Transcript

Climate, “car spreading”, and conflict

From The BMJ · Episode page · Watch on YouTube

· 44 min · 7,551 words · 76 timestamped sections

This is the full, timestamped transcript of "Climate, “car spreading”, and conflict", an episode of The BMJ published November 18, 2025 (44 min, about 7,551 words). It mentions 15 people, works and ideas, including Sophie Cook, Andy Haynes, BMJ, Brazil, Barbara Sedova.

What this episode is about

The discussion centers on the intersection of climate change, particularly its impact on the Amazon ecosystem and its connection to social justice issues such as conflict and health disparities. Key points include the role of large vehicles in exacerbating climate hazards, the need for equitable health innovations, and the voices of Brazilian indigenous communities highlighting the urgent challenges facing this critical environment due to deforestation and other threats.

Key takeaways

  • Climate change isn't just hot air; it fuels conflict and threatens public health globally.
  • SUVs: the heavyweights of road hazards, packing a punch in climate change and pedestrian safety.
  • Innovations in women's health risk perpetuating inequalities; equity must accompany progress like a well-matched dance partner.
  • The Amazon is not just a forest; it's a living library of biodiversity and indigenous wisdom facing dire threats.
  • Climate change's deadly duo: 70% of Europe's extreme heat deaths are tied to human-induced climate change — nature is not on our side.

Who speaks in this episode?

What is discussed, and when

  1. – 5:00: Brazil, Andy Haynes, BMJ, Sophie Cook
  2. – 10:00: Andy Haynes, London School of Hygiene and Tropical Medicine
  3. – 15:00: Brazil
  4. – 20:00: COP 30
  5. – 30:00: Sophie Cook, SUVs, Imperial College London
  6. – 40:00: Joselyn Clark, Gates Foundation
  7. – 44:13: Joselyn Clark, Sophie Cook, Gates Foundation, Cameron Abassi

Notable quotes from "Climate, “car spreading”, and conflict"

  • Welcome to the medicine and science podcast from the BMJ. I'm Sophie Cook, head of clinical content at the journal, standing in for Cameron Abassy. We've just had our annual climate edition. So, in today's podcast, we'll be discussing.
    about Sophie Cook · at
  • So, we have a series of pieces written by Brazilian indigenous authors talking about a number of different themes particularly around the Amazon and how it's this vital ecosystem for human and.
    about Brazil · at
  • We have. Yes. So the cover was commissioned from a Brazilian illustrator from an indigenous community called Kath Zappi Puri and she worked on it in collaboration with another…
    about Kath Zappi Puri · at
  • So, Andy, to set the scene for our listeners, could you tell us a bit about the scale of the health problems that we're seeing as a direct result from conflict and climate change? Well, of.
    about Andy Haynes · at
  • And what's especially worrying is that the countries most exposed to climate impacts often also have the weakest health systems and many of them are already dealing with instability and conflict. So really.
    about Barbara Sedova · at
  • What your are your biggest hopes for the conference this year and are there sort of any particular changes that you hope to see as a result?
    about COP 30 · at
  • Problems. And as part of the issue, we've also published an editorial looking at SUVs. The growth in both the sales and the size of SUVs is increasing both road pollution and…
    about SUVs · at
  • So, the BMJ has got a strong track record of publishing on women's health.
    about BMJ · at

Who and what is mentioned in this episode?

People

  • Sophie Cook — Person · Host (standing in for regular host) · 3 mentions · first at
    Introduces the episode, moderates interviews across segments (climate/conflict; SUVs; women’s health innovation), and provides summaries of BMJ issue content.
  • Andy Haynes — Person · Main guest (in-studio expert) · 2 mentions · first at
    Provides the core expert commentary on climate change, conflict, and health; also discusses COP, NDCs, and mitigation/adaptation co-benefits.
  • Barbara Sedova — Person · Online guest (climate/conflict researcher) · 1 mention · first at
    Co-discusses evidence on climate-conflict-health linkages, vulnerability in fragile contexts, and priorities for mitigation/adaptation and climate finance/NDCs.
  • Joselyn Clark — Person · Main guest (women’s health innovation segment) · 4 mentions · first at
    Introduces and frames the BMJ collection on transforming women’s health through innovation, emphasizing equity, evidence, and power dynamics in innovation ecosystems.
    The BMJ has also published a collection on transforming women's health through innovation led by the BMJ's international editor and head of scholarly comment, Joselyn Clark, who joins me today. Joselyn, thanks for joining us.
  • Juliet Dobson — Person · Online guest (BMJ editor) · 1 mention · first at
    Explains the BMJ annual climate issue focus (Brazil/Amazon/COP30), highlights themes and cover commissioning details.
    And online by Juliet Dobson, the BMJ's managing editor.
  • Cameron Abassi — Person · Referenced regular host (absent this episode) · 2 mentions · first at
    Named as the usual presenter; establishes hosting context and continuity for the podcast.
    Podcast from the BMJ. I'm Sophie Cook, head of clinical content at the journal, standing in for Cameron Abassy. We've just had our annual climate edition. So, in today's podcast, we'll be discussing climate change and conflict.
  • Kath Zappi Puri — Person · Referenced contributor (cover illustrator) · 1 mention · first at
    Credited as the indigenous Brazilian illustrator commissioned for the BMJ climate issue cover, symbolizing Amazon, women/children, and biodiversity themes.

Books & papers

  • BMJ's climate edition — Book · Primary recommendation · 1 mention · first at
    The annual climate edition of the BMJ, focusing on Brazil and the Amazon.
    And some of the big themes our authors brought up. Yeah. So this is the fifth year that we've published an annual climate issue in the BMJ and the focus this year is Brazil. The reason being that COP 30 is taking place in BM.

Companies & orgs

  • BMJ — Company · Publisher · 1 mention · first at
    The publisher of the journal and host of the podcast, focusing on climate change and health issues.
  • Gates Foundation — Company · Collaborator · 2 mentions · first at
    Collaborator in the collection on transforming women's health through innovation.
    Develop a collection of articles that looks critically at this emerging field of women's health innovation. I'm really proud of the journal's track record and I think recently…
  • London School of Hygiene and Tropical Medicine — Company · Affiliation · 2 mentions · first at
    Affiliation of a guest discussing climate change and public health.
    Separating them out from natural variability. So, for example, over the summer, some of my colleagues at the London school suggested that about over 70% of the extreme heat…
  • Imperial College London — Company · Affiliation · 1 mention · first at
    Affiliation of a guest discussing the health effects of SUVs.
    Injuries that pedestrians and other drivers experience after being struck by one of these cars. Earlier this week, I spoke to Anthony Lavity, associate professor of public…

Products & tech

  • SUVs — Product · Case study · 2 mentions · first at
    Discussed in the context of their negative impact on road safety and pollution.

Places & events

  • Brazil — Place · Setting · 3 mentions · first at
    The focus country for the climate issue, discussing its environmental and health challenges.
  • COP 30 — Event · Key event · 2 mentions · first at
    The upcoming COP 30 event in Brazil is a central topic, discussing its significance and expectations.

Full transcript with timestamps

Welcome to the medicine and science podcast from the BMJ. I'm Sophie Cook, head of clinical content at the journal, standing in for Cameron Abassy. We've just had our annual climate edition. So, in today's podcast, we'll be discussing climate change and conflict. That can also possibly be a trigger which can be exacerbated by climate change.

Why SUVs erode road and climate hazards. The height of the bumper, the location on the body that the injuries occur, the injuries can be more severe.

And we'll be looking at women's health innovation. Innovations without equity can actually reproduce the same hierarchies and discriminations that those innovations claim they wish to disrupt. Today I'm joined in the studio by Andy Haynes, professor of environmental change and public health at London School of Hygiene and Tropical Medicine. Welcome Andy.

Thank you. And online by Juliet Dobson, the BMJ's managing editor. Hi Sophie. And Barbara Sedova from Potam Institute for Climate Impact Research.

Good afternoon. Hi Barbara. Um Juliet, let's start by talking a bit about the issue this year. Um and some of the big themes our authors brought up. Yeah. So this is the fifth year that we've published an annual climate issue in the BMJ and the focus this year is Brazil. The reason being that COP 30 is taking place in BM in the Amazon in Brazil. So we wanted to focus on how the climate emergency is particularly impacting on the Amazon. So, we have a series of pieces written by Brazilian indigenous authors talking about a number of different themes um particularly around the Amazon and how it's this vital ecosystem for human and planetary health. But it's really in danger and at the moment the Amazon it's this source of biodiversity and nature. It's a carbon absorber and it holds so much knowledge from the communities that live there in terms of protecting the rainforest, but it's at risk from deforestation, from cattle

grazing, illegal mining, and oil extraction. And so the pieces really explore the impact that that's having on the communities that live there, but also the impact that it has on the whole world.

Thank you, Juliet. Can you tell us a bit more about the the cover as well, because that's quite interesting. We've drawn on the Brazil content for that and tried to to work with a Brazilian artist.

We have. Yes. So the cover was commissioned from a Brazilian illustrator from an indigenous community called Kath Zappi Puri and she worked on it in collaboration with another illustrator. And the cover really depicts it depicts the Amazon but also the role of women and um children in the Amazon and nature and biodiversity. and she gave a really beautiful description of what the cover is really meant to mean. And it's it's not just showing the Amazon and the people living there, but also them kind of living as one and living as part of the forest.

Thanks, Juliet. For you, out of all the content, were there any pieces that you particularly enjoyed reading or editing or anything where you think there were particularly important messages for our readers? Well, I really enjoyed the piece about um biodiversity and how the Amazon is this rich source of biodiversity and the climate emergency and climate crisis and biodiversity are these two twin crises that we need to tackle simultaneously. Um we talk a lot about climate but actually this is a health issue and the issue does include some original research and education articles as well.

So Sophie, do you want to tell us a bit more about those? Absolutely. Thanks, Juliet. So we've got a couple of research papers. One of which looks at the impact of tropical cyclones on um mortality and health and also another one which looks at how living near green spaces can impact on mental health admissions. And in our education section, we've also got an article which although not directly related to climate, it is an environmental issue is noise pollution. And that's not perhaps discussed as much or given as much airtime as some of the other health effects um that we see. Uh and we have a really nice what your patient is thinking article and it was written by a woman who lived in Indonesia and it reflected on her own experience being pregnant and then a new mother in an extreme heat wave. She describes the problems she had with breastfeeding, the effect it had on her baby, and really sort of raises

awareness about how we need to think more as health professionals about how heat does affect the postpartum period.

Great. Thank you, Sophie. Thanks, Juliet. Well, we'd urge everyone to have a look at the content online. There's plenty more to explore. So, thanks for sharing your highlights with us. Um, Andy and Barbara, you've been really patient listening to that. Thank you. Um, but we've got you here to talk a bit more about the article that you wrote for the edition, which is tackling the complex links between climate change, conflict, and health. So, we are seeing an increase in conflict around the world, unfortunately, at this time, and climate change we know is intensifying. And both of these are leading to loss of life and health harm.

So, Andy, to set the scene for our listeners, could you tell us a bit about the scale of the health problems that we're seeing as a direct result from conflict and climate change? Well, of course, climate change is becoming manifest around the world, as you say, and thanks to advances in what we call attribution science, we can increasingly link uh health effects to human induced climate change. In other words, separating them out from natural variability. So, for example, over the summer, some of my colleagues at the London school suggested that about over 70% of the extreme heat related deaths in Europe could be attributed to humaninduced climate change. And if you just take the 2022 and 2024, um there were about 60,000 heat deaths, something of that order in Europe alone. So you can see that on a global scale, it would be quite substantial. And of course, these deaths are likely to increase with

climate change. But direct effects of heat are just one pathway. I mean we're also seeing changes in infectious diseases uh reductions in crop yield a whole host of different pathways affecting both physical and mental health and of course climate and conflict is an emerging area that um we wrote about in our in our comment really trying to explore the complex linkages between the two.

So for a while we've been hearing about the potential for climate change to exacerbate conflict. Do we know that that's actually happening now? And do you have any sort of case examples about that?

Nobody will be surprised when when I mention the Sahel and probably the farmer her conflicts where herders need to uh change uh their roots due to climate risk and uh increasingly enter um the farming areas uh many violent clashes between farmers and herders um in the Sahel are happening. So the prospects are not looking great um given the intensifying impacts of uh climate change.

I think the example of the Sahel is a very good one. There have been a number of studies suggesting for example in countries where you've got what they call ethnic fractionalization and you know multiple ethnic groups that may not necessarily may have cultural differences and so on including this tension between the animal the herders and the the more sedentary farmers. uh these can be a situation in which the risks are increased also where u you get droughts particularly in the in the growing season of crops and you've got an agriculturally dependent population that can also uh possibly be a trigger which can be exacerbated by climate change. So there are a number of different pathways by which climate change can uh directly or indirectly influence conflict and also of course it climate change makes recovery from conflict that much more difficult uh as well.

And uh what's especially worrying is um that the countries most exposed to climate impacts often also uh have the weakest uh health systems and many of them are already dealing with instability and conflict. So really these fragile contexts are areas which can get trapped in the vicious cycle of reinforcing um climate impact conflicts and deteriorating health.

So can you tell us a bit more about that um Andy or Barbara about the evidence and the data about who is most vulnerable to these synergistic effects? Who are we seeing affected most in this situation?

Well in terms of vulnerability there's geographic vulnerability. um people in low and middle- inome countries are often held to be more vulnerable. But we also know that some groups in relatively high income countries are vulnerable to the elderly and increasingly we're understanding that extreme heat and other climate uh impacts can affect a pregnancy and u young children as well. So it's a very rapidly evolving scene I would say and we're probably underestimating the impacts both of conflict a and of climate change because conflict also has uh impacts which are beyond the direct effects. The direct effects of the bombs and the bullets and so on. We know that populations that live within 50 kilometers of conflict for example have higher risks of maternal and infant deaths. One study suggested perhaps 10 million uh children uh killed as a result of conflict uh over a 20-year period and many of those deaths would

occur indirectly through the disruptions of health care systems, supply chains, uh violence of of various kinds due to the breakdown of law and order. So it's a kind of toxic mixture really of both climate and conflict which is driving ill health in many parts of the world. And of course, um, conflictaffected countries also have difficulties in adapting because now it's very clear that we have to adapt because we're already virtually at 1.5 degrees centigrade. And so we've lost that almost certainly lost that Paris agreement target. So we have to adapt as best as possible. And yet those fragile and conflict affected states have the most difficulty in adapting. Sometimes they don't get sufficient funds. and when they do get funds, it may not be administered in the best way because you really have to engage the communities if you want to have an impact on on climate adaptation. So, it's really a mixed and

and as we've heard a synergistic a picture. It it's worrying and I think with so much conflict around the world and climate change accelerating as we said, we really need to think of solutions. I mean, what do you think needs to happen next to reduce the harm that we're seeing?

Well, there there are two responses you can have or at least two responses in climate change terms. One is to adapt to the changes that we can't prevent. So create more resilient health care systems, more resilient supply chains, more resilient food systems and so on that underpin human health. But also we have to mitigate and in climate change terms when we talk about mitigation what we mean is cutting greenhouse gas emissions. So CO2 is the one that everyone knows about really because it's a long acting uh greenhouse gas. But they're also uh the what many people call super pollutants. super pollutants because they're much more impactful molecule for molecule than carbon dioxide uh like methane for example which comes from ruminant animals from rice patties from gas leaks and so on and other greenhouse gases as well. So we have to act on all these greenhouse gases simultaneously and we're just not

doing that at the necessary speed and scale. But I suppose the other side of that, the good news story is that when you do mitigate, you can get big health benefits, near-term benefits over and above the benefits of reducing the risks of climate change. So you get, for example, benefits from reducing fossil fuel related air pollution. We published that paper in the BMJ um a couple of years ago showing that about five million premature deaths a year could be attributed to fossil fuel related air pollution and there are other preventable deaths from unsustainable food systems and the kind of dietary limited dietary choices that many people have unsustainable transport systems and so on. So these are deaths which can be prevented in the near term and bring these added benefits over and above preventing the risks of climate change.

So, of those things that you've just discussed, Andy, and then I'll come to you afterwards. Barbara, what do you think um which one change in particular do you think is likely to be the most impactful?

Well, it depends what to whether you mean impact on the climate or impact on health. If we take the climate for the moment, I mean, clearly it's a fossil fuel phase out that's really crucial and that's of course uh something which is not really fully on the table in Brazil as we've heard. Uh unfortunately, it should be, but but it's not. Some nations are pushing for it, but others of course are resisting that because their economies are based on the exploitation of fossil fuels. So I think that's that's the big uh prize that we need to aim for is actually reducing and ultimately rapidly in fact phasing out our dependency on fossil fuels and that will bring major health benefits if we can do that in an equitable way. What we don't want to do of course is increase energy prices that disadvantage the poor and so on. So it has to be done a just and a fair transition towards a net zero and healthy economy.

And Barbara, what what changes would you hope to see? As already uh pointed out by Andy, I think both uh stepping up mitigation and stepping up uh adaptation is key to um you know reducing all sorts of uh climate impacts uh including those on conflict and including those on health. Uh for me stepping up uh action on these two fronts uh is uh crucial but simultaneously it needs to be um ensured that uh climate action both mitigation and adaptation are compatible with other global policy priorities that they don't uh reinforce inequality poverty or that they are basically um compatible with peaceuilding um efforts. So trying to make climate action uh synergetic with other decision making uh um along the sustainable development goals um is I think um the priority at the moment

but we know how poorly that's happening. Do you think that we can get from talking about this to actually being effective? Yeah, I mean uh I I do and um I think the hope is uh in intersectoral and interdisciplinary collaboration. So I I really believe that uh research and science should um collaborate together because the crisis are getting uh more and more complex uh requiring more and more knowledge from from different areas and um uh and understanding from different areas. And again once we have this knowledge this needs to be effectively translated and communicated to decision making. Um so I I truly believe that evidence-based uh decision making could could be very helpful in this area.

This is something that we've been long advocating because many of the determinants of health whether they be social, economic or environmental are of course mediated by policies outside the direct control of the health care sector. And I think those of us working that have worked a lot in health care have not always been very good about reaching out to colleagues in in other sectors and sometimes when I've had the opportunity to speak to decision makers to ministers or whatever I've said to them look you may be the minister of energy or whatever but actually you're a minister of health whether you like it or not and the sooner we recognize that the better. So we do need I think much better governance mechanisms at the kind of cabinet level that would take responsibility for this interreationship between human health and environmental sustainability because I think that politically, you know, not many people

are prepared to really vote and campaign for the environment. That doesn't really resonate much as we might hope it would with many people. But when we talk about health, the health of their family, of their loved ones, uh that does resonate much more. So I do think the health message working through different sectors can really uh have a much bigger impact than using the kind of traditional arguments around oh well environmental sustainability or or whatever it is. And I think we need to look for countries which have successfully managed to integrate intersectoral action. And a lot of that integration actually occurs at the subnational level. So when you talk to city leaders, they are much more attuned to the idea of working with different sectors uh to deliver benefits for their local population. They're often much more in touch with the local obviously their population than a national leader

is. And perhaps that's where we need to look for some of the successful examples.

And if we turn our attention just briefly to COP, um you did mention COP, Andy. We know that outputs from COP have been disappointing over recent years. what your are your biggest hopes for the conference this year and are there sort of any particular changes that you hope to see as a result?

Well, I think obviously there's an opportunity to build on the health day which is occurring uh at the moment. Um I I would say that the Bellain health action plan does focus really almost exclusively on adaptation and I think many of us hope to see a more balanced plan which would include both adaptation and mitigation. But we [snorts] are where we are and adaptation is an important uh topic to uh to emphasize and to implement. I think what we really need of course is is real action and not just speaking and that's always the challenge with COP. what kind of actions are going to follow from COP and um we need to see a greater mobilization of funding because funding as we know has been inadequate and actually that takes us back a little bit to the whole issue of conflict and arms because it's been very striking how military expenditure has increased over recent years and the most recent data suggests $2.7 trillion

a year that we're spending on arms and you know by coincidence or not that's roughly the same amount of money that we need to decarbon ize the energy system globally.

So, of course, I'm not naive enough to imagine we could just transfer arms spending to climate, but if we could divert some of that military expenditure to fund adaptation and mitigation actions and an increasing transfer of resources from militaristic to peaceful purposes, you know, we could address many of the challenges facing the world at the moment.

Indeed. Thank you, Andy. and Barbara, any thoughts from you on on COP and what you hope to happen this year?

Yeah, thanks. Um, so for me, I I can only second um Andy's points on um you know uh uh not only talk about uh plans and ambitions but also uh implement them and um see some action. So um I think more uh ambitious uh NDC's or nationally uh determined contributions would be uh one uh really important area of action and um another one uh would be to implement the climate finance uh commitments of the global north countries to support um global south countries in implementation of uh uh of ambitious climate action plans. So uh really um action on both fronts and um um when I say action I mean action not only commitment uh is I think um key at this stage.

Do you think COP in its current form is is still fit for purpose and you know given the criticisms of recent years or is there another model that you think would work better?

Well you you can't just abandon COP. I I mean obviously some uh the fossil fuel industry I'm sure will be delighted if we abandon crop. they wouldn't have to send so many thousands of people spend all their money lobbying COP which they do at the moment. Um so we can't abandon it. Um but COP is not the only game in town. There are lots of activities occurring at the national and subnational level which need to be reinforced. You know there's still quite an appetite amongst city mayors for example for action around adaptation and mitigation of climate change. And as we know there's quite a lot going on in the healthcare sector itself which was responsible for about 5% of emissions.

Incidentally, the arms the military sector is responsible for just over 5%. Uh and uh so you put these two together and you've got substantial proportion of greenhouse gas emissions. So I think we need to reinforce and support many of the actions that are going on outside COP. But with regard to COP itself, I think what needs to be done is first of all there needs to be some restrictions on who can attend. I I don't think that people who've got an obvious conflict of interest in increasing the use of fossil fuels should be allowed to attend. Of course, at the moment, I guess the UNF triple C doesn't have the power or the influence to prevent them, but I think that's a reform which is frankly uh long overdue. And then secondly, I think we'd like to see um human health and human outcomes more generally at the core of the negotiations. It's not just about reducing greenhouse gas emissions,

although that's absolutely vital. We also need to make sure that the interests of the world population and and of course the security of our planet planetary health which is the integration of human health and the health of natural systems that needs to be much more foregrounded in the negotiations. I'd like to see more health um representation on the negotiating teams for example that would be really beneficial. So there's quite a lot that can be done to reform COP as it is. Uh but we shouldn't limit our actions to COP. We should also be doing a great deal of work between the the different cops.

So Andy, you've written another opinion piece for this issue with Jess Begley and Fabio Cresto Elena where you highlight the need for governments to do more in terms of their nationally determined contributions and how health doesn't really factor into many of these plans. So can you tell us a bit more about that?

Yes, this term nationally determined contributions uh NDC's not NCDS which will be more familiar to your probably your listeners. These nationally determined uh contributions are the commitments essentially that countries make under the Paris agreement. So they have to file uh under the agree under the terms of agreement they have to file their commitments to reducing greenhouse gas emissions and adapting to climate change. And we know that within those NDCs there are big potential opportunities to benefit health. uh for example, you know, from reducing fossil fuel burning, reduced air pollution, more sustainable transport systems that support walking and cycling, more sustainable food systems that support food security and also healthier diet, more sustainable diets, the the problem is that although um about uh you know 90% of them or so make some kind of reference to to health and about 2/3

refer to adaptation actions, but less than a third really identify the kind of health benefit benefits of mitigation and the problem is also that many of these statements are very high level so they don't really have an implementation uh plan attached so they're of limited value in that respect and there's really an opportunity I think to build on these NDCs which are official government commitments to really make sure that health is much more embedded in those uh commitments and we suggested four specific things that could be done one of course was to align the national emission reductions the greenhouse gas emission reductions to the Paris agreement target which many nations of course are not uh uh and uh that includes both carbon dioxide and these super pollutants like methane and and nitrous oxide and others. The second is to take action in the health care sector itself. So we know that the healthcare

sector is responsible for four to 5% of emissions more in the USA and there's as we know a lot that can be done within the health care sector to reduce emissions but also to create much more resilient health care systems that are more resilient to extreme heat floods etc. The third thing is this point about intersectional action. It's something we're we often talk about we're not very good at doing. So really working with colleagues in other sectors to maximize the health gains of these sectoral policies by reducing uh inequalities for example or also by capitalizing on the health co- benefits of better energy policies, better transport policies and so on. And the fourth is really important as well and that's really focusing on implementation because I've mentioned many of these are very high level statements and what we need are implementation plans with clear targets and milestones. So implementation and

evaluation and monitoring to ensure that we're really making progress are absolutely crucial. If we could put all those things together, then I think the NDC's could become a really important um lever tool for advancing climate change and also advancing public health. Thank you,

Andy. Barbara, thanks for joining us. And those articles we've been talking about are all freely available on bmj.com and we'll add links to the podcast notes to help you find them. As we've heard, tackling issues that impact the climate are also really helpful in improving other health problems. And as part of the issue, we've also published an editorial looking at SUVs. The growth in both the sales and the size of SUVs is increasing both road pollution and the severity of injuries that pedestrians and other drivers experience after being struck by one of these cars. Earlier this week, I spoke to Anthony Lavity, associate professor of public health at Imperial College London, and trauma surgeon Cleo Kennington. We discussed the health effects of this car spreading.

Cleo, as a clinician who's seeing uh the the trauma um inflicted by by motor vehicles, what prompted you to want to write this editorial? Within my work looking after victims of trauma, um it's well acknowledged that about a third of our um cases are elderly people who've had falls um uh with low impact trauma. A third are motor vehicle collisions and about 5 to 10% are penetrating trauma and the remaining 20 to 25% are other things. Um and we have a lot of work within the hospital at prevention. So for the elderly uh patients, there are lots of clinics focusing on preventing elderly people from falling, picking up those at risk, um providing treatment to prevent them from falling over. From for the the youth violence, we have a lot of work within the hospital um uh supporting these young people to prevent them from going on and get having further injuries. But we don't have any um con concerted um prevention programs

led by the hospital to protect our patients from uh road collisions. um and and and the dangers of this

and I think if it's if it's all right I was going to say because so Cleo I remember when you and I talked recently you had talked about how I mean there are you know there are surgeons who are sort of out there in the media talking about knife crime you know about those penetrating injuries but um there hasn't really I think been any of that thus far um around these these vehicles and their added danger

um so it's quite obvious to me that I'm seeing more and more of these large cars on our roads and as you say in your editorial they now make up 63% of new car sales as of 2024. So Cleo, as someone who deals with the impact of these on patients, what has this meant for your trauma work? We can see when I have been involved in cases which would definitely involved with SUVs. um the injuries can be more severe, more difficult to treat because of the mechanics like the the weight of the car and the the the the height of the bumper, the the location on the body that the injuries occur, that the injuries can be more severe. If it's a peripheral injury, more like a a limb injury, we are more able to treat those.

If it's a brain injury, once the injury is done, we can do a lot to prevent the injury worsening, but we can't um undo the brain injury. And those are more common um like we've said in in injuries related to SUVs.

And you mentioned also in the editorial about sort of um the impact on children as well.

Certainly um when a a child is is hit by an SUV, especially because the height of the bonnet is the same height as a an 8-year-old. Um it can have a much more devastating injuries. Anthony, what sort of data do we have about the injury and pollution effects of SUVs at a country level? So last year in injury prevention, you know, we published this systematic review, you know, really the question was if you're walking or cycling, if you're hit by an SUV, is that more dangerous than being hit by a, you know, a normalsized car? That find sort of 24 studies. Quite a lot of them were in America, but you know, it was very clear that, you know, for adults, you know, we talk about this 44% increased odds of dying. And that's higher at sort of 82% in kids which you know is what we would expect you know if we think um about the size of them and how they hit kids as sort of Cleo talks about. So we have good data I would say

on the the road injury picture. Um we have probably less good data around this the pollution specifically. You have to piece that together a bit more. you know, we know that they are, as I said, producing more tire wear, producing more uh brick emissions and we know that that's a big contributor to the pollution we see in urban areas particularly and we know obviously very clearly that you know out outdoor air pollution is very negative for health. So I think we can you know be I would say be clear in our minds that this is what is happening but that you know the data on the real specifics are probably a bit more lacking there. Um but I mean I think we I would say I mean certainly my opinion is we know you know we know enough to say well you know this is really a problem that we should you know think about trying to deal with.

Anthony, people often buy these cars thinking that they're going to be safer for their families and that's a big factor in their decision, but obviously we're now seeing that that's not the same for those outside of the par. So, what information do you think people need to be given or need to be aware of when they're contemplating decisions like this?

Yeah, it's a good question and I think it I mean I think it does help to think yeah about why people are making these decisions. I mean I would say you know I'm very much a structural determinant of health public health you know uh person and would advance those arguments I mean we can talk a bit about the individual decisions that people are making but um you know re you know car manufacturers are you know producing these cars they're getting larger they're getting heavier they're getting wider every every year Um, and that's that's a a choice they've made. They're, you know, they're putting big amounts of money into marketing these cars to people, as you say, partly based on saying, you know, this will be safer for your family. And so, you know, I think it's worth thinking about why there are so many of these larger cars on the road. I mean, in terms of people's individual decisions, I think, you know,

being being clear about these extra risks um is helpful. you know, lots of people and who can blame them in a way are not, you know, thinking, you know, when they buy a new car, they're not thinking what's going to happen if I run over a 10year-old, right? That's not really part of the um part of people's thought process. But I think you know raising awareness around the fact that maybe this is safer for you inside although I'm not entirely sure of the evidence on that but you know we are pretty certain we're very certain that you know there's these extra risks to people outside your car. So I think you know being clear about these things um can help.

I I was struck in the piece about the relative difference in tax between France and the UK on these cars. Can you tell us a bit more about that and whether this was a deliberate public health policy from the French government?

Yeah, it's I mean it's it's striking. I think the um you know it's a 20fold difference the sort of acquisition tax to have a larger car in France than in in the UK. So obviously you know that's big big numbers. I don't know particularly whether it's much higher in France because they've thought particularly about these public health arguments. Um but I guess what I would say is you know if we think about sort of vehicle taxation you know including also you know things like fuel taxation Britain hasn't gone very far in terms of thinking about what are the health impacts of these things you know it's not even you know in the conversation you know what would happen to you know any sort of health metrics so that's very much something which isn't considered but you know very much could be and we So I mean I would say what we know from lots of you know public health things is you know changing taxes

changing prices firstly it's one of the big levers that governments have uh but also we do know that that does change behavior and you know we think that you know if people if there were fewer SUVs that would change health outcomes so so it seems like a missed opportunity to have these you know levels of taxation on these larger cars which are you know much lower than you know quite comparable geographically close places.

So as a result of you know raising the awareness of this in the editorial what would you both like to see happen next? Cleo perhaps I'll come to you first. I hope that more doctors will uh read this article and understand the health and safety implications of SUVs and realize that it's not cool to have an SUV and use their their their power to not buy SUVs and not have not drive cars like this. Um as well as advocating for uh changes in uh policy to mean that less people use them as well.

Thanks Cleo and Anthony. What would you like to see happen next? Yeah, I mean I' I'd very much echo Cleo that um you know having doctors, the medical community advocate uh for these issues is is helpful. We've seen that through lots of uh lots of public health um issues in the past and you know currently um partly I mean hopefully the awareness is going to you know drive some um individual people to make sort of different choices around the cars they are buying. But um I mean I think the you know the big changes are going to be really you know around sort of taxation and so you know you know parking policy is changing and so in car different places and that's you know going to make a bit of a a bit of a difference but so hopefully all of these things together are going to mean there are you know fewer of these vehicles on our roads and you know they are roads are safer the air is cleaner um and I think that would

be a good news to and that article reducing the health harm arms from ever larger cars is available on bj.com. Again, links from the podcast notes. The BMJ has also published a collection on transforming women's health through innovation led by the BMJ's international editor and head of scholarly comment, Joselyn Clark, who joins me today. Joselyn, thanks for joining us.

Thanks for having me, Sophie. So, the BMJ has got a strong track record of publishing on women's health. um how does this new collection add to the contribution and what are some of the key messages for our general medical audience?

Thanks. Yeah, I I mean I think it's been a great fit that the BMJ went into partnership with the Gates Foundation to develop a collection of articles that looks critically at this emerging field of women's health innovation. I'm really proud of the journal's track record and I think recently there's it's become almost fashionable to be talking about women's health with this kind of innovation lens but the new visibility and attention to the field is very welcomed and in fact it's broadened the community really much larger than we've seen traditionally. So now we have fem techch entrepreneurs, we have business interests, we certainly have a lot of economic cases being made um around advancing women's health and the kind of prosperity um it will bring to economies if we do close the so-called women's health gap. So it's it's bringing a lot of new players um into the community that was traditionally um centered on

academic research and and policy. And whilst of course that's that's new for us and there's um a lot of challenges associated with that it it's it's very welcome so that we do advanced progress in women's health which has been frustratingly slow.

Thanks Joselyn. It seems that the collection covers wide areas within the field of women's health um innovation. What most surprised you or do you feel are the most significant findings or recommendations from these articles? Well, the first one is is this the first surprise is the one that's frustrating which which is that over decades of advocacy for women's health that progress in funding in R&D in the inclusion of women in in clinical trials in sex and gender disagregated data things that we've been calling for over decades including in the BMJ are still not being realized.

For example, you know, despite women being 50% of the world's population, they have never in history um been represented in those numbers in global health funding. Less than 10% of US National Institutes of Health funding, for example, goes towards female specific um conditions. Less than 5% of global health R&D in the world goes towards conditions that women either uniquely or disproportionately um are impacted by and something like less than 2% of venture capital health investments go toward women and women do outlive men as we know but they do experience a global health gap which is about 25% more of their lives are spent in ill health. So there's clearly a gap that needs to be filled. Um and that's you know a a frustrating one to confront but at the same time this emerging field of women's health innovation perhaps can help us close that. The ways that the collection I think contributes to the

conversation is you know principally adding scholarship to an area that's rapidly growing. These are seven articles um all women led by a number of um authors from different disciplines around the world representing 14 different countries globally and together they examine issues like data science, artificial intelligence, diagnostics, other digital tools, decolonial thinking, the barriers to women's advancement in careers and leadership and talk about how we can unlock um some of those domains in order to advance more funding, more attention to the development of women's health innovations that you know both draw on women's expertise in their design but also um deliver products that um meet the unique needs and lived experience of women. And for the BMJ, what you know we're interested in are the things that matter most to us, which is we want the path to transforming women's health innovation and to improving women's

health and rights. We want that to be ethical. We want it to be evidence-based. We want it to be equitable. And of course we want to, you know, support those working in the field to to also question the systems of power that um, you know, allow for women's health to not be prioritized in the way that it needs to be.

Thanks, Joselyn. It's a really rich and diverse selection of articles that you've discussed there. I just wondered that, you know, after this collection, what do you think needs to be prioritized next? Well, what I'd like to invite listeners to do is, you know, absolutely have a look at the collection, which as I said is seven independent analyses um that are multi-disiplinary, authored by international authors, all open access on bmj.com. We have two external um experts that wrote editorials for us that really do um emphasize the need for us to be asking tough questions about power.

Women, as we know, deliver most of the health care um in the world. But women shouldn't just be the deliverers of innovation or indeed just the beneficiaries of what we're proposing um in the women's health innovation field. But women should be architects of those innovations. They should be the architects and the designers of what those those solutions are so that we can ensure that the products, the technologies, the digital tools that we develop actually reach the women that need them. As one of um those editorialists, Dr. A bear Okareki said at the webinar that we hosted a few weeks ago to formally launch the collection, innovation without equity is not innovative.

The current ecosystem under during which or through which the innovations have been developed and implemented is actually very is not designed to reflect women. It decides who gets funded, who is heard, and whose lives are actually deemed worthy of improving. And as an African woman in global health, I've actually learned that innovations without equity can actually reproduce the same hierarchies and discriminations that we that those innovations claim they wish to to disrupt. So, it's important to recognize that unfortunately women are still not in the positions of power as often as we want despite our rhetoric about inclusion and we've been talking about inclusion for a very very long time.

How can readers and listeners learn more about this collection? The collection which we developed with the Gates Foundation is fully available open access on our website.com/collections. We also hosted a webinar that we've just put on the website where all the authors of the articles presented rapid fire um key messages from each of their articles and we were able to have external experts reflect on the collection and we had a very nice uh conversation about how to chart an ethical evidence-based and equitable path forward for women's health innovation.

Thank you Josinim. That's it for this episode. Cameron will be back in a fortnight for more medicine and science. I'm Sophie Cook. Thanks for listening.

Questions about this episode

Who speaks in "Climate, “car spreading”, and conflict"?

Sophie Cook (Host), Andy Haynes (Guest), Juliet Dobson (Guest), Barbara Sedova (Guest), Cleo Kennington (Guest), Anthony Lavity (Guest), Joselyn Clark (Guest).

What is "Climate, “car spreading”, and conflict" about?

The discussion centers on the intersection of climate change, particularly its impact on the Amazon ecosystem and its connection to social justice issues such as conflict and health disparities. Key points include the role of large vehicles in exacerbating climate hazards, the need for equitable health innovations, and the voices of Brazilian indigenous communities highlighting the urgent…

What is mentioned in this The BMJ episode?

15 people, works and ideas are mentioned, including Sophie Cook, Andy Haynes, BMJ, Brazil, Barbara Sedova, Joselyn Clark. Each one on this page links to its own page with every episode that mentions it.

How long is "Climate, “car spreading”, and conflict"?

The episode runs 44 min; the transcript is about 7,551 words in 76 timestamped sections.

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About this transcript: the episode's spoken words as captioned on YouTube, split into timestamped sections. Reclip.Me locates every person, work and idea in the text, keeps the time it is first named, and quotes the words around it verbatim. Last updated January 24, 2026.