At the time of this issue of International Hospital Equipment & Solutions (IHE) going to print, the annual high-level conference on climate change and global warming organised by the UN Framework Convention on Climate Change is being convened in Bali, Indonesia. The aim of the meeting is to agree on how to reduce greenhouse gas emissions after the current Kyoto Protocol targets expire in 2012. Since it is highly improbable that even the current Kyoto targets will be met, the prospects for an “après-Kyoto” agreement seem all the less likely. This does not undermine the importance of the challenge — the real significance of the current Bali conference is that it is the first one to be organised since the Intergovernmental Panel on Climate Change (IPCC) warned that evidence for global warming was “unequivocal”, with the IPCC even going so far as to state that climate change was “very likely” the result of human activity and that such conclusions should remove any doubt over the need to act.
While the Bali conference was in the midst of its debates, a landmark paper was published (New England Journal of Medic--ine Dec 6th 2007; 357: 2329) on a subject that is considered by many as the medical world’s equivalent of the impending crisis of global arming, namely the upcoming and equally inevitable obesity crisis. While there is a limit to the extent of the analogies, the two areas have indeed several similarities, not the least of which is the likelihood of a significant negative effect on the quality of life. Both the obesity epidemic and climate change also share the characteristic that preventative action needs to be taken before all the relevant scientific evidence has been accumulated. There are many who suggest that the cost of any current preventative action is too high, preferring to wait for some dramatic technological solution (a wonderful new ‘clean’ energy source for global warming or an equally miraculous new gene therapy or pharmaceutical product to treat obesity). There are even a few who (still) question the very existence of the problems. For obesity, the NEJM paper should dispel any doubts. Having undertaken a massive study (based on no fewer than 5 million person-years of follow-up!), the authors of the NEJM paper showed clearly that the current epidemic of childhood obesity is already having, and will continue to have, dramatic effects in adulthood, principally through a huge increase in adult coronary heart disease. Up until now, while there has been no doubt about the existence of the epidemic of childhood obesity, the question was whether this would inevitably have consequences in later life. Thanks to the recent NEJM study, the answer is clear: yes, it will. Like global warming, the solution is not so clear.