their millions, although probably a billion people go to bed hungry each night, but we have resorted to intensive, industrial farming of land and animals to feed people. That farming is heavily dependent on fossil fuels for fertilisers and energy and is slowly destroying the soil on which life depends. The apocalypse may simply have been delayed and take a different form, but population is still part of the problem.

When I was born in 1952 world population was just over 2.5 billion. It’s now nearly 8 billion and is expected to reach 9.8 billion in 2050, and 11.2 billion in 2100. Whether the world can support its current population and be sustainable is debatable. Discussion of population is sensitive not only because it involves a basic human right but also because it can seem racist—because it is people in the Global South who continue to have many children. It’s crucial to recognise that consumption is more important than population in determining harm to the planet—the average Australian emits the same amount of greenhouse gases as 50 Rwandans. Unfortunately for the planet, Rwandans aspire to live more like Australians, and Australians would struggle to live like Rwandans.

Have we, I wonder, with such a high global population got time to move to a living economy and would a living economy be able to support 10 billion people? Might we be dependent on modern science to support such a population? In Regenesis: Feeding the World Without Devouring the Planet a book just published by the environmentalist George Monbiot joins with many others in arguing that our current agriculture and food system is unsustainable. But he argues that we can feed the world population with big changes in farming and what we eat, in particular substituting meat from exploited animals with “meat-identical proteins and fats made from plants, fungi and….genetically modified bacteria” that require little land.

Now may not be the time for a major change and is the living economy sufficiently thought through?

Other worries that it may not be wise, regardless of whether we can feed 11 billion people, to try and make a major change from an extractive to a living economy when we have so little time left to avoid catastrophe and that what we are changing to is as not as clear as it needs to be.

Just before the pandemic I attended a debate with the motion “To stop climate collapse, we must end capitalism” between Monbiot and Adair Turner, chair of the Energy Transitions Commission and the first chair of the UK Climate Change Committee.  A vote before the debate showed that 38% of the well-heeled audience of about 500 supported the motion that capitalism must end; 28% were against, and 34% (including me) were undecided. By the end more than half of the audience, including me, were against the motion. I see considerable overlap with the debate over changing from an extractive to living economy, and Monbiot argued for something that sounded very like the living economy.

Both speakers saw the severe flaws in our current system and agreed that there must be substantial change to avoid catastrophe, but Turner won the argument on two main points. Firstly, he argued that this was not the time to be making such a whole system change when we had so little time to avoid a planetary collapse. He talked of how it would be essential to convince the Chinese with whom he worked closely and who are the biggest emitters of greenhouse gases, and he thought that the Chinese would laugh at him if he suggested such a change. Worse, they would wonder why he wanted them to change from a system that made Western countries rich. Did he want them to stay poor? The second argument that won the debate for Turner was that the economy Monbiot was advocating was far from worked out, and to make the change would be a leap in the dark at a perilous time.

I think that the same arguments apply to the transition from an extractive (capitalist) to living economy. This is not an argument that it shouldn’t happen but that it may be necessary to concentrate on avoiding an increase in global temperature, recognising that that will require big change, before changing the whole economy.

“Many priorities” is no priority: concentrate on reaching net zero

Finding a way to live in harmony with the planet will require huge change, but the argument for concentrating on one target—achieving net zero to keep global temperature increase as low as possible—is that it is more likely to be achieved than trying to change the whole system. A counter argument is that concentrating on one part of a system when the whole system needs to change leads to failure. 

But a strong advantage of working on net-zero and global temperature is that we have data and targets. We can know how well or badly we are doing.


The arguments advanced in the webinar are very attractive, and I’m convinced that we must keep climate justice at the centre of all campaigns to achieve sustainability. I’m also convinced that we need to make big changes in how we live, including in our economies and our health systems, but I’m unconvinced that we have the time and space to pursue the strategies advocated in the webinar. Our best strategy may be to make the major changes we will have to make to achieve net zero and then work to achieve a much fairer, more just world. I am old (70) and may, of course, be wrong. The world belongs to young people and the people who are yet to be born.

Richard Smith is the Chair of the UK Health Alliance on Climate Change