Perhaps the most important news coming out during the last week is about a climate change deal agreed to by almost all the countries in the world. If global warming increases, much of the planet is eventually going to become inhospitable for humanity. It is going to happen unless humanity learns to change its ways. It all started with the industrial revolution. Countries became rich, industry flourished and a large number of people were dragged out of poverty into the middle class.

During the last hundred years, life expectancy increased even in poorer countries like Pakistan. And people started to live better. All this doing and living better brought a couple of things with it. First of course more of us started to live longer. Suddenly the population of the world exploded. As more people lived they needed places to live and to grow food. Forests were torn down to make space and provide wood to build houses and furniture and with deforestation we started to remove the one major way nature had of taking greenhouse gases out of the air.

Then industry gave us the joy that comes from burning fossil fuels in our homes, in our factories and in our cars. All this progress spewed gases into the air that produced a ‘greenhouse’ effect. Heat became trapped in the atmosphere and the world started to warm up.

More than the long term results from warming of the world, something more immediate started to happen in many industrialised countries. The carbon particles from the coal being burnt to produce electricity and to run factories started to hang around in the air we breathe. This combined with the exhausts from vehicular traffic has made the air in many major cities harmful. Recently Beijing had an emergency lasting a number of days when the air was dangerous to breathe! But it is not just the environment that is making human life difficult. And yes intensity of the recent heatwave in Karachi that cost many lives can also be blamed on global warming.

As people become better off, they start eating things that they wanted to eat but could not afford in the past. Many years ago during my practice as a heart doctor in the United States, many heart patients I saw were ‘older’ immigrants from Europe or were survivors of ‘the great depression’. As I used to tell my trainee doctors, all of these men and women came to America or worked hard to get out of poverty to lead a good life, and they did. They started to eat all the things they were too poor to eat and drink in the old days. Things like milk and cream and butter and meat. And of course they no longer had to walk miles to work or carry heavy loads around; they had cars or trolleys and machines for that. What happened? They started getting blockages of the heart arteries and heart attacks. Living well has its problems.

Eating and living well and then developing heart disease is the perfect metaphor for what is happening to our world. Most intelligent people realise that ‘over indulgence’ is bad for them and yet most of us are addicted to the good life even though we realise that we might eventually have to pay a price. Of course the poor, and of them there are many including countries, say that the well to do have had all the fun and now they want us to stop wanting to live well also. That might be true but the problem is that if the entire world starts to fall apart; it is the poor and the poor countries that will suffer the most. For instance much of Bangladesh might just end up under water.

Already we are seeing extremes in temperatures and increasingly unpredictable weather patterns. The severe heatwave in Karachi that caused many deaths earlier this year is a typical example. Also, we will see unusually heavy rains leading to flash flooding in the higher altitudes and inundating rains leading to cities being flooded during extremely heavy rainy seasons.

All these ‘changes’ will require new planning to face excessive heat, floods, cities swamped with rain water and also extreme cold in areas where winters are usually cold. Many might think that Lahore being in the centre of the country will be immune from these weather extremes but that is not so. Extreme heat and cold are possible as will be flooding both from river as well as rain water. At the same time we will over the next few decades have to deal with a rapidly increasing population and greater pressure on cities due to rural migration into urban centres.

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For developing countries like Pakistan there are three important factors that need to be considered as far as global warming and the recent agreement is concerned. First is the rapidly changing climate patterns I mentioned above, second is the need to restrict the use of fossil fuels that could have a negative impact on development and poverty alleviation and third the increasing population that will require more food and other infrastructure needs that require development.

From a healthcare perspective the first imperative and most immediate imperative is to make sure that the sort of medical crisis that occurred in Karachi during the recent summer is planned for appropriately. Also contingencies should be prepared in case this happens in other major cities also. So far I have not seen any official report on why all those people died in Karachi during the heatwave that coincided with the month of fasting. That of course means that no plans have been made to prevent a recurrence of that problem. Then there are other health related issues like threats of epidemics during major floods and inadequate food supply during periods of drought. These existing problems will get much worse.

Interestingly, we in Pakistan actually have a federal minister for ‘climate change’. An entire department with senior bureaucrats are attached to this ministry. What perhaps is the foremost function of all these senior people, including the minister, is to attend meetings about climate change that interestingly are always held in developed countries that obviously have cooler weather and no loadshedding. Whether this ministry has made any long term plans about how Pakistan will cope with the coming problems associated with climate change is entirely unlikely.

One simple question for instance. What will happen to Gwadar port on which hinges Pakistan’s future development after a rising sea level? And what will happen to Karachi under similar circumstances is frightening to think about. Besides the safety of coastal cities, the problem will also be of relocating the residents and providing them with an entirely new infrastructure to live in.

While the rest of the world is thinking about moving away from the use of fossil fuels, Pakistan is concentrating almost entirely on these fuels for its energy needs. The worst is going to be the use of coal. No wonder our prime minister did not have much to say at the recent climate meeting in Paris.