-Matthew Chersich and Peter Knox
Guest Contributor Prof. Matthew Chersich MB, BCh, MPh, PhD, is a public-health doctor working at the research institute at one of South Africa’s premier medical schools.
Public and scientific discourse in climate change has largely centred on environmental degradation and extreme weather events, with less attention paid to human health impacts. Health conditions related to exposure to air pollution are well recognized, and include lung cancer, asthma, and childhood stunting and Alzheimer’s Disease. Direct health consequences of rising global temperatures are less known, however. Conditions linked to extreme temperature range from preterm birth, food- and water-borne infections, homicide and suicide, to renal failure in outdoor workers, and deaths in the elderly. Indirect impacts of changes in climate, such as expansion of areas affected by malaria and dengue, also have marked implications for health. As the field of climate and health research becomes more established, important questions around conflicts of interest (COI) need to be considered. Burnt by unethical behaviours of scientists funded by tobacco and pharmaceutical industries, the health sector, perhaps more so than other sectors, has a heightened awareness of vested interests. The fossil fuel industry has missed few of the tricks used by the tobacco and pharmaceutical industries to protect their interests, delay action and maximise profits.
In scientific research, it is accepted practice in journal articles and conference presentations that conflicts of interest are openly declared. Declarations don’t necessarily mean that one’s work has been influenced by these interests, but being transparent provides the information needed for editors and readers to assess whether that might be the case. We argue that the principles and standards that underpin declarations of COI relating to research on tobacco impacts or drug effectiveness should equally apply to research on climate-related topics.
At the core of a COI declaration is the principle that any profits gained from or a financial stake in any industry about which you write should be declared. However, a more nuanced approach would categorise COI into three areas. The first category of conflict includes instances where resources have been received from a commercial sponsor, either directly or via one’s institution, for any aspect of the research conducted. With tobacco declarations, any company that derives more than 5% of its revenue from manufacturing tobacco products is considered a ‘tobacco company’ or entity. It follows therefore that any direct funding from a fossil-fuel company for research on air pollution harms or climate and health should be declared.
The second category of conflict one should disclose is any personal financial relationships with entities that are outside the submitted work. These include relationships that could give even the appearance of potentially influencing, what was written in the submitted work. The ICMJE Form for Disclosure of Potential Conflicts of Interest used by most health journals states this as: ‘You should disclose interactions with ANY entity that could be considered broadly relevant to the work.’ Here, one is obliged to report all sources of revenue paid directly to you or your institution, regardless of the amount of compensation. If one does research on planetary health, returns on investments in fossil fuel companies that, for example, a university holds through endowment funds, or that an individual holds through investments in their pension fund, constitute interactions with entities relevant to one’s work. Though not explicitly mentioned in the ICJME declaration, many academic journals include stocks and other investments in their definition of financial interests. With investments in the fossil fuel industry, the investor is seeking and contributing to an expansion of the industry in scale or scope, and a growth in its profitability. An increasing number of people and industries are choosing not to hold these investments, cognisant of the public health imperative for shrinking the industry and reducing its profitability – key steps in advancing renewal alternatives. We contend that readers of articles on climate-related topics need to know whether the authors and their institutions hold the former or the latter vision.
The third category of conflict is broad, covering other relationships or activities that readers might perceive to have influenced what is written in the submitted work. The ICJME guidelines advise a broader rather than a narrower interpretation of what one considers a personal or institutional relationship, noting that: ‘If there is any question, it is usually better to disclose a relationship than not to do so.’
Researchers who declare that their university invests financial reserves in fossil fuels may face censure on the basis that doing so brings the university into disrepute. This, however reflects a fundamental misunderstanding of what a COI is. If reputation were a criterion for making a COI then few would be made at all. In fact, doing something that does or might appear to bring ‘disrepute’ is why we make COIs in the first place. Nowadays it is unimaginable for a researcher to be told not to declare that the funder of their drug trial is the drug manufacturer, for fear that such a declaration would threaten their university’s reputation. For individuals who hold that they have a COI, it is a question of whether they are willing to act on their conscience, even if that incurs consequences. Importantly, when researchers signs the COI form, they promise that they are being truthful.
Readers’ views on what is an acceptable relationship are dynamic. Indeed, the threshold beyond which researchers may have relationships with the fossil fuel industry, is reducing given the groundswell of activism against the climate crisis, influenced by the activities of figures as diverse as Pope Francis, Extinction Rebellion, and Greta Thunberg, among others. Academics are increasingly cognisant of the COI that fossil fuel investments carry for their universities. Faculty staff have dug up the lawns of Trinity College, Cambridge to bring attention to their college’s relationship with the fossil-fuel industry. In societies in which freedom of expression is highly valued, such protests are understood. In other societies, frank declarations of COI might lead to dismissal or pressure to resign.
Declaring fossil fuel investments, normalising this approach, and making visible the parallels between tobacco and fossil fuels as noxious to health, opens new mechanisms for responding to the climate crisis and making investments in fossil fuels less palatable, especially with companies prospecting for new fossil fuel reserves.
Pension funds in South Africa, and indeed university endowment funds are notoriously opaque about their investment portfolios. In addition, many people prefer not to know where their funds or their university’s funds are being invested, providing ‘protection through passivity.’ The default pension package generally includes fossil fuel investments, though in some workplaces employees may “opt into” a ‘green package’. Many of the most successful public health interventions centre on an ‘opt out’ approach, most notably with HIV testing, where the healthier option is the default. In this case – the ‘green package’ which one may opt out of if one prefers the higher yields that are likely from fossil fuel-friendly investments. It is a sad reality that for many people, such profits are important for shoring up their financial security. Taking a step back, however, one can view this as a rather short-term gain that compromises the public good. When one’s house is burning, will that extra 1% dividend really have been a sound investment? This ‘hear no evil, see no evil’ approach benefits individuals, financiers and ultimately the fossil fuel industry itself. But it is less advantageous for future generations, and the animals and plants which we are charged with protecting.
This is ultimately a conflict between human, animal and environmental health on the one hand, and the free marketeerism of late capitalism on the other. For those doing research on planetary health, our hands need to be transparently clean.
 International Committee of Medical Journal Editors. “ICMJE Form for Disclosure of Potential Conflicts of Interest.” https://www.bmj.com/sites/default/files/attachments/bmj-article/pre-pub-history/Merged_2.pdf
 cf. “Cambridge’s Trinity College Lawn Dug up by Extinction Rebellion.” 17 February 2020.
 Cf. Laudato Si’ 67, where Pope Francis writes: “This implies a relationship of mutual responsibility between human beings and nature. Each community can take from the bounty of the earth whatever it needs for subsistence, but also has the duty to protect the earth and to ensure its fruitfulness for coming generations.”