In a shack that now sits below sea level, a mother in Bangladesh struggles to grow vegetables in soil inundated by salt water. In Malawi, a toddler joins thousands of other children perishing from drought-induced malnutrition. And in China, more than one million people died from air pollution in 2012 alone.

Around the world, climate change is already having an effect on human health.

In a recent paper, Katherine Burke and Michele Barry from the Stanford Center for Innovation in Global Health, along with former Wellesley College President Diana Walsh, described climate change as “the ultimate global health crisis.” They offered recommendations to the new United States president to address the urgently arising health risks associated with climate change.

Bangladeshi children make their way through flood waters.

The authors, along with Stanford researchers Marshall Burke, Eran Bendavid and Amy Pickering who also study climate change, are concerned by how little has been done to mitigate its effects on health.

“I think it’s likely that health impacts could be the most important impact of climate change,” said Marshall Burke, an assistant professor of earth system science and a fellow at the Freeman-Spogli Institute for International Studies.

There is still time to ease — though not eliminate — the worst effects on health, but as the average global temperature continues to creep upward, time appears to be running short.

“I think we are at a critical point right now in terms of mitigating the effects of climate change on health,” said Amy Pickering, a research engineer at the Woods Institute for the Environment. “And I don’t think that’s a priority of the new administration at all.”

Health effects of climate change

Even in countries like the United States that are well-equipped to adapt to climate change, health impacts will be significant.

“Extremes of temperature have a very observable direct effect,” said Eran Bendavid, an assistant professor of medicine and Stanford Health Policy core faculty member.

“We see mortality rates increase when temperatures are very low, and especially when they are very high.”

Bendavid also has seen air pollutants cause respiratory problems in people from Beijing to Los Angeles to villages in Sub-Saharan Africa.

“Hotter temperatures make it such that particulate matter and dust and pollutants stick around longer,” he said.

In addition to respiratory issues, air pollution can have long-term cognitive effects. A study in Chile found that children who are exposed to high amounts of air pollution in utero score lower on math tests by the fourth grade.

“I think we’re only starting to understand the true costs of dirty air,” said Marshall Burke. “Even short-term exposure to low levels can have life-long effects.”

Low-income countries like Bangladesh already suffer widespread, direct health effects from rising sea levels. Salt water flooding has crept through homes and crops, threatening food sources and drinking water for millions of people.

“I think that flooding is one of the most pressing issues in low-income and densely populated countries,” said Pickering. “There’s no infrastructure there to handle it.”

Standing water left over from flooding is also a breeding ground for diseases like cholera, diarrhea and mosquito-borne illnesses, all of which are likely to become more prevalent as the planet warms.

On the flip side, many regions of Sub-Saharan Africa — where clean water is already hard to access — are likely to experience severe droughts. The United Nations warned last year that more than 36 million people across southern and eastern Africa face hunger due to drought and record-high temperatures.

Residents may have to walk farther to find water, and local sources could become contaminated more easily. Pickering fears that losing access to nearby, clean water will make maintaining proper hygiene and growing nutritious foods a challenge.

Climate change will affect health in all sectors of society.

All of these effects and more can also damage mental health, said Katherine Burke and her colleagues in their paper. The aftermath of extreme weather events and the hardships of living in long-term drought or flood can cause anxiety, depression, grief and trauma.

Climate change will affect health in every sector of society, but as Katherine Burke and her colleagues said, “….climate disruption is inflicting the greatest suffering on those least responsible for causing it, least equipped to adapt, least able to resist the powerful forces of the status quo.

“If we fail to act now,” they said, “the survival of our species may hang in the balance.”

What can the new administration do to ease health effects?

If the Paris Agreement’s emissions standards are met, scientists predict that the world’s temperature will increase about 2.7 degrees Celsius – still significant but less hazardous than the 4-degree increase projected from current emissions.

The United States plays a critical role in the Paris Agreement. Apart from the significance of cutting its own emissions, failing to live up to its end of the bargain — as the Trump administration has suggested — could have a significant impact on the morale of the other countries involved.

“The reason that Paris is going to work is because we’re in this together,” said Marshall Burke. “If you don’t meet your target, you’re going to be publicly shamed.”

The Trump administration has also discussed repealing the Clean Power Plan, Obama-era legislation to decrease the use of coal, which has been shown to contribute to respiratory disease.

“Withdrawing from either of those will likely have negative short- and long-run health impacts, both in the U.S. and abroad,” said Marshall Burke.

Scott Pruitt, who was confirmed today as the head of the Environmental Protection Agency (EPA), is expected to carry out Trump’s promise to dismantle environment regulations.

Despite the Trump administration’s apparent doubts about climate change, a few prominent Republicans do support addressing its effects.

Secretary of State Rex Tillerson, the former chairman and CEO of Exxon Mobile, supports a carbon tax, which would create a financial incentive to turn to renewable energy sources. He also has expressed support for the Paris Agreement. It is possible that as secretary of state, Tillerson could help maintain U.S. obligations from the Paris Agreement, though it is far from certain whether he would choose to do so or how Trump would react.

More promising is a recent proposal from the Climate Leadership Council. Authored by eight leading Republicans — including two former secretaries of state, two former secretaries of the treasury and Rob Walton, Walmart’s former chairman of the board — the plan seeks to reduce emissions considerably through a carbon dividends plan.

Already an issue, malnutrition will increase with droughts in Sub-Saharan Africa.

Their proposal would gradually increase taxes on carbon emissions but would return the proceeds directly to the American people. Americans would receive a regular check with their portion of the proceeds, similar to receiving a social security check. According to the authors, 70 percent of Americans would come out ahead financially, keeping the tax from being a burden on low- and middle-income Americans while still incentivizing lower emissions.

“A tax on carbon is exactly what we need to provide the right incentives and induce the sort of technological and infrastructure change needed to reduce long-term emissions,” said Marshall Burke.

Pickering added, “This policy is a ray of hope for meaningful action on climate.”

It remains to be seen whether the new administration and congress would consider such a program.

What can academics do to help?

Meanwhile, academics can promote health by researching the effects of climate change and finding ways to adapt to them.

“I think it’s fascinating that there’s just so little data right now on how climate change is going to impact health,” said Pickering.

Studying the effects of warming on the world challenges traditional methods of research.

“You can’t create any sort of experiment,” said Bendavid. “There’s only one climate and one planet.”

The scholars agree that interdisciplinary study is a critical part of adapting to climate change and that more research is needed.

“If ever there was an issue worthy of a leader’s best effort, this is the moment, this is the issue,” said Katherine Burke and her colleagues. “Time is short, but it may not be too late to make all the difference.”

Stanford scholars are encouraging the new administration to consider steps to alleviate the uncertainty and anxiety felt by countries in East Asia about U.S. intentions toward the region.

President Donald Trump’s anti-China rhetoric during his campaign and his recent withdrawal of the U.S. from the Trans-Pacific Partnership have contributed to the unease in the region, which is drifting in ways that are unfavorable for American interests, they said.

Stanford’s Walter H. Shorenstein Asia-Pacific Research Center (APARC) recently published a 27-page report with recommendations on topics of trade and defense that would improve relations between the U.S. and Asian countries. The report, co-authored by eight Stanford scholars, is aimed to help shape U.S. policies in the region.

“The advent of any new administration provides an opportunity to reassess policy approaches,” wrote Gi-Wook Shin, director of the Shorenstein center. “A new mandate exists, and it is our hope that that mandate will be used wisely by the new administration.”

Trade and defense

The biggest trade concern for experts in the region is President Trump’s decision to withdraw the U.S. from the Trans-Pacific Partnership (TPP) and his intention to focus on bilateral agreements instead of multinational pacts.

The agreement, which bound 12 countries in the region by a set of international trade and investment rules, had problems, Stanford scholars said. For example, some have criticized the treaty for not requiring full compliance with international labor standards for all the participating countries. Also, the rules of origin, which were supposed to give preferential treatment to countries in the TPP, were deemed to be weak by many, allowing goods produced outside the TPP to receive benefits.

But it would not be wise or efficient for the U.S. to start negotiations from scratch in the region because the U.S. withdrawal from the agreement, which was touted as a model for the 21st century, already has hurt its credibility with other Asian countries, said Takeo Hoshi, director of the Japan Program at the Shorenstein Center. In addition, Asian countries view the idea of bilateral agreements as an attempt to force trade deals on them that disproportionately benefit the U.S., he said.

“The TPP was not perfect and many problems remain, but they are not removed by abandoning the TPP,” Hoshi wrote in the report. “Completely abandoning the TPP could hurt not only the U.S. economy but also erode U.S. leadership in Asia.”

Hoshi said the U.S. should rely on aspects of TPP that are consistent with the current U.S. trade policy when creating new bilateral agreements, while maintaining and improving existing free trade agreements with other Asian countries.

Another immediate concern for scholars is the maintenance of security and stability in the region.

“The region is unsettled because of uncertainty about us,” said Thomas Fingar, a Shorenstein APARC fellow. “The U.S. has long served as the guarantor of prosperity and security in the region but Asians are no longer convinced that we have the will or ability to do so. This has real consequences … It’s not simply because they are already beginning to act as if we intend to play a less active or positive role.”

If China’s national power and economy continue to expand, it will become increasingly difficult to maintain stability in the region if the U.S. does not continue to play a constructive role. Possible dangers include escalation of tensions between China and the U.S. or its allies following accidents or tactical encounters near areas over which China claims sovereignty.

In the report, scholars recommend a comprehensive review of security in the region to make sure military plans are in place that prioritize management of a possible collapse of North Korea or a sudden military strike coming from the country. Other priorities should include peaceful resolution of China-Taiwan differences and ensuring military access in the South China Sea and East China Sea, wrote Karl Eikenberry, director of the U.S.-Asia Security Initiative at the Shorenstein Center.

“The United States also should engage in a more long-range, exploratory strategic dialogue, first with allies and partners, and then with Beijing, to identify potential areas of mutual interest that can help prevent the unintended escalation of conflicts and reduce already dangerous levels of misperception and mistrust on both sides,” Eikenberry wrote.

China is key

Maintaining a peaceful, productive relationship with China should be of the utmost importance for the U.S., according to the Stanford scholars.

“Managing America’s multifaceted relationship with China is arguably the most consequential foreign policy challenge facing the new administration,” Fingar said.

Although President Trump’s anti-China rhetoric during his campaign made Asian countries anxious about the future, China has been criticized by many American leaders before. Ten previous U.S. presidents were critical of China during their campaigns, but once they assumed office, their tone changed and they adopted a more pragmatic view of U.S. interests in the area, Fingar wrote.

However, while in the past China’s political moves have been predictable for the most part, now that its economy is slowing, the country is increasingly relying on social control and nationalism to reinforce regime legitimacy. This makes China less predictable, according to Fingar.

But the scholars say that there are several opportunities to approach the relationship with China in a way that is beneficial for the U.S. and the rest of the region.

One such opportunity would be for the U.S. to declare its willingness to join China’s newly created Asian Infrastructure Investment Bank, which was formed in early 2016 to support construction projects in the Asia-Pacific region. This would be an “any outcome we win” opportunity that would showcase the U.S. desire to cooperate with China and help establish the region’s confidence in the U.S., Fingar said.

The new administration should also consider pushing for a quick completion of a Bilateral Investment Treaty with China – something that two previous U.S. administrations were not able to achieve. Creating this agreement would help protect things that are important to the U.S. businesses and reassure the willingness of the U.S. to deepen its relationship with China, according to Fingar.

“In my view, how we’re going to establish or reestablish relations with China is key,” Shin said. “Will there be more tension? That’s really important. This affects not only the U.S., but also our allies in the region.”

Alex Shashkevich is a writer for the Stanford News Service.