Climate leadership - knowledge is power
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Welcome to Medicine Science from the BMJ. I'm Cameron Abassi, Editor-in-Chief of the BMJ. It's an often cited statistic that if healthcare was a country, it would be the fifth largest carbon emitter. At the BMJ, we want to change that and move healthcare towards a more sustainable future. So, in this episode, we're talking all things climate.

We sort of recognise that we don't need more evidence on the climate crisis and how it's detrimental to health. We already have enough. But what we need now is sort of clear leadership to really embrace that knowledge and to drive forward change. How CliFi can help us think about a better future. We have some evidence that there is an improvement in complex communication and being able to distill ideas into accessible and more readily available language.

And what climate change means for tuberculosis. Out of 10.6 million, according to the last report, falling ill with tuberculosis, more than 2 million are attributable to undernutrition.

Our commitment to tackling climate change is constant, but we also have an annual special issue which is around the time of the COP meeting that takes place each year. And we've just published our fourth special theme issue. I'm joined by Sophie Cook, who's the head of clinical content at the BMJ, and Juliet Dobson, our managing editor and head of opinion.

who put together the issue. So welcome, Sophie and Juliet. Hi, Cameron. Thank you. Thanks for joining us. So tell us a little bit about the issue. Sophie. So each of our issues have centred around a theme. And this year we commissioned articles that were focusing around leadership and also leadership

knowledge and the power of knowledge and how with the climate crisis, like any other important sort of public health issue, knowledge is power. We sort of recognise that we don't need more evidence on the climate crisis and how it's detrimental to health. We already have enough. But what we need now is sort of clear leadership to really embrace that knowledge and to drive forward change. But knowledge is also complicated and confused by

misinformation and disinformation, which is quite a problem when it comes to the impact of climate change, and particularly the impact of climate change on the planet and on people's health and well-being. There's a particular piece about misinformation and disinformation.

If you tell us more about that. Yes. So in the issue, we have an article by Simon Pietek and colleagues looking at misinformation and disinformation and the problems that they cause around information on the climate crisis. And I think what we know is that this was a huge issue during the Covid pandemic.

and caused a lot of problems with sort of public health messaging. And, you know, there are issues around climate messaging as well. So PeerTech and colleagues talk about what we can do to try and overcome this problem, which is a growing issue. And it's important that we think about sort of ways to produce trusted information, to educate people on where to get their information, and also the role of tech companies in trying to minimise this disinformation and misinformation that we see. So starting at the top,

And I think as a medical journal, we have a very important role in, you know, controlling sort of the information that we put out and making sure that it's evidence-based and important and can be used by our readers to, you know, in their consultations with patients and the public. We know that they are very well-trusted doctors and health professionals, and there is an opportunity for us to help amplify the right messages to overcome this problem that we have with mis- and disinformation. Yeah, because the point about trust is key, isn't it, Sophie? I mean,

where there are issues around information and the provenance of that information, health professionals have an important role to play. Medical journals have an important role to play. Yeah, absolutely. I think that as a medical journal, people will come to you and expect that you're

articles and the content that you produce are high quality and they're sourced from you know appropriate individuals who are using the right evidence to make the recommendations and suggestions that they do in the articles and I think you know that information can then be taken and shared with patients and hopefully we can be sharing the right messages to make sure that we're reaching a wider audience than just the people that are reading the BMJ.

So that means we all have a responsibility to make sure we know the facts. We're armed with information so we can advise patients. When we're talking to people, we can be explaining to them the extent and the impact of the climate crisis and what needs to be done. I mean, that seems to be a theme in the issue, Juliette.

Yeah, absolutely it is. And as Sophie was saying with misinformation and disinformation, climate is an area that's particularly vulnerable to that. It's partly because social media has a role to play in that, in sharing a lot of disinformation. And it's threatening people's understanding around the severity of the climate crisis and sort of downplaying the urgency of the fact that we need to act differently.

It's something that we've seen play out recently. Just after we published the climate issue with the hurricanes in the US, the amount of disinformation that was being shared really, really changed people's, the public's perception of it. And in some cases, even led to people thinking there was a sort of conspiracy theory. Yes.

Yeah, I think that got quite a lot of publicity. What are the other themes in the special issue? So as Sophie explained, the main theme or the overall theme of the issue is around knowledge and how knowledge is power. And we wanted to focus on that in a variety of different ways. So some of it was around disinformation, misinformation, but also looking at

climate anxiety and how that plays out, particularly among younger populations and children. What does that mean, climate anxiety? Well, it's an anxiety about the climate emergency, what it means for our health, but also, I suppose, a sort of deeper, more existential anxiety. It feels so hard to, on an individual level, to make a difference and to change the sort of course that we can see that we're on.

And that's very anxiety provoking and it's increasingly becoming an issue that healthcare professionals are having to face with patients, and particularly younger patients. Yeah, so you mentioned young people, Juliette. I mean, there are pieces about children and child health in the theme issue. Sophie, tell us what they are trying to explain.

We have a piece about children and the climate emergency which highlights just how vulnerable children are for various reasons. They are often, you know, displacement, for example. There's problems as a result of sort of food scarcity around the world and the impacts of those extreme weather events that we're seeing increasingly frequently.

And also, I think that children are vulnerable to climate anxiety. You know, they're the ones who are likely to be much more impacted than older generations. And therefore, there is this increasing proportion of children who are now presenting with mental health issues. And one article that we have considers that specifically and the fact

that we need better education for children in the climate in schools. We need to give more information to families about how to deal with it. And also, we need to think about how to provide the mental health and psychological support that these children need when they do present with these symptoms of climate anxiety. Yeah, Sophie, you began to talk about some of the solutions. I mean, the issue does have papers talking about solutions, which I think is something that struck me when I read the articles. And it's important to talk about solutions, isn't it, Juliette?

Yeah, absolutely it is. And there are some really key things that some of the articles are calling for. So, for example, the PeerTech article about disinformation talks about the importance of strengthening the public health message and learning from a public health approach so that we communicate clearly with the public. Also working with social media companies and tech companies to counter some of this disinformation. They also talk about the rising unemployment.

rising threat of AI and the impacts that that's going to have and really sort of thinking about how that will play out in the climate emergency. And there are other articles as well that talk about how to frame the climate emergency around the language that we use. Another piece by Julian Sheather, an ethicist and longtime contributor to the BMJ, has written about how we need to

new form of medical ethics that really grapples with the climate emergency and what that will mean for medical ethics and medical practice. We aren't just telling others to do things, are we? We also believe that we need to take action and we've committed to achieving net zero in our publishing activities.

And that's part of a commitment that we're making along with other publishers. At the BMJ, we've measured our baseline carbon footprint and we're going to work towards reducing that. One of the actions in that commitment is to be very strict about our advertising policy and also divesting from fossil fuels, advocating for that.

I think that's something that all medical journals should be doing. Do you want to explain exactly what we're saying, Juliette?

Yes. So we launched a divestment campaign in 2020 and that was just before the pandemic. And we've now taken some time to refresh the campaign and relaunch it with this issue. And we're calling on everyone to divest from fossil fuels. And it's something that we have also done as the BMJ. So you mentioned advertising. Yeah.

We don't take advertising from fossil fuel companies and we will no longer be taking advertising from banks that invest in fossil fuel companies. We also already don't accept research that is funded by fossil fuel companies. Okay, so we're trying to play our part, which I think is important. We're not perfect, but we're going to contribute and continue.

to push towards our own targets here. Sophie, you're a clinician. I mean, what do you think all of this means for clinicians? Should clinicians be active in all of this? I think clinicians have a real trusted role in the community and I think they are respected by people. They're in a privileged position where they have lots of interactions with many people from different walks of society. So I think for us, if we can provide clinicians with evidence-based information about the

problems associated with the climate crisis and the solutions. These are messages that can be disseminated more widely through patient interactions. So I think for me, as a clinician, what I take away from this is that this is everybody's responsibility. And I think we all have to be armed with the right information and the understanding that this is important and urgent, and we have to act now. And that even though individuals doing things on their own may seem very small, collectively, health professionals have the power to

implement change. Yeah, I think it's a really excellent issue. We'll put a link in the programme notes, but thank you for putting that together and thanks for joining us. One slight departure from our usual journal content is a focus on cli-fi. Climate fiction is a growing genre of speculative fiction and it imagines what our climate future may look like.

We wondered what role fiction might play in helping us navigate that future and wanted to use the podcast to think that through. So joining us, we have Howie Frumkin, Lakshmi Krishnan and Sarah Grossman. Howie, welcome. Just introduce yourself.

Thanks very much, Kamran. Very nice to be here. I'm an emeritus professor at the University of Washington. I'm senior vice president at Trust for Public Land, which is a national land protection organization here in the U.S., and a member of the BMJ editorial board.

Thanks, Howie. Lakshmi. Thank you so much. I'm Lakshmi Krishna and I'm a physician, cultural historian of medicine and founding director of medical humanities at Georgetown University in Washington, D.C. And I hold a Ph.D. in literature and I'm a practicing internist and health services researcher. So I'm interested in a multidisciplinary approach to addressing critical issues in health care.

Great. Thanks, Lakshmi. And we've got Sarah with us. Sarah. Hi. Great to be here. I am Sarah Grossman. My novel, A Fire So Wild, is about a wildfire that tears through Berkeley, California, and how that affects the families whose lives are upended as the heat and smoke descend on the city. And it's based on reporting I did as a journalist for HuffPost over six years on the climate crisis and other social justice issues.

Great. Well, I hope we can learn more about that over the next few minutes. But first of all, let's try and explain what cli-fi is. Luxby, you're a literary expert. I'd never heard of cli-fi. Is it a thing? Is it real?

It's definitely a thing. We like to name genres, though, in literary studies. So, you know, I'm looking forward to the next incarnation. But it's definitely a thing. It's a robust area of genre fiction within speculative fiction. And I think really speaks to...

what's going on right now. It's pressing and it's urgent. But we could say that there were things that would count as cli-fi that weren't called cli-fi. Do you have any prominent examples? Give us an example of something. Yes, I'm very biased because I trained in 19th century literature. So Mary Shelley... Most people love 19th century literature. Right.

Who doesn't? But, you know, Mary Shelley, best known for Frankenstein, wrote an incredible piece of what I would call cli-fi called Last Man. That's also a pandemic novel. It's about climate change. It's about

you know, new diseases that erupt in the setting of climate change. And it's about the titled last man wandering through the earth, trying to figure out what to do in this new reality. And it's an incredible book. I highly recommend it. But yeah, that's just one example. But there's tons of other formal cli-fi that I'm sure, you know, Sarah's book, of course, is part of that tradition.

Well, you've got it all thinking now, what other examples there are. But do you think that it has a purpose? Can it be helpful in terms of thinking about climate change? Yeah, absolutely. I absolutely think it does. I think it has instrumental and existential and hopeful purposes. So

I firmly believe that fiction tells us where we are and how we got here and pathways out of whatever here may be. I view books as magic. It's a magic trick in a way, right? A book was written in the past, but it can mirror the present reality and then it can imagine a potential future. And so when we think about the climate catastrophe and what we need to do to prevent it, absolutely we need the science, we need the financing, we need the policy and the will, but

We need a cultural shift and fiction can be a catalyst for that. Yeah, I mean, how you're in the business of trying to get people to think differently about the impact of the climate and change behavior, but also be hopeful. And your piece actually talks about the power of fiction. How do you see it actually helping people to understand what's happening around us and perhaps changing behavior?

Comrade, it's been interesting to me to think about fiction in analogy to medical treatments. When we prescribe a medication, we want there to be both safety and efficacy. We expect certain outcomes from a medication, specifically improving a health condition.

When we think of fiction, it may be fair to think about it the same way. What are the outcomes we hope for from a good piece of fiction? One may be a better understanding of an issue, a better cognitive grasp of the dimensions of the climate crisis.

One may be a set of emotional responses, either offering us solace in the face of a grim reality, perhaps inspiring us to empathy for future generations who will be impacted by climate change and therefore giving us a better emotional grip on ourselves.

on climate change. It may be that we want the climate, the fiction to inspire us to action, to inspire us to take political steps or to take lifestyle steps that will help address the climate crisis. So if it's fair to ask of fiction that it delivers certain outcomes,

That raises a set of empirical questions. Does a particular book work? Does it function that way? Now, I'm not sure that it's fair to ask fiction to do that. After all, fiction is art, and art for art's sake has perfectly sound value. I can't help but bring a physician's mentality to fiction and think about it in almost a transactional way in terms of the outcomes we'd like to deliver. Okay, but do you think then you might prescribe fiction

people to read climate fiction? Well, that's a fascinating question, isn't it? I would prescribe it if I had evidence that it is safe and efficacious, just the same as for a medication. So if we have evidence that fiction brings about in people some changes that we think are desirable, it would be a great tool in our armamentarium, wouldn't it? If, on the other hand, we have evidence that climate fiction depresses people and immobilizes them, I wouldn't want to prescribe it

So I think the answer is it depends. And maybe we need some more evidence. But I'm sure whether it makes you, you know, gives you hope or makes you feel a little despondent, it makes you think deeply about the challenges and the future. I mean, Sarah, coming to you, tell us about...

how you came to write your book. And then tell us a little bit about what it's about. - Sure. So I was a reporter up in the California Bay area, which is deeply impacted not only by heat waves, but particularly by wildfires. And as a reporter, my job was to tell individual stories of a certain fire, how it impacted a certain community in a certain span of time.

And while you were able to pan out to the larger climate crisis as context, there's nothing quite like fiction to be able to bring a whole breadth of experiences and issues to the fore and sort of tie them all together because the climate crisis doesn't happen in a vacuum.

and communities are not isolated in how they're being impacted. So one of the things I look at in my book, A Fire So Wild, is how the inequities drawn out by a capitalist system, the housing crisis, health crises, mental health crises,

are all tied in to the impacts of something like the climate crisis in the Bay, which means season after season, people are being faced with the prospect of losing their homes, losing their livelihoods, even if they don't having air impact their ability to literally breathe when they're outdoors. And how that looks for someone who is unhoused versus someone who has access to an air purifier in their home.

Yeah. Fiction gives you sort of a breadth of stories and you're able to bring in things like white supremacy and racism and how different communities are impacted in different ways by a climate crisis. You might not be able to look at when you look at one particular story that you're reporting on. Yeah. Lexmi, do we think then fiction, specifically climate fiction, do we think it can be influential?

I mean, what do we know about the influence of fiction? Yeah, it's a great question. You know, the humanist in me is always concerned about trying to measure or find empirical evidence for something that is intangible. And I think Howie made that point beautifully already. At the same time, and this is where I'll bring in the exciting field of medical humanities.

which really is trying to bridge medicine and health care and social and cultural and historical dimensions of health and fiction being part of that. One of the things I think many of us in the field are trying to do is actually figure out how we measure the impact of the humanities, of fiction on so many of these issues.

factors really. So, you know, thinking about physician training and medical education, how does fiction help physicians communicate the complexity of the climate crisis and understand the complexity? And we have some evidence that that there is an improvement in complex communication and being able to distill ideas into accessible and more readily available language.

systems-based thinking, that's a hard thing to measure. But how do we think about how the clinic is connected to the community and the city and, you

and the landscape in the natural world, innovation. I'm naming a lot of things that are sort of difficult to measure, but I think that many of us intuitively understand that fiction, because it allows us to imagine other possibilities, to put ourselves in the viewpoints or in the shoes of someone else and experience other perspectives, already does this.

And medicine is at that intersection of empirical science and arts and humanities already. So, you know, I would say I think that fiction does do these things and we need to we need to measure it, because I think for clinical and scientific audiences, that is particularly important to make the case. But at the same time, let's not lose something by by attributing everything to empirical measurement.

Yeah, but I entirely agree with you. But you did say that there is some evidence...

uh what did you mean by that then what kind of evidence is there there is um some evidence and for example the medical education literature um don't ask me to cite a study right now cameron i'm sorry but um perhaps we could add the links afterwards yeah there is an increasing body of evidence on the humanities and humanistic thinking and health equity and systems thinking connecting those areas um so again i'd be happy to uh

look those up and send them I can't cite them off the top of my head please do please do this is the BMJ we need to kind of add that information yeah I'm sure you've got it on somewhere okay thank you Sarah you started off as a journalist that you're reporting facts as a journalist generally and you've moved to fiction what about accuracy I mean you know where do you draw the line on that

Yeah, it's definitely an art or a dance. Sometimes it depends really what kind of art you're trying to create and what for. For me in this case, you know, they've been talking a lot about Kalei Phi as like in a near distant future, a

For me, this story, while it is fiction, it is based very much in the present moment. And that was important to me because the climate crisis is extremely here now. And what we're hoping to provoke in readers is...

an urgency to their own lives and their own understanding of what's happening that doesn't place it on some nebulous future or another generation. This is our responsibility. So when it comes to fact, for me, it was...

Part of what I could bring the reader in on was to create a world that was very familiar and true to them, that this is not some other universe that this is all happening in. It is ours. And that means that we have a necessary duty and responsibility towards the land that we live on, the indigenous stewards who we stole the land from, etc.,

And I don't think that that is a rule necessarily for cli-fi or any kind of fiction. I think, you know, the artist can choose how much to depart from fact. And you don't come to fiction for like a data report. You can go to a scientific journal for that. Okay. Yeah. But you do present presumably some solutions in what you're writing. And do they need to be

Real ones do they need to be kind of realistic? Yeah for me the

Type of story I want to be telling. They are quite realistic. Some of the ways that people come together is largely in community and turning towards one another to solve for this. So it includes protests. It includes participating in land back movements and conservation movements. It includes folks who are ignoring the crisis and choosing to go on with their lives and and the.

what kind of effect that has on them and their understanding of themselves as ethical humans in a world that they're responsible for. So for me, it is very grounded. But I do think that fiction allows for a really important imagining of a better future that can go beyond the solutions that are present right now. That's not...

my book. But many books do that work for us to go forget the constraints of the world we've built. Let's imagine together what is possible beyond. Yeah. Yeah. Lexi, what do you think about this? Well, I have two thoughts. The first is that I would ask what we mean by accurate.

Because if we mean technically precise and reproducible, no, I don't think it needs to be accurate. Perhaps no one is surprised by this answer from a medical humanist. It actually brings to mind for me arguments about literary realism.

In the 18th and 19th century, so the proponents argued that fiction should be a faithful representation of reality, but there were reactions and counter reactions to that. And in the 19th century in particular, it was the rise of speculative fiction, which was the proto-fantasy, sci-fi, and arguably clandestine.

Cli-Fi arose from speculative fiction. So the authors of those genres said deviations from strict realism can often get to the heart of human experience and societal issues in a way that more quote unquote accurate portrayals might not. I would texture this somewhat, and I'll also add a few examples, little jewels for our listeners with climate fiction that is set in a fantastical world.

like N.K. Jameson's Broken Earth trilogy, which I cannot recommend enough, or Oryx and Crake by Margaret Atwood, might actually, by departing from our current reality, allow us to approach something from a fresh perspective. It's like new eyes free from preconceived notions or biases. The second point I'll make, though, is that if climate fiction sets out to be didactic,

then it should be, I think, based on sound scientific understanding of climate change and its potential impacts. And it ought to be plausible, as Sarah's book is, so that it inspires action. But I think to Sarah's point, it really depends on what the writer is setting out to do. Yeah. I mean, how is it about inspiring action? What's your take on that?

I would love for fiction to inspire deep thinking and to help people grapple with an immense problem that is maybe difficult to grapple with in real life. So fiction may make it easier to do that. I also would love for good fiction to instill a sense of hope and inspire action because Lord knows we need action now to confront the climate crisis.

Yeah, very true. Okay, Lakshmi's already recommended one or two pieces of cli-fi for us. You might get a chance to recommend another one in a minute, Lakshmi. Howie, what would you recommend? Other than Sarah's book, of course. Of course. For recommending Sarah's book. Are there any other ones that you would recommend? You know, one of my favorites is Ministry for the Future by the science fiction writer Kim Stanley Robinson. I like it because it is scientifically grounded.

And for somebody who's relatively literal as I am, it's plausible. I also like it because based on a firm grounding in science, it points a way, not necessarily the way, but it points a way to solutions that

And it left me feeling hopeful. Maybe there actually is a path toward tackling the climate crisis. And it's a great story with well-developed characters and it's artfully written. Okay, but do you prefer literary realism? This is what you're saying. I do as a reader. I completely take Lakshmi's points. But for me as a reader, if the plot is completely implausible...

then I rebel against it. It has to be plausible for me to feel comfortable with it. As long as it's a good read. Sarah, what would you recommend? There are a couple books. One book I think of is Xochitl González, who wrote Olga Dies Dreaming, and it happens in a present-day New York and has the effects of Hurricane Maria on the island of Puerto Rico and on the Puerto Rican diaspora as part of it.

And another book is C. Pam Zhang, who wrote Land of Milk and Honey. And it's a speculative fiction about a future in which there is no longer any food and a private chef goes to serve a very elite, wealthy colony. And, you know, tension arises from there. Very good. Yeah.

So Lakshmi, I'm going to give you one more. I think you've got a list of thousands of books you could recommend. Recommend one or two more to us. Thank you for giving me that opportunity. I appreciate it. Don't go for the thousand. Go for the one or two. No, just the one. So mine is one of those that I would count as cli-fi before cli-fi. Actually, I've got to say I love that. Cli-fi before. Yeah, that's fantastic. It's Day of the Triffids.

Oh, yes. Yeah, John Wyndham, 1951. And the premise is it's a post-apocalyptic thriller that really combines...

environmental degradation, a pandemic, killer mutant plants, a possible alien attack. I'm sure you can tell where my preferences go in terms of literature, what's not to like. These things haunt my nightmares, these ambulatory carnivorous plants. But I want to say I first read it. I came across it randomly as one comes across the best books. I was actually working in a hospital in Sri Lanka

where the memory of the 2004 tsunami was still very fresh. And the book stayed with me, not only because it's weird and wacky and like the British humor, it's just wonderful. But I was surrounded by, you know, I'm on this incredibly beautiful, in this incredibly beautiful country, surrounded by this beautiful, lush foliage, a country where I felt very at home. And this book hit me, if you'll pardon the...

colloquialism like a ton of bricks like it was just such a prescient look at how quickly our safe and certain world can crumble and I was working at a place where the memory of this catastrophic um climate related event it just happened so it really stayed with me there's also a super weird 1960 something movie uh I don't know that I recommend that well there's more than that they used to be a when I was when I was a child a long time ago should we say

there was a BBC TV series of the day of the Triffids. It was absolutely frightening, but it did. I didn't know plants could be so frightening, but it did inspire me to read that book and all other John Wyndham books. So, yeah, I think that's a very good note to finish on. I want to thank you all for joining us. And we're all we're all going to dip into cli-fi now, I hope. Thank you. Thank you. Thanks. Thanks.

Our final segment today is sticking with the effects of climate, but focusing on how the issues of migration and food security are going to impact the spread of TB and what we need to do to tackle it. Paul Simpson, our partnerships editor, finds out more. In November, the BMJ will be at the World Innovation Summit for Health in Qatar, where we are a media partner.

At the conference, one of the sessions and related reports that the summit will be publishing is focused on tuberculosis among refugees and migrants. I spoke to the chair of the report to understand why they are focusing on TB and migration and how climate change and related food insecurity will impact the disease. I'm Dr. Teresa Kasaeva, Director of the World Health Organization Global Tuberculosis Programme.

The linkages between tuberculosis and migration are unfortunately very close and quite strong. Ancient disease, it's one of the oldest global pandemic, but unfortunately still killing millions of people every year. TB is everywhere.

in all the countries. The most affected is Southeast Asian region, African region and Eastern Pacific region.

So top affected countries are India, Indonesia, Nigeria, South Africa. In our conversation, Dr. Kaseyeva highlighted that understanding burden of TB in sending countries is crucial for receiving countries who are planning services and providing access to treatment for refugees and migrants. But she also warned against discrimination and stigma.

When we are talking about migrations, we can see from the latest study that the risk of this population to the local population is minimal. So that's why we should not be afraid, we should not stigmatize these people, but we should try to provide the fastest and the best possible support to them.

And of course, especially when it's related to some emergency movement due to the conflicts or to the climate change related disasters, this knowledge about highest burden regions and highest burden countries will help to the hosts to prepare adequately to receiving them and to providing access to treatment. It may become a significant additional financial burden, but

But there is no other way with diseases like TB. Diagnose as early as possible and put on treatment because it's disseminating, it's transmitting. And one person who is sick with active tuberculosis can transmit to many other people, especially those in close contacts.

In this episode of the podcast, we've been focused on climate change. Both TB and migration are two of the great global challenges that the planet faces. There are clear links with climate change, which could mean that ever more people are on the move globally as regions are affected by disaster, conflict and food scarcity. Food insecurity as one of the drivers of TB epidemic is one of circumstances closely related to the climate change.

Malnutrition, undernutrition is one of the drivers and risk factors for development of tuberculosis.

So if you look at the people who are most frequently suffering with TB, I've told out of 10.6 million, according to the last report, falling ill with tuberculosis, more than 2 million are attributable to undernutrition. Treatment itself is difficult.

difficult despite of much better options. It's a complex of several drugs that should be taken from four minimum months up to six, nine months and people cannot stay and tolerate treatment without nutritional support. Nutritional support is essential condition for successful treatment completion and positive outcomes.

Without the multi-sectoral efforts, we will not be able effectively to address this problem. The upcoming World Innovation Summit for Health report outlines several recommendations and case studies that illustrate how host countries can support and protect migrant and refugee populations from TB.

However, TB remains a seemingly intractable problem, despite being a preventable and curable disease. Currently, the main reason of slow progress towards ending TB, and by the way, this is one of the sustainable development goals to end TB by 2030, is a lack of prioritisation

and lack of funding. According to our last Global TB report, you remember that 22 billion annually is required, only 5.7 billion US dollars was available.

And out of this 5.7 billion, around 1.2 billion from the international donor funding, including global fund, but the rest of the money from the country's domestic resources. But it's far, far from sufficient. It's around 25%. With this level of funding, it's naive to dream that we will be successful.

We need to invest and tuberculosis is one of the 13 diseases with the best return on investments. So every dollar investment brings back at least 46. So let's try to be responsible and invest in our future.

You've been listening to Dr. Teresa Kasayeva, who is the director of the WHO's Global Tuberculosis Programme and chair of an upcoming report on TB among refugees and migrants at the World Innovation Summit for Health.

That's it for this episode. We'll be back soon with more medicine and science. We'll be asking why in 2024 women are still not properly represented in medical research. We'll also be hearing about palliative care and the misconceptions that are limiting its use. I'm Cameron Abassi. Thanks for listening.