In South Africa, one of the major concerns of many people is a disintegrating public health system and an increasingly expensive private health system. Other national concerns are the failing education system, the level of corruption in government and general lack of delivery. But, while all of those are important, most of us are still too complacent about something that will alter our lives irrevocably – climate change.

If you read anything on geology and the history of our Earth, you will see that we are probably coming to the end of one of the most climatically stable eras in our planet’s history. Climate change is inevitable and with it, massive changes in our way of life.

To my mind, having read extensively on the subject (wearing the hat of the scientist I was before I did medicine) I am convinced that there are major anthropogenic causes for the current global warming – which is shown conclusively by measurements going back hundreds of years. Along with this are ice cores showing the growing load of carbon dioxide in the atmosphere, far in excess of what is required for the greenhouse effect that keeps the Earth habitable. These massively rising levels of carbon dioxide and other greenhouse gases have come about since the 1950s when there was a massive surge in the use of fossil fuels in our industries, as well as the start of the rising consumerism that is part of the problem.

Most of these greenhouse gas emissions have come from the West – massive industries, a high standard of living which consumes relentlessly and produces a large carbon footprint. But, in Africa, South Africa plays the role of the West – our carbon footprint is large and, apart from our industries, is produced by a relatively small part of the population who are able to live the Western lifestyle. In the latest round of talks on climate change – unsatisfying as they were – countries such as South Africa, China, India and Brazil were no longer able to hide behind the label of ‘developing world’ and claim that they needed to continue to pollute in order to develop.

Climate change will affect every aspect of our lives. In the Western Cape we are already seeing a change in the seasons, with lower winter rainfall, later onset of summer and higher temperatures later into the year. This will affect agriculture – it already is – and those who are at subsistence level suffer the most. As with nearly all adverse man-made phenomena it is the poor who bear the brunt.

The overall effects on individual health – and population health – still remain fairly speculative, but it is almost certain that there will be an effect on health and well-being. The first effects are seen in people whose livelihoods have been taken away already – subsistence farmers in remote parts of the northern Cape and fishermen on the west coast. Doctors are educated people – and it is up to educated people to stand up and discuss the elephant in the room. We have already gone too far to prevent the 2°C rise in temperature that Kyoto was trying to prevent – we must come up with innovative ways to reduce the harms that this temperature rise will cause.

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