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Yes. Yeah. Yeah. Two. Yes. Yeah, I, yes. Yeah, that OK. Right. Right. So came back it I, yeah. OK. Not OK. Yeah, that three. OK. Three I Yeah. Nice. I, it Right and Right. Yes. No. All right. I, yeah. Two. I don't know. Two the right side. You, I Yeah. Right. OK. OK. No, all that's special, good colleagues. So we make a start. I don't know why it's dark at the back. I don't know whether there is that switch beside the door there. Does that do anything? Let's turn them back on again. Turn them back on. That's fine. I've got some control here but it looks like it's gonna be dark at the back. But, hello. Uh This is the first day, right of this. Since the vacation. Yeah. First lecture. Thank you for making it. About what, 2/5 of you? That's not bad. It's a very cold morning. Uh uh By the way, personally, I don't think we sort of make it easy to motivate people to come to lectures when of course it is being recorded and you can watch it again. But in my humble opinion, well done for coming here. Because I think you get something that you will not get from this again if you ever do listen again, which frankly most of you don't, uh, you know, because I listen for the first time online properly. I mean, so, uh this is a lecture on planetary pathology and they probably aren't exactly lectures like this in every medical school, but I know that they are becoming increasingly common and ii wonder if you can cast your mind back to the first term that you were here. I describe something called a whole arch and um it looks at different levels and the level that we're going to be looking at in this lecture is, is a planetary level, which is the largest scale item on this hierarchy. And planetary health and sustainable health care is one of the helical themes of your curriculum. There's 16 of them, this is one of them and that means it's going to turn up in every year of the course in some guys. And this will be part of your assessment. In fact, believe it or not, the year three students had an AK dealing with sustainable health care uh to do with uh inhaler switches as it happens. Um And this is this lecture is the second of three. You might remember, I lectured on the topic of planetary physiology. In the first year we have this one and then we have one in year three for the year three. So I think it's next week or the week after on sustainable health care. And um uh you know, I think you, you might think that a lecture on planetary physiology might be considered a little bit weird but serious scientists do treat the planetary system uh as being alive in the sense that it has all of the different, the same principles of feedback that you see in the human body, for instance. Uh And these were the, these were the learning outcomes of that lecture. Uh We will not go through these now, but these were covered in some depth. And one of the things we talked about was the way that the body and the planetary system work by various types of feedback loops. What we call normative, sometimes called negative and amplificatory, often called positive feedback loops. And I'll just give you a simple example, might just cut the lighting on this slightly, but this is the ocean. The ocean is actually a buffer. So just like the blood, when carbon dioxide levels rise in the blood, it's more of it is dissolved, the blood acidify. And this is how we maintain our ph homeostasis. Similarly, with the ocean, it does a very good job of mopping up the post industrial carbon dioxide. And I've read different figures, but roughly 40% of all the carbon dioxide that's ever been burnt is now in the ocean. And if it wasn't for that, of course, we'd be in a catastrophically hot world. So this is an example of planetary physiology in action. Um Another thing this is from the very first lecture that you ever got at Bristol Medical School because Katrina uh do Professor Katrina and Turner and I gave this lecture on what is health. And I do remember I showed this diagram and it's showing it's the idea of health as something where you kind of, you walk around in the bottom. But if you go too far, you can cross a threshold and then everything's different, the system disequilibrate and it has to find a new norm, which is potentially a potential metaphor for that would be to move into like a chronic disease state. And, um, I illustrated that I remember with a slinky. Do you remember, do you ever remember the slinky? Yeah. So you can, you can, you know, you all had little brothers and little sisters who got hold of your slinky and destroyed it by pulling it too far so that it wouldn't restore. I don't want to destroy my one little slinky here. But you can see the idea this, it has got a latitude beyond which you can't pass and the, the planet has exactly the same thing. And these have been quite well defined and the slink, um, the, the, the green bit in the middle is the safe operating zone. And that's the sort of about as far as you can, you can expand the slinky and it will still go back to look like a slinky afterwards. Once you disturb the system beyond that point, then it is starting to disequilibrate. And you can see that for these 10 planetary boundaries, we're at different places. You might be interested to see how, how far out of sync we are with our nitrogen balance. Does anyone know like roughly why that is if you could just say it in a sentence, why is the nitrogen balance so imbalanced within the global system at the moment, sir? Correct. But what type of fertilizers in particular are for? Well, nearly most when people think of fertilizers, they're generally thinking of nitrates, phosphates and uh potassium are two other very important ones. But where does the nitrogen that has allowed the population explosion to occur come from? Does anyone know the atmosphere? It comes from the atmosphere? And how, how does it get into the soil? Say again, harbor process? Ok. So somebody invented a way of taking the how much nitrogen is there in the air around me right now? What's the percentage here? Roughly 79? Yeah, it's high 70% nitrogen plants can do this but they can't do it on a very large scale, but they invented a way of taking the nitrogen and convert. You use it. The trouble with the process is that it uses a hell of a lot of energy because cos um the carbon comes from fossil fuels and they, they reckon that, you know, when you eat a punnet of say Spanish cherry tomatoes, the carbon that makes those tomatoes actually comes from fossil fuels, that's the root into it. And, and so yeah, biodiversity. Uh yeah, it's worth mentioning about bio biodiversity here because they so much so so often hear about the climate crisis. But increasingly you're hearing people talking about the climate and nature crisis because of the situation illustrated on that, on that slide. So today we're gonna recap a little bit around the physiology. We're going to look at the impact of global environmental change on human health. That's why we call it planetary pathology. And I'm just gonna throw in the idea that all of us have a part to play in this situation, both professionally and personally, as you'll see, uh do I have any authority to talk on this topic? Uh a little bit. And the coauthor, actually the main author though, it wasn't my idea. So he got to be the first author that's fair enough of this book. And this book was based on a student choice project that ran for many years called Sustainable Health Care. And uh so I know about that. I've done like perhaps some of the others, I've done quite a bit of reading over the years, a book I once read very meticulously, cos I needed to know the stuff to write. This book was the rough guide to climate change. But Um I'm not a, I'm not a climate scientist. I'm a kind of enthusiast who has a, a kind of clinical slant on these things. This is the cover for the book that we wanted BM BMA books to use. They didn't share a sense of humor. But why would we have chosen this even ingest as the title title, the cover page? Anyone know what, where these are from Easter, Easter Island, you're saying? Say that. Yeah. OK. So uh when uh Captain Cook on one of his colonizing missions to the South Pacific discovered, you could say Easter Island, uh he found that the people who lived there were quite mean. I mean, sorry, lean. They had like very primitive canoes and they were living in a very kind of primitive way in the middle ages. Easter Island was an extremely successful society successful enough to make some 200 of these effigies to move them from a quarry, which was a big deal like Stonehenge level complexity and, but as a culture, they made one really big mistake. Does anyone know what it was? They cut down all the trees faster than the trees could grow. And if you want to move one of these, you need a lot of trees because they basically use them as rollers. And generally speaking, it's a metaphor, albeit a rather climate, this metaphor for where we might be going with the climate and that's why we chose it. So um I know that I'm talking to an intelligent audience and I forgive me if this is sort, sort of too basic. But the, the climate side of nature crisis is mainly driven by carbon dioxide which comes in fossil fuels. And here you can see a graph of fossil fuels against time is this is a very famous graph. It's called the keying curve. Does anybody know where these measurements are made? Does it say it does? OK. Where, where is, where is Mono you Hawaii? OK. Correct. It's Hawaii, why Hawaii? And not say because there's no, there's no real industry in the eye. So the concentration conducted in a way is a mixture. It's a reasonably good accurate measure of the the mixed conduct levels of the atmosphere. And I guess there must be some issue about what height it is at. Um you can see in the top left there's a, there's a pop out there showing the seasonal variation of carbon dioxide levels. Does anybody want to guess as to why this is a very consistent finding? Uh why haven't the carbon dioxide levels drop in, in uh in, in that pattern photosynthesis? OK. But there's photosynth, why would there be photosynthesis in a seasonal fashion? Because it's well, well, the measures are continuous, they're done every day and the uh they are the true mix that is the to the whole atmosphere. So why would, why wouldn't show that you're on the right? I want you to think a little further from what you said it is due to the synthesis. But why is it in that shape? No, you can guess. Ok, it is. This is where most of the plaque on in the ocean it's impressing. That could be true. But I don't think that the car goes directly into the atmosphere probably goes into the ocean. So it's a different story. So what about terrestrial plants? Terrestrial plants are mainly in the northern hemisphere, right? Most of the work, most of the land is in the northern hemisphere, right? So what you find is that um the carbon dioxide is sucked out of the atmosphere during the spring through to the summer. So by the plants that are mainly in the northern hemisphere, because the nor northern hemisphere summer is obviously opposite of the southern hemisphere. Anyway, actually, you don't need to know that fact. It's just interesting to know why it's like like that. And the cond said against time history for it, if you go back many millions of years, you do get a planet where the all con side. But in in the recent past, the the 800,000 years past, that is the p the picture of conduct against time which we know from. How do we know that? Guess how are you? I guess how do we know what, what the carbon oxide levels were? A 600,000 rock rock rock I ice. So they drilled down Antarctic Antarctic ice. Very old ice. And that, and you can tell, they can also tell the temperature of the past, which I find slightly harder to understand it. Must, I haven't studied that. So, the things that I've circled in blue, what, what are they generally know that I ice ages? Yeah. So we had regular ice ages. We had one quite recently. Um, the, uh, leadership in the wilderness teams. They were in the Lake District there. The ice age that shaped those valleys is fairly recent only 10,000 years ago, was that ice age completed? But you can see that the figures never go above 300 parts per million carbon dioxide until you get sorry to the recent year where I checked yesterday, the average because this also changes all the time, but the average for 2023 was 421. So you get the sense that there's a lot of carbs, a lot of extra carbon dioxide going on. And this is the reason for it. You can see very little carbon dioxide being emitted from fossil fuel consumption and then this massive change. And a sort of concerning feature is that the rate of change is not changing very much since 2018. Although it has, I'm pleased to say for, for the UK and some other countries and all of this and we don't need to talk about the greenhouse effect, but this carbon dioxide leads to these effects and we're gonna get on to the human health implications. But if anybody asks you, well, mate, how, how much has the planet heated up? A good answer is 1.1 degrees since previous levels. But I wanted to ask you, like, when you're trying to work out how much the planet has heated, uh what are some of your challenges? Like, how do you reach a figure? Like 1.1? Like, like what, what are the difficulties in a, in a, in a single figure? Well, it's, yes, yes, very itching. Yes. What type of variation between the shot? Yes, good. So, can you tell me more about that you're getting? Oh, yes. So, so they, they, they have monitors all over the earth, right? And we need to have, we need to do that because obviously it gets colder as you go north and south. So there's changes uh across the globe like that. Um which is generally hotter in winter, the co land, the sea, the sea actually holds heat much better than the land does. Um And there's also uh what something that really confounded their early measures was if you're near a city called the heat island effect, so the temperature in the countryside near a city is much colder than the, than the, than it would be sort of hotter than it would be if there was no city present. So there's a lot of confounding here. Uh And And one of the, one of the things that is worth knowing is that the average global warming of the Arctic is much greater than, and the Antarctic is much greater than the average. It's around about three degrees. Uh And a very interesting thing about these graphs is that the, um the simulations have proven to be true. What does that mean? It means that if you go back to that 10 years and you get to predict what's gonna happen to the temperature, the scientists have done this, it's all published and then you see what actually did happen to the temperature. And the answer is that the predictions as you can see here, simulated and natural are really very good. So this means that we can have some confidence about this. And this is projections for the temperature average temperature of the earth surface, roughly 80 years from now, depending on what the global humanitarian response is. So at the top, there's probably do nothing at all at the bottom would be stop all carbon dioxide emissions tomorrow. If you did that, you'd still have global warming because the carbon dioxide that we've got lasts for, I've read different estimates between 300 1000 years. I'm gonna figure that it's probably will this be in your lifetime maybe if you do? Well, you might make it uh to see uh probably somewhere around three degrees of global warming. So remember, it's 1.1 now, centuries end. It's almost definitely not, not going to be one point. It's definitely going to keep going up. I think you'll be sure of that because we know from past predictions or past predictions have proven to be true. And I'm thinking maybe three degrees of global war. So that's gonna make a big difference to the planet. It's gonna make a big difference to health. Um Yes, we talked about it being a bit warmer at the the poles. One of the things is as you probably see on like documentaries is the ice melts in the art. So when people pay money to go to walk North Pole a few, a few summers ago when they got there, there was no ice at the North Pole. It was completely just seawater. Now, that's bad for things like polar bears because polar bears live on ice and that's where they do their health problems. But I would say like pretty bad, you know, but for, for the global system, there's another major um implication of losing sea ice. Does anyone know what it is? It's a problem. So if you know, I see. Ok, so, so according to our colleague here there in the ice, so that, that's, that's an interesting answer. And there's another one, what else is gonna happen if you melt all the ice in terms of global warming up sea level, sea level, right? Ok. Thank you for that. We've got a great little um experiment coming up on the sea level, I'll show you that in a sec. Actually, what I'm thinking about is that all of that ice is brilliant at reflecting he, so if you feel any ice you lose what's called the albedo effect. Oh 01 sec, that's what I was gonna say about the Aldo effect, which is that um if you see the, the sunlight is when it's not reflected off the surface, the UV light is absorbed brilliantly by seawater. But since you mentioned it so wisely about sea level rises, let's just do that as a little experiment. Can you get your men? That's the wrong number. Sorry, it was the number at the start. Uh I'll shout it. So what should I do? Should I just go back? That's the 474546, double eight. So if you put that into men and give a vote on, is that working? Ok. Thanks. Yes. Question does Arctic. According to colleague here, Arctic, seawater melting will further increase our issues with sea level. Let's just uh let's see what colleagues think about that. OK. Well, just I thought I'd try put some ice in this flap. I said this is, thank you very much. This is warm water. So I should take the whole night. But just think from your sort of general life experience, what's likely to happen to the level of this water as this ice melts eventually, it just sort of. No. Ok. So the answer is no. But if ice is floating in the sea and it melts, it doesn't affect, you know, it has a margin of a tiny effect on the sea level. But if you add ice, you get really messy here, if you add ice from a fresh water glacier, yeah, you've, you've overflowed it. Right. That's the ice from places. It's a very different thing to sea water melting. So good thought, but I don't think it is actually a major factor. Ok. Yeah. Ok. So that was a little bit of rehearsal about some of the background factors. Now, the question then for us as medics is what is the effect on health of this? And I just pulled this from the Center for Disease Control in America. They, they just had this graphic which I liked and we can't cover all of these. It's each one could easily be a lecture. In fact, on the subject of air pollution, I believe there's one of the respiratory consultants from South Mead is going to be talking about the effect of particulates, these tiny particles um on not just respiratory but also cardiovascular health. This is just one of the, the books, the other books that I'd recommend on this topic. It's very detailed and we'll just take a few important headlines. Um, the curious thing about um, heat wave, I think heatwaves are quite a good place to start because they are the direct ac the direct effect of heat. So we talk about global warming or what happens if you just heat the atmosphere. Um There are problems with this concept because we don't really have a unitary di definition of a heatwave. Um The one that I've got here from the World Meteorological Organization says it just says five days or more consecutively of heat where the daily maximum temperature is higher than the average maximum temperature by five degrees. Uh So I've heard other definitions which involve like how hot it stays at night, for instance. Um But it does make it interesting because you can have heat waves in Greenland by that definition. Um You know, I I've heard people say that it's surprisingly warm up there in summer. Um And the curious thing about heat waves are that really no one should die from them because humanity is actually very adept at adapting to heat as you know, people live in the desert. Um And um yet what we know from data looks like a very complicated slide, but what it's really trying to show you is the number of people in 2020. That's the right hand side of each graphs in these two age groups, over 65 and under one years of age because they're the most vulnerable to populations, number of excess people exposed to risk of heat wave compared to the 1986 2005 average. So you can see from just eyeballing that chart that the bars are getting taller as you, as you go forward in time. And what are the, the health impacts of these heatwaves? Well, I don't know whether, you know, you wouldn't remember it, of course. But 20 years ago this summer just passed, there was a magnificently hot spell in Europe and the excess deaths were incredible. There was about 70,000 people died. Um, a lot of people strangely in Paris now, I don't know whether you're familiar with French summer culture, but it's very normal in France to uh to leave Paris uh and go to the coast during August. Uh But what they didn't do is they didn't take the old people with them. And so so the sort of general feedback systems and monitoring of older people was inadequate. And that's one of the reasons why we had such an extraordinary number of deaths mainly from cardiovascular disease. Is this situation going to get worse? Well, the answer is yes, for a number of reasons, one is the number of people that are old is increasing. And also, as you've already seen, the temperatures are increasing, I don't know whether anybody in this room has actually experienced uh a serious been in a serious heatwave in the last few years. I don't know whether you'll be willing to share your experience with us. I don't think UK heatwave, could you say, what was it like? There was also because of that. There's been a drought in the last, like, three years. Yeah. So, like all the crops, I went back this Christmas. So, well, in, in winter. Yes. It just because that, um, so I was just, um, we live like a pond but that is, that, is that the patient in widespread, uh, the drought is quite widespread. The actual, like, in terms of, like, from? That's right. That's your, anyone that experience from Asia or Africa perhaps? Ok. Ok. Well, more and more of us it's quite hard to imagine this. Has anyone read this book? Uh, it's, it's quite a, it's a sort of faction. So it's a fictionalized account of a future drought and it's, uh, it's, it, it gives you, it definitely gives you a sense of what things might be like when we get into the sort of 2234 degrees of global warming range. Mhm. Right. So you talked about drought. The other side of the coin here is, is the same amount of water on the planet. It's just being redistributed. Um, and the floods are really interesting, I think, um, like, why do we get floods? Like what? Just name a few causes of floods? Too much rain. That's what, so we get excessive rainfall. What else? Tsunami. Yeah. So again, II think we can't really blame tsunamis on global warming. That's a, that's a geophysical phenomena, isn't it? Um, but also the sea level rise issue. Um, compounds the effects of stormy weather, for instance, in low lying islands. And one of the really interesting things about flood. Not interesting. It's the wrong word but notable things about flooding is that they have much bigger effects in low income countries for two main reasons. One low income countries don't have the capital resources to build flood defenses. And second of all, when the flood comes, they don't have the infrastructure to affect adequate relief. So uh in a flood, you can drown, literally just drown, you can con contract infectious diseases because the sewage system is overwhelmed. An interesting. So I keep saying interesting, I don't like that word. Notable thing in places like Bangladesh uh after the floods, one of the surprising causes of morbidity and mortality was, does anybody know like a surprising one that involves an animal? It's actually snake bites because the snakes, snakes, as you probably know, they don't really like human beings. They hide away most of the time when they get flooded out of their hiding places, then they come into contact with human humanity in a, in a, in a different way. And I would like to mention about floods is the mental health impact of being flooded. So imagine if just imagine for a moment like this is your folks' house and this has happened to it, you know, like you're gonna need a lot of resilience to roll with this sort of thing. And you know, people are incredibly resilient. But uh so I missed this slide, which is what this is showing is three parameters. It's looking at depression, anxiety and posttraumatic stress disorder. These are all formally diagnosed and then it's looking at three categories unaffected by floods. These are all the state is all from England by the way, disrupted by flood. That probably means you had to evacuate your house and your kids' schools were closed for a couple of weeks. And the third category is where your house is actually flooded. And the three bars are to do with distance from exposure 12 and three years. And you can see there's a, there's really quite a significant and you can look at the um confident confidence intervals as well. There's quite a marked effect on these three diagnoses of being flooded. Yeah. Mhm. Uh Flooding we mentioned um is compounded by rising sea levels. There's any you can work it out if you look at that graph, but would anyone like to sort of sh ok. I'll tell you that's about high, high, that distance. There is about high, high far sea levels have risen in in. This is another very difficult thing to measure, by the way, is the sea level, they not do it using satellites, but they reckon that it's, it's like something like a couple of millimeters a year. It sounds very little, but it's amazing how much effect on coastal communities just that amount of sea level rise? You think? How big the sea is, how the whole ocean, what is it like? I forget now, is it like 60% of the whole surface area of the globe is ocean? That's, it's an awful lot of water to raise it by that much. But you can see on the graph and I II, I think the um you know, that trend that you see there is going to continue and occasionally people talk, I think like what the data I've read and II just going by the data is that if you raise the, the sea level by 50 centimeters, that much, that has a surprising effect on the, on the geography of countries such as our beloved England. So that's flooding in the FS. If you look down the bottom left, you can see some areas around Bristol are already what's uh worth knowing is there are areas of England and I think Somerset, which are actually, they're below sea level, they're kept dry by the, by the presence of sea defenses. Um So I don't know what's gonna happen. This is a, this is a, a clip from a film I wouldn't say controversial but certainly notable film by er, the presidential candidate Al Gore. And he's dealing here with a, a different scenario which is the complete melting of either the Antarctic or the Greenland Ice Shelves. These are vast quantities of fresh water. These are the ice poured into the glass but just miles high of the stuff and, and let's just have a wee look and see what that, what he says about that. You might not hear him. No sound. You don't really need the sound because you're what you're watching and the red is the, uh, is the sea level the, if Greenland broke up and normal or if half of Greenland and half of West Antarctica broke up and this is what would happen to the sea level in the farm. Mhm. This is what would happen to San Francisco better. A lot of people live in these areas. Silicon Lake, the Netherlands, one of the low countries absolutely devastating the area around Beijing. That's home to tens of millions of people even worse in the area around Shanghai. There are 40 million, we're still Calcutta and to the East Bangladesh, the area covered includes 60 million people think of the impact of a couple of 100,000 refugees when they're displaced by an environmental agent and then imagine the impact of 100 billion. Um As far as I can tell from reading the literature, no one's predicting that that's gonna happen in the next 100 years. Um It's just way too much ice to to imagine melting. But um that's assuming that things change gradually. Of course, they don't always do that. Um I don't know what's happened. So you mentioned about Spain, I don't know what's happened to the actual economy as a result of that. I mean, people's livelihoods must be under threat like that. I mean, even like in the U you like to see less food from it, they also have a very industrialized system that might be protected to some extent, you know, you see it. Ok. II just have a moment to get my bearings. Ok. Ok. So the food insecurity is interesting because you've got population increase, as we said, that was going to be a factor um in terms of the number of people affected by heat waves, but humanity's taste for, for instance, meat products is really rising at the moment. And of course, that's very carbon intensive. And that's why when people say, you know, what can you, what can I do for global warming? You know, the one of the answers is to eat a more plant based diet because plants don't, um they just don't use as much energy, sorry, animal plants don't use as much energy for the same number of calories as meat does. No. And uh again, you've got the impact of floods. It's a terrifying picture from Pakistan in I think it was 2022. Is it 2022? It had phenomenal floods. About a third of Pakistan was covered in water at one point. And you can just imagine this devastating river. It's just about light literally on the point of bursting its banks. And I hope those poor people managed to get, get to safety before it did. Um Just rather like you were saying about Spain. There's, there's lots of areas of the world which are in drought at the moment which you never hear about. So the southern Iraq, for instance, they, they're, they're experiencing a terrific drought there. I wonder whether this, this little clip would work for us. My name is and my family inherited this profession from our ancestors. We're romantic, but we have been living in this area for 12 years. Has you have I did before the drought. Our areas used to be a much good fish and livestock, but it's been worsening for the last three years, but we can't take it anymore. Our livestock has perished. Fish have died and so have birds all because of the water shortages. Yeah. Ok. Why is that? We have to buy water, keep our buffalo alive and my, my, we also have to buy father to feed her because there is no grass anymore. But in many cases, our buffalo died because they drink the water in the marshes which contaminated or our animals become trapped in the, well, I have lost 25 bles this season. If this continues, I will have to sell all of them and change jobs. But where shall I go from here? Ok. I think that story is really quite a common one across the globe at the moment. I know how to get to my next. Yeah. Um I talked about you know, like you, you, you pour glacier, you pour um Antarctic or Greenland ice into the sea, the sea level rises and that's quite a major factor in all of this. But there's another big issue around glacier melt. And I'll just tell you that, which is that glaciers in hot countries are often where people get the water from. So most of northern India is served by melt waters from the Himalayas and this, the TNI glass here um has supplied, is it La Paz anyone know, I forget it's the Bolivia, it's Bolivia, I think. Uh and they're gonna run, that's a big city which is going to run out of water when the glaciers are gone. And as a result of all of this, there's going to be a lot more moving around the planet than there is at the moment. This is a rather interesting book. It's called Nomad Century. And it's, it's, it tries to answer the question of what humanity will do when the numbers of migrants are not in their tens of thousands or 100s of thousands, but in their tens of millions. And it's actually a very optimistic book and says that, you know, it is possible, humanity has always migrated and it is possible but we will have to start building cities in places like Siberia, in Scotland, in Iceland because these are the parts of the globe that will be habitable because when the temperature gets to like three or four above average, the equatorial regions may be just too hot to live in. I haven't really read, dug into the science on that, but it seems very possible. So we've looked at all of the things that I've ticked here. I just want to mention we haven't talked about extreme weather in the form of storms. Now, they, they are really, they're very dramatic, but quantitatively, they don't have a massive impact on humanity. but I've got some skin in the game here because my brother has had his whole adult life on an island called Saint Martin in the West Indies. And twice now, I forget what year the first one is. But the second time in 2017, the island was completely, was really devastated by a hurricane. Uh And, um, we talk about hurricanes in categories 1 to 5, but they had to invent a new category for this one. It was a category six hurricane and he had all of this very expensive hurricane proofed windows in his house and they were all designed to deal with winds of up to 100 and 50 miles an hour in hurricane Irma. The winds were 210 miles per hour. And what seemed to happen was that the pressure gets so low that things just burst or implode. Um, and everything was wrecked and they're still, they still really haven't recovered. Uh So, you know, spare a thought for those people and the same stories would sit around wildfires. My final point uh to finish on time is I just wanted to ask you a little bit about the rainforest because they seem to have slightly gone out of focus a little bit. But the rain forest destruction is, is extraordinary. About half the rain forest that existed in 1945 doesn't now exist. It's uh arable land or um land used for, for, for grazing cattle. Um So in terms of human health, can anyone shout out a few reasons why we might want to look after the rainforests? Medicines? Thank you very much. Coming to one in a minute. Anything else? Yeah. Uh If we read it first person, yeah, it's a small but significant factor, isn't it? So the animals are now much closer to the hu humans, more difficulties uh because the, you know, for the animals and the human beings. Um OK, this, this image I've got for you, I'll give you a clue what it is. It's a frontier, a border between two countries and the one on the right is a forest and the one on the left isn't, does anyone happen to have a guess what border this is between Brazil? I good because you know Brazil has issues with cutting down rain forest. Say again, Colombia, I don't see why you should be there. It's a bit of a silly question because on the right is the Dominican Republic. Therefore, on the left is Haiti. Ok. Now Haiti has, uh when, when you get torrential rain on, I think it's called his beautiful word, isn't it rather colonial? To be honest, come to think of it. But his, his is, is the is, and you get much, much greater impact of rain in Haiti than you do in the Dominican Republic. And that's thought to be largely due to the fact that rain forest just hold the water in a way that the forested land doesn't. So the water runs off much faster and creates these sorts of very rapid flood situations which you don't get when you've got forest. I mean, I remember when I was teaching this before, I said guys, if it's raining, if it's raining heavily, is it good to be under a tree? Yes. If it's not raining and it has been raining heavily, is it good to be under a tree? No, cos it keeps raining after the rain has stopped because the water is still, it's basically slowing down the process of the water entering the land. Someone said medicines. Ok. This is a anyone, first of all, can you recognize this if you have a, have gardens in your childhood in life? Does anyone recognize this flower? Even if they don't know what it's called? Does anyone know what it's called? Ok. It's actually called the Greater Paraly. Ok. Next question is what medicines make the greater parag you impressive? You, it's a really uh common chemotherapy agent called vinCRIStine. In fact, 65% of medications used in the treatment of cancer are derived directly from plants and most of those plants come from the rainforests. So whoever said medicine is dead on a very sort of anthropocentric view of this situation, but surely an important one. I just put that up because it's just a reminder that nature, like there's no high pressure involved here, it's all done with no solvents, just water and atmospheric pressure and plants can make molecules like that. Uh And bacteria, well, there's nothing a bacterium can't make, to be honest. I mean, if you ever see a picture of the B12 molecule, for instance, it's one of the most complex molecules in existence organically. So I'll not read these through, but these are the health effects and it's probably others that um we should mention but haven't. And um just a little interesting thing scientists are now um proposing a diagnosis called eco anxiety. It's curious, you know, I'll tell you how they define it. The question you're about to answer. It is over the last two weeks. How often have you been bothered by the following problems when thinking about climate change and other global environmental conditions? And then it lists a bunch of things like on edge in experiencing insomnia, persistent intrusive thoughts, loss of pleasure and social interaction. So it's trying to make a link between these two phenomena. And um let's just see whether anyone here, you know, it's anonymous, isn't it? Uh, it, it, it's not, um, I don't know why. That's not very good. Yeah. Uh, yeah. Ok. So, in what I would like to think is an intelligent audience, some of us are affected by this, in a way that is beyond just rational thought. It's actually affecting our mental health. It's, it's beyond just an idea. It's a real, real serious concern. Ok. Excuse me. Find on my way back. OK, so we've got five minutes. Uh And yeah, I just wanted to just grab a sort of sense from the audience of levels of motivation around doing something and I, when I say doing something, we'll come to it now, but both personally and professionally around this agenda. Let's see whether we right. But i it's quite um it'd be worth unpacking this if we'd more time. So some people may feel unmotivated because they see they don't see any purpose in trying, they think, well, it's not gonna happen anyway. What's the point of doing anything? It's not that they don't care. It's just they, they're not motivated and so on. So it's very nice to see that. Thank you for your votes. And um yeah, I just thought find somebody and just, just share with them a couple of things that we as a medical school community or we as individuals could do to answer the question of what should our response be to the sort of data that we shared this morning. So, let's just have a little bit of time, a couple of minutes and then we'll hear some examples. Professional or personal responses. Yeah. Yes, I see. I.