The Climate Crisis and Health Inequality: Climate Activism in South Korea - KPTU presentation

Video presentation (with English subtitles) by Lee Hyangchoon, President of KPTU Healthcare Workers’ Solidarity Division, South Korea on healthcare workers' struggle to defend and expand public health and care services in the context of public-centered response to the climate crisis in Korea.

Presented at PSI event "Fighting for a feminist, decolonised, green social contract: union stories from Asia and Pacific" held on 9 March on the occasion of International Women's Day 2022.

Presentation script

The Climate Crisis is a Health Rights Crisis

On September 6, 2021, 252 world medical journals urged the international community to take an active response to overcome the climate crisis through a joint editorial leading up to the COP26 Climate Conference. The editorial warned that if the global average temperature surpasses 1.5°C above what it was before industrialization and nature continues to be destroyed, a crisis much deadlier than COVID-19 would occur. Despite this, while the first agreement made in five years at the COP26 conference in October was reached, and it did mention that coal power would be gradually reduced, the agreement still did not specify an intent to try and resolve the climate crisis.

The cycle of infectious diseases is gaining momentum, exemplified by SARS in 2002, the swine flu in 2009, Ebola in 2014, MERS in 2015, and COVID-19 in 2020, and the climate crisis is further encouraging the spread of infectious diseases and threatening human health in many ways. Direct health effects from climate change include injury, death, and other medical conditions caused by heatwaves and other extreme weather disasters. Those who are vulnerable to heatwaves have been additionally exposed to heatstroke and sunstroke with 475 million heatwaves worldwide in 2019 alone, and the situation is only becoming more alarming. The mortality rate of the 65-year-old population succumbing to heat-related deaths has increased by 53.7% over the past 20 years.

Climate change threatens the security of access to food and drinking water, promotes ecological changes such as the spread of climate-sensitive infectious diseases, and causes socio-cultural changes such as population movement and reduced access to health care services, which indirectly affects health. Air pollution kills 7 million people worldwide every year. Changes in the food system caused by the climate crisis are also serious. Food production is threatened by rising temperatures and the increasing frequency of weather fluctuations. Grain production in 30 countries has decreased over the past two years, and this decrease is a trend in all regions. In the 2050s, food security will be threatened as crop yields are projected to decrease by more than 10% on average due to increasing carbon dioxide concentrations that lower the nutrient quality of crops. Coral bleaching is occurring due to an increase in sea level temperature, and scholars predict that this phenomenon will lead to a decrease in water resource production.

The World Health Organization estimates that 250,000 people will die every year between 2030 and 2050 due to direct and indirect health effects from climate change. This is a conservative estimate that includes the deaths of elderly people due to heatwaves, deaths from increased infectious diseases such as diarrheal disease, malaria, and dengue fever, deaths from seawater flooding, and deaths from child malnutrition. It does not include the effects of the suspension of medical services due to extreme weather or climate events. The World Bank announced that climate change will drive more than 100 million people to extreme poverty by 2030. Poverty can lead to regional disputes with refugees, and mental illness is known to chronically persist in natural disaster victims affected by drought, floods, and forest fires.

The Climate Crisis and Inequality

Although everyone is affected by climate change, the people of underdeveloped countries who have contributed the least to greenhouse gas emissions, children, adolescents, the elderly, women, and low-income vulnerable groups are all more severely and fatally threatened by this crisis. People of impoverished countries, people in poverty worldwide, and those under vulnerable conditions have already previously suffered from social inequality, and now they will be the first to be sacrificed and have their lives threatened. These folks are also less risk-responsive and less resilient. Climate disasters have an uneven effect on people's health depending on their residential area, resources, and abilities to cope with various climate effects. The climate crisis is further increasing social inequality.

Thirty-three firefighters and 1 billion wild animals including koalas and kangaroos were massacred in the wildfires that ravaged the Australian continent. Around the same time, a novel cororavirus began to sweep the globe, taking the lives of more then 5 million people. Severe droughts and typhoons are also resulting in an increase in sex labor. According to the United Nations, 80% of climate refugees and 70% of the world's poor are women. As the impact of the climate crisis escalates, so does the mortality rate of impoverished girls and women in third world countries. At the same time, these people suffer more from sexual violence, premature marriages, sexual labor, and discontinuation of their education. Five times more women are dying than men, and for female individuals, parenting and childcare labor is disproportionately aggregated. This is why climate justice is gender justice.

Reforming the Healthcare System in Response to the Climate Crisis

As the climate crisis worsens, a shift in the health care sector is also required. Carbon emissions from the medical sector account for about 5% of global emissions. In order to reduce carbon emissions in the medical sector without degrading the quality of health care services, profit-centered excess medical care should first be discontinued. Instead of following the “logic of profit and capital,” the role of public health care should be built up so that anyone can easily and equally access it and receive proper treatment and care.

In addition, the health care system should be changed so that it can be converted into a just system to reduce energy and medical waste. Various approaches are needed, including monitoring the impact of the climate crisis on health and life; monitoring the health effects of the climate crisis; evaluating climate vulnerability in the community; and research, surveying, and preparation of alternatives plans to reduce carbon emissions in the health care sector.

“Health Care Without Harm(HCWH)” has proposed seven roadmaps to healthcare reduction, which if applied to Korea, are as follows:

1. 100% Conversion of Power to Clean Renewable Energy: Reduce unnecessary energy and water use, and convert 100% of fossil fuels to safe and clean renewable energy. Hospitals have their lights turned on 24 hours a day, and they are spaces that utilize various high-cost, high-energy machines and use a massive volume of water. Due to medical commercialization, Korea is currently importing cheaper equipment at a standard of "medical armament competiveness" and rolling them out after running inspections overnight, which is creating a problem. In other words, regulations are also needed to convert to climate-resilient health care. Clean renewable energy conversion is a way to achieve climate resilience that allows patient treatment and management even in an energy crisis environment.


2. Investment to achieve zero carbon emissions in facility expansion and infrastructure construction at medical institutions: Promote low-carbon transportation when designing and constructing buildings and infrastructure, or use eco-friendly building authentication tools and standards to seek emission-free building design. Natural lighting and natural ventilation are beneficial to both the environment and patients. Additional beds, increased density, and the expansion of auxiliary businesses such as large parking facilities and funeral halls are all harmful in preventing infectious diseases and reducing carbon emissions. Medical care, which is gradually becoming larger due to competition between hospitals, is not suitable for the climate and era of infectious diseases. Restrictions on the total number of beds are also desirable for carbon reduction, with planning that is suitable to and an appropriate system that can be used closest to the needs of local residents .

 3.  Transition to zero emissions and sustainable movement and transportation: Reduce long-distance movement for hospital use, and integrate eco-friendly medical use into urban planning so that medical facilities can be used by public transportation.

 4. Supply healthy and sustainable food, support climate-friendly agricultural: Healthy, local, and sustainable fresh seasonal food supply systems in hospitals and food ingredients purchases and diets that support climate-friendly agriculture will be used to transition to eco-friendly food. There is also a need for a policy to reverse the outsourced privatization of hospital restaurants for cost reduction reasons.

 5. Establish a low-carbon system of producing, distributing, consuming, and disposing medical supplies: Reduce the unnecessary use of medical supplies, replace high-emission supplies with climate-friendly alternatives, and switch to a climate-friendly production, distribution, and consumption system. The move is aimed at reducing greenhouse gas emissions as a whole by reducing prescriptions for drug use without clear health improvement effects and by prioritizing medical personnel's efforts to diagnose and manage patients early so that they can actively intervene in prevention. It is also necessary to transition to an eco-friendly fee system, not the current fee-for-service system that promotes medical waste and excess-medical care.

6. Put into action the reuse of wasted resources in the medical sector, improve waste disposal methods: Medical care should reduce waste in all aspects. Health care is an area where disposable plastics and excessive packaging materials are recklessly used in the name of "sanitation." Instead of major personnel and spaces in hospitals for disinfection and reuse, automation to increase turnover further increased the waste of medical resources and the carbon emissions from waste disposal. Medical waste is a source of air pollution, therefore it is necessary to create a system of waste separation and risk-specific treatment, to reduce waste by utilizing recyclable medical resources, and to restrict the over-packaging of medical devices and treatment materials. It is necessary to create a virtuous cycle structure and system for the continuous management of waste, and for the reduction of the volume and toxicity of medical waste from the supply and procurement of medical resources to the placement of medical technology. To this end, the  purchase of climate-friendly medical resources must be prioritized, and public resource control and planning must be prepared in the public medical system.

7. Improve the effectiveness of the medical system: It is recommeded to integrate the climate effectiveness of the medical system into its evaluation and to reduce wasteful medical practice and treatment. It is necessary to establish a medical system that considers both patient treatment and its effects on climate, and to create a way to zero greenhouse gas emissions as a whole. To this end, we need medical care that prioritizes life and the global environment over profit. Even within the health insurance system, it is necessary to support the prioritization of climate-friendly medical institutions and medical resources, and to enact restrictions on financial support for superfluous medical care that does not consider carbon emissions. 

KPTU's Struggle for Climate Justice in 2022

The climate crisis is a result of the greed and destruction of the capitalist economic system of those with an abundance who desire to have more. Therefore, "principles of a public nature" should be applied to respond to the climate crisis instead of "market principles," in order to allow anyone to equally enjoy necessary commodities. In particular, every time there is a change in political administration, regardless of the administration’s nature, a situation is created where the privatization of public institutions, various deregulation policies, and medical privatization are being cleverly pushed, and KPTU is fighting to achieve a "public-centered just transition" in various public, transport, and social services such as energy, transportation, and medical care in response to the climate crisis.

In the energy sector, the Korean government has set a goal of raising the renewable energy ratio to 30.2% by 2030. Target setting is also an issue, but more problematic is that the government is pushing for a bypass privatization of the power industry under the pretext of converting to renewable energy by setting the target as "private" to invest a large-scale national budget in technology development. In the end, all of those benefits return to SK and LG, Korea's leading plutocratic conglomerates. Meanwhile, put on the back burner is the job security of workers at coal-fired power plants suffering from employment insecurity under the energy source conversion policy.

In the medical sector, the Korean government is constantly attempting to introduce medical privatization policies including the deregulation of unproven treatments or diagnostic devices, the commercialization of personal medical information, and allowing telemedicine (non-face-to-face) due to the shorter cycle of infectious diseases and difficulties in face-to-face treatment. At the same time, the "expansion of public beds and recruitment of manpower" that the state should take responsibility for is no different from what it was before COVID-19. For two years of COVID-19, medical and care workers have been out on the streets demanding hospital capital from the government, but the situation has not improved.

In 2022, KPTU is preparing to expand its projects centered on the power generation and energy sector to all areas of public, transport, and social services, including transportation, medical, and local public services. It calls for a significant expansion of renewable energy centered on the public sector through integrated power generation companies, a re-publicization of private power plants, and an "expansion of public transportation to reduce carbon emissions" connected to railroads, subways, buses and village buses.

As mentioned at the outset, women in particular are employed at higher rates in the medical and care sector, and the struggle is actively underway to strengthen the public nature of this sector, which is most vulnerable to and most affected by the climate crisis. Korea operates a national medical insurance system, but only less than 10% of public institutions actually provide medical-care services. The private-centered supply system has increased medical expenses and promoted the growth of the private medical insurance industry. Because of this, people are exposed to double the suffering, first from disease or injury, but then also from their livelihood being threatened. Accordingly, our medical and care workers are fighting to reduce the burden of medical expenses, and to expand public hospital beds by 30%, establish public hospitals in medically vulnerable areas, and provide free medical care for children so that anyone can be treated at a low cost and receive safe care. In addition, for the lives and safety of the people, sufficient manpower must be secured by improving the working conditions of personnel providing medical and care services.

The climate crisis is a health crisis. It has also come to light that the climate crisis is a matter of social justice. COVID-19 is showing us that the climate crisis is infringing on health rights. It is showing us why the entire world should be working together to present solutions to the climate crisis.

A just transition to Health for ALL is climate activism. In order to stop the planet from abandoning us, to save ourselves, and to protect our health, we must do everything in our power right now. We are the ones that must create a sustainable future.