Friday, April 25, 2014

How Australia (and other developed countries) Can Prepare For An Impending Cancer Epidemic. Improving Early Detection/Treatment and Palliative Care.

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Ageing and Cancer. My Experience

My Submission For the 2014 Cancer Council Essay Competition.

"You're a little young to be in here aren't ya, son?"

"Aren't we all?" The man slouching in the chair opposite me chuckled, adjusting the tubes attached to his forearm.

"What did you have?" 

"Multiple Myeloma," he said, struggling to turn in his chair as the pump's alarm went off. "Had a few goes of chemotherapy, and it's going to stop soon."

"That's great news! Congrats!" I exclaimed. I could only hope to be in his position.

But the next thing he said shocked me.

"Yeah, I've lived long enough. I'm ready to move on."

I was diagnosed with leukemia at 17. After being diagnosed, I was in shock... miserable and depressed. I'd been told I had a 10% chance of living to see 21..
But, after a while, I saw a second way of looking at things. I saw my youth as a blessing. It meant that I could get the hardest, most effective treatment possible and survive, possibly even thrive after it. I didn't have heart disease or kidney issues or a family to have to look after - I would have the best chances possible for the disease I had.

I was ready, willing, almost looking forward to start chemotherapy by the time my central line was put in.

So his words, only weeks after starting chemo, really got to me... I mean why would someone just give up, especially after they'd gone through so much already?

Today, it doesn't surprise me as much. I've overheard my doctors ask other, older patients, with similar diseases, at similar, sometimes better stages than mine, if they'd considered not continuing treatment. And I get why too. Cancer treatment is horrible. And after 3 year of it, featuring I can't remember how many bags of chemo, 2 stem cell transplants and a near-fatal dose of radiation, I know what it's like to be tired. So tired that death wouldn't be that scary... it'd be almost welcome. It would DEFINITELY be easier than living.

That's me at 20. I can barely imagine going through that at 70.

Introduction: The Link Between Age and Cancer:

Young people, like me, do get cancer, and they get it in large numbers too. But cancer is still a diseases of the elderly. In 2009, 73.5% of all male, and 63.6% of all women in Australia diagnosed with cancer were over the age of 60 [1]. For a variety of reasons, increased exposure to carcinogens and weaker immune systems being the major ones, cancer incidence increases exponentially with age, and this can be seen in the graph below.

Incidence of Cancers in the UK by Age

As seen above, cancer incidence increases almost exponentially with age in developed countries[2-5]

Our Population Is Getting Older:

A challenge faced by many developed countries, including Australia, is an ageing population, due to low fertility rates combined with increased life expectancy. Australia's fertility rate lies at around 1.88 [6], and is projected to stay below the replacement fertility rate of 2.1 [7], and the life expectancy of all developed countries, has historically, and is expected to continue to rise over time too. Australian men are expected to live 5.5 years longer, and women 4 years by 2060 [10], and 1/3 babies born in developed countries today are expected to make it to 100 years of age [8].

The impact of a longer life expectancy and lowered fertility rate is clear in the skewing of Australia's population demographics over time [12].

The Ageing Population's Impact on Prevalence of Cancer

Considering this trend of an ageing population, and the fact that cancer incidence increases greatly with age, cancer is bound to become more prevalent than it already is. Indeed, Australia is on the brink of a cancer epidemic. 128,000 new cases of cancer were detected in 2013, and that number is set to increase to 150,000 by 2020. Overall, that's a 40% increase since 2007 [9]. That number stands to rise even more by 2060 when more people will be above 50 years of age than under. With peak incidence of cancer striking between 65 and 80 years of age for men, and plateauing at 60 for women, an ageing population is the major factor in the increase in cancer prevalence.

Proportion of the Australian Population aged 65 or older.

The proportion of Australians over 65 years of age is set to increase and increase at a steady rate. With 1/2 men, and 1/3 women expected to get cancer by 85 [11] and with about 2/3 of people with cancer developing it beyond 65[1] cancer rates are only bound to rise too.

Cancer's Current Burden on the Economy:

Cancer cost Australia $4.5billion in direct healthcare expenditure in the 2008-09 financial year [13], and that number only stands to rise as cancer becomes more prevalent. The impact on productivity is even greater. Cancer treatment is a long process, that often leaves many unable to work. In terms of productivity, 551,300 healthy years of life (measured in DALYs) were lost to cancer in 2012 [14] and the average cost of cancer per person, including loss in productivity, lies at $966,000 per person [15], totalling a staggering $83.4billion of lost productivity for all patients with cancer in 2005, over their lifetime [15].

Accommodating for the Increase in Burden of Cancer.

Making sure we're ready for the cancer epidemic is critical to keeping its already high economic and social burden of healthcare from increasing even further. And It's imperative that Australia acts early in tailoring infrastructure, policies and education to mitigate its impacts.

Catching and treating cancer in the early stages, through effective, accessible screening protocols, quicker diagnosis and the use of preventative, early phase treatment options not only leads to better treatment and quality of life outcomes for patients, but is also more cost effective than treating cancer at later stages and hence should be prioritised in future policies.

With 43% of cancers in developed countries being caused by correctable lifestyle choices [16], focusing on reducing incidence of preventable cancers will also help reduce the burden of cancer.

But though prevention and early treatment is the best way to mitigate the burden of cancer,  elderly patients in particular are not always able or willing to progress with treatment and are the highest users of palliative care facilities [33]. Therefore improving access and quality of palliative care, and grief councelling facilities should also be a high priority. 

Education about these issues at the undergraduate level is the most effective way of ensuring that Australia's health professionals are ready for the cancer epidemic to come.


Improving Screening And Prevention of Cancer:

In most cancers, early detection is correlated with better prognoses and better quality of life post treatment.

Bowel Cancer 5 year survival statistics based on classification:

Stage A cancers, those which haven't penetrated through the inside of the bowels have a very high 5 year survival rate, while Stage C and D cancers, which have spread to the lymph nodes or all around the body have low 5year survival rates.

Because symptoms of many cancers are non-specific and present in later stages of diseases, as many as 1/2 bowel cancers and 1/3 breast cancers present in later stages [23].

Screening is often the only effective way of catching cancers early on, when they are more easily curable. Biennial Fetal Occult Blood Tests (FOBT) which detect bowel cancers with minimal invasiveness, has been proven in multiple randomised controlled trials, each comprising of at least 48,000 subjects, to reduce mortality rates by 15 - 21% [16 - 19]. One Minnesota study found annual tests reduced mortality by a staggering 33% [16], all because cancers were detected earlier, in their more curable stages.
The BreastScreen Australia program Evaluation Report found that breast cancer mortality had decreased by 21-28% in all breast cancers [20] since its implementation, and regular cancer screening for colorectal cancer has been shown reduce deaths by as much as 60% [22].

The Benefits of Improving Screening and Early Intervention Infrastructure:

Screening services for cancer costs our government $332million a year[13], but despite the high cost in both the setting up of facilities and utilisation of them, the offset price in direct treatment alone recovers for it. That's not even considering the wider implications of having a healthier, work-fit, more productive population. Treatment at early stages is almost always cheaper, and more effective than managing late-stage-cancer. For example, resecting precancerous polyps costs $2,000 and has a 70% greater chance of success compared to $66,000 a year to treat advanced bowel cancer [21].

Per member per month (pmpm) cost paid by insurance companies for later stage, invasive cancers showing the benefit of treating diseases early, before hospitalisation and more interventional medicines and procedures make it less likely to succeed and more expensive too [25]

Health economists agree that the intervention plus screening costs involved are effective if they cost less than $50,000 per year of life saved (pyols) [22]. Colorectal cancer screening, mammograms in women over 65, and 3 yearly pap smears have been shown to fall well below that figure, the former costing $11,592 and $36,843 respectively and the latter only costing $5,392 pyols [22]. These life years saved pay off economically through increasing the workforce and consumption. 

Insurance companies in other developed countries have proven the cost effectiveness of covering screening tests too. Investing $2.95pmpm yields up to $3.75 in savings[28]. Also, those with cancer claimed on average $2,390per member per year, versus $360 for those without cancer. Thus insurance companies investing in screening is definitely economically viable for the companies, as it would save on having to pay out those increased claims, and will enhance the governments efforts in getting Australia screened.

Issues Facing Australia's Screening Programs:

For screening tests to be effective in reducing the rising burden of cancer, tests need to be cheap, accurate, affordable and targeted to the right locations. 

Currently, due to an insufficient workforce and lack of access to screening facilities, Australia's compliance with the BreastScreen program has plateaued at 56% compared to America's compliance rate of 81.2% [23].
Policies, such as Australia's National Bowel Cancer Screening Program (NBCSP) need to target the correct populations too. Currently, 61% of bowel cancers occur in those aged 70 and older [29], but no-one over 65 is included in the current program. Only 15million dollars a year, on top of $37million already put in is required to provide screening to 75 years of age [29], probably because facilities to act on early detection tests aren't adequate. When looking at the costs of later intervention however, it becomes clear this is most likely worth it, and should be rolled out as soon as possible.

Mammograms in women in the 40 - 49 age group have been proven to not decrease mortality over time [24] due to denser breasts in younger populations. Thus there are limitations to current screening technologies that practitioners should be aware of.

Issues of equality in access to screening and treatment is of import too, especially in Indigenous and rural settings. Indigenous Australians still face a huge gap in cancer mortality and screening rates, and are also less willing to accept treatment [27]. They have a 1.3x greater mortality rate due to cancer, are 3-3.9x more likely to develop preventable cancers (such as lung and liver cancer), and only have a 36% rate of compliance with breast cancer screening programs[26] due to a cultural, socio-economic, distance and  awareness reasons. Mortality rates increase with increasing remoteness in rural Australia [41] due to problems in accessing care and screening facilities.

Designing an Effective Screening/Early Intervention Program

Scotland's Detect Cancer Early Program attacks the issue of an increasing burden of cancer by working on a variety of aspects concerning screening and prevention of cancer.

The program focuses on raising public awareness, ensuring diagnostic and imaging departments are well equipped for the increasing rates of screening and early treatment and working with GPs to promote referral for investigation at earlier opportunities and in raising data too, which "constitutes a priority for early diagnosis initiatives and research" [44]. In its first year there was a 4.3% increase in people being diagnosed at stage 1 for the 3 cancers targeted, showing it to be an effective strategy.

Australia needs to model its future policies regarding this issue in a similar, all-encompassing manner to reduce the burden of cancer.


Preventing Cancer:

As stated above, 43% of cancers can be linked to lifestyle choices, and these usually manifest due to decades of bad health habits. Reducing these not only reduces the burden of cancer, but also that of other diseases too.

Preventable, Lifestyle Choices that directly cause cancer. [16]

Reducing Risk Factors

A huge proportion of disease is directly attributed to tobacco use. Hence policies and tobacco cessation rehabilitation measures proven to work, such as tax increases and anti-smoking media campaigns [30], to where they're needed, in areas like Northern Queensland with a very high 38% age-adjusted smoking male Indigenous population [31] will be greatly beneficial. The same applies for providing HPV vaccines in Indigenous women. Poor diet and alcohol consumption also leads to increased likelihood of cancer, and needs to be addressed through better patient education.

Systemic Changes that Promise Better Care

The increasing use of multidisciplinary teams to manage patients before hospitalisation, along with databases like the E-Health Record, will hopefully mean these lifestyle choices can be better managed and tracked over time by GPs. TeleHealth and other long distance medical services are also looking to provide better access to good health and treatment to rural and remote communities too.

 Improving Palliative Care

What is Palliative care?

Palliative care encompasses a holistic approach to end of life care, and hence encompasses a broad variety of roles in healthcare, from hospital, hospice or nursing home care, to grief counseling to radiological intervention to reduce pain.

World Health Organisation outline of the role of palliative care. [32] Below is its aims.

Current Trends in Palliative Care

Palliative care needs to be up-scaled and optimised to cope with the increase in cancer prevalence at older ages. 54,446 patients accessed palliative care in 2013, 88% of whom were 55 years or older [33] and 77% of whom had cancer [34]. That number had increased by 56% over a 10 year period, as the prevalence of elderly patients with cancer, those most likely to seek palliative care, will increase. Hospital facilities provided 653,000 days of care to cancer patients at the end of life between 1998 and 2008[34], in addition to the $3.5million/year in subsidies for prescription medications to ease symptoms at the end of life [33].

Improving Palliative Care

Obtaining Data on Palliative Care

But palliative care isn't just restricted to hospital settings. Community and GP management of palliative care isn't being monitored at present, making it hard to determine what services exist and what needs to be improved. However, this is set to change soon with an NDMS (National Data Minimal Set) been deemed to be feasible [35].

Increasing the role of GPs in Palliative Care

To cope with the increased seeking of palliative care, primary care physicians should be trained to deliver and manage palliative care in a multidisciplinary team setting. Currently, 56% of GPs  feel that they should be responsible for palliative care [36], but many doubt their ability to fulfill the role due to lack of training [37] and don't seek further training for workload, cost of course and loss of time reasons[38]. Thus additional training within GP specialisation and at an undergraduate level would make palliative care more accessible in the future.

Increasing Palliative Care Specialists

Specialists in palliative care currently make up 0.38% [33] of all health specialists, with only 92, servicing 108 registered palliative care services; this already indicated a shortage but is more concerning when considering that many more services exist without being registered or providing data. More training and education of this already shorthanded field is required.

Technology's role in Improving Access to Improve Access

Though Australia is ranked 2nd in the world in the Quality of Death Index, we are ranked 19th in terms of providing access to a basic end of life healthcare environment [42] indicating both a lack of specialisation and lack of access by rural communities. Again, TeleHealth is promising in delivering care to rural communities and this, along with the Personally Controlled E-Health Record will make palliative care more accessible to rural populations [43]. 


Why Medical Students Need To Be Aware of These Trends

Cancer is already a prevalent disease in Australia. 339,077 people were diagnosed with cancer from 2007 - 2012 alone [14]. With our ageing population, this figure is set to rise in the following years.
Implementing proper, accessible screening protocols nation-wide, advocating healthy lifestyle habits and improving palliative care access and facilities is vital to ensure Australia can deal with the increased cancer burden due to an ageing population, and education of future doctors and health professionals is a priority.
The Cancer Council's Ideal Oncology Curriculum [40] mandates that awareness of the public health factors, including epidemiology, screening and the impact of cancer on psychosocial health is as important as the learning of cancer biology and treatment. They are our future GPs and specialists and they should be aware of these trends, and on how to deal with them.
Education on the benefits and limitations of screening technologies, on the economic and health benefits of catching cancer early, methods and the importance of reducing cancer risk factors and the accessing and importance of palliative care are all best learnt at the medical student level.
Hence, ensuring that our next generation of doctors are aware of the trends and impacts of cancer, and ensuring more are trained in this field is crucial to ensuring the burden of disease remains low.           


[1] Australian Cancer Incidence and Mortality (ACIM) Books – All Cancers combined for Australia (ICD10 C00-C97, D45-46, D47.1, D47.3). [Accessed January 2013].
[2] Cancer Statistics Registrations, England (Series MB1) , No. 42, 2011
[3] Cancer Incidence in Scotland, Information and Services Division, April 2013
[4] Cancer In Wales, Welsh Cancer Intelligence and Surveillance Unit, April 2014
[5] Cancer in N. Ireland,,31480,en.pdf 1993 - 1995
[6] Births, Australia, ABS 3301.0, 2011
[8] Historic and Projected Mortality Data 1951 to 2060, Office For National Statistics,, March 2012
[9] Cancer incidence projections: Australia, 2011 to 2020. Cancer Series no. 66. Cat. No. CAN 62. Canberra: AIHW, 2012
[10] Population Projections, Australia, 2012 (base) to 2101, ABS 3222.0, November, 2013 
[11] Non-melanoma skin cancer: general practice consultations, hospitalisation and mortality. Cancer series no. 43. Cat. no. 39.Canberra: AIHW. 2008.
[12] Population projection 1997-2051, Australia, 1350.0 - Australian Economic Indicators, Dec 1998, p 11
[13] Health system expenditure on cancer and other neoplasms in Australia 2008-09. Cancer series 81. Cat. no. CAN 78. Canberra: AIHW, December 2013
[14]  Cancer in Australia: an overview, 2012, Cancer series no. 74. Cat. no. CAN 70. Canberra: AIHW
[15] Cost of Cancer in NSW, The Cancer Council NSW, April 2007.
[16] Professor R Peto, The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010, British Journal of Cancer (2011) 105, S1–S1. doi:10.1038/bjc.2011.473, Dec 2011
[17] Shaukat A, Mongin SJ, Geisser MS, et al.: Long-term mortality after screening for colorectal cancer. N Engl J Med 369 (12): 1106-14, 2013.[18] Mandel JS, Church TR, Bond JH, et al.: The effect of fecal occult-blood screening on the incidence of colorectal cancer. N Engl J Med 343 (22): 1603-7, 2000.
[18] Hardcastle JD, Chamberlain JO, Robinson MH, et al.: Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 348 (9040): 1472-7, 1996.
[19] Kronborg O, Fenger C, Olsen J, et al.: Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 348 (9040): 1467-71, 1996.
[20] BreastScreen Australia Evaluation Advisory Committee Final Report 2009
[21] Cancer Council Australia, Australia's response to the social determinants of health Pre-Budget Submission, 2012 - 2013,
[22] Screening to Prevent Cancer Deaths, US Department of Health Centers for Disease Control and Prevention Report, 2008,
[23] S Jane Hadley et al, Surveillance of Screening-Detected Cancers (Colon and Rectum, Breast, and Cervix) --- United States, 2004--2006 Morbidity and Mortality Weekly Report, Surveilance Summaries, November 26, 2010 / 59(SS09);1-25             
[24] Anthony B Miller et al, 25 year follow up of breast cancer incidence and mortality of the Canadian National Breast Screening Study: Randomised Screening Trial, British Medical Journal 2014;348:g366, January 2014
[25] Bruce Pyenson et al, Cancer Screening: Payer Cost/Benefit thru Employer Benefits Programs, C-Change and the American Cancer Society, November 2005
[26] Chun Chen and Ellen Connel, Cancer in Aboriginal and Torrest Straight Islander peoples of Australia: an overview, Australian Institute of Health and Welfare, 2013.
[27] Condon J, Barnes T, Armstrong B, Selva-Nayagam S, Elwood M. Stage at diagnosis and cancer survival for Indigenous Australians in the Northern Territory. Med J Aust. 2004;182(6):277-80,
[28] C-Change Together, Making the business case: How engaging employees in preventative care can reduce healthcare costs,, Spring 2008
[30], Australian National Preventative Health Agency website, Accessed April 2014
[31] Cunningham J, Rumbold AR, Zhang X & Condon JR . Incidence, aetiology, and outcomes of cancer in Indigenous peoples in Australia. The lancet oncology 9:585–95. 2008
[32], World Health Organisation Palliative Care Page, Accessed April 2014
[33] Australian Institute of Health and Wellness. Palliative care services in Australia 2013. Cat. no. HWI 123. Canberra: AIHW. 2013.
[34] AIHW 2011. Trends in palliative care in Australian hospitals. Cat. no. HWI 112. Canberra: AIHW. Viewed 21 April 2014
[35] Australian Institute of Health and Welfare (AIHW) 2004. National palliative care information collection: a way forward for community-based palliative care. AIHW Cat. No. HWI 77.
[36] Burt J, Shipman C, White P, Addington-Hall J. Roles, service knowledge and priorities in the provision of palliative care: a postal survey of London GPs. Palliat Med 2006; 20(5): 487-92
[37] Field D. Special not different: General practitioners’ accounts of their care of dying people. Soc Sci Med 1998; 46: 1111-1120
[38] Dowling S,Leary A, Broomfield D. Palliative care education: a Delphi survey of Irish general practitioners. Education for Primary Care 2005; 16(4): 458-466(9)
[40] Cancer Council Australia. (2007). Ideal Oncology Curriculum for Medical Schools, accessed April 2014
[41] COAG Reform Council 2012, Healthcare 2010-11: comparing outcomes by remoteness, COAG Reform Council, Sydney, 2012
[42] Sarah Murray et al, The quality of death, Ranking end-of-life care around the world, Report by the Economist Intelligence Unit 2010.
[43] National Rural Health Alliance Inc, Palliative care in rural and remote areas, Fact sheet 34, October 2012.

[44] Lyratzopoulos, G., Abel, G. A., McPhail, S., Neal, R. D. & Rubin, G. P. Measures of promptness of cancer diagnosis in primary care: secondary analysis of national audit on patients with 18 common and rarer cancers. British Journal of Cancer, 108(3), 686-690, 2013

Sunday, April 20, 2014

Global Warming. We Finally Know How To Fix It. Why It's Not Gonna Happen.

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Global warming. It's made out to be scary.. apocalyptic really, with scientists all around the world spelling out doom and gloom for the upcoming century. Sea levels rising, more freak storms, entire environments changing drastically... 

Healthwise, the World Health Organisation predicts a resurgence of infectious diseases due a lack of adequate drinking water (not just to evaporation... algae thrives in warmer conditions) and the spread of mosquitoes, lowered nutritional standards due to drought and ineffective agricultural techniques, and increases in international conflicts as millions, more likely billions are displaced and forced into hunger and starvation.

Quite a lot of panic over a few warmer days, right?

Well, it is a thing. It's happening as we speak. And even if you're less inclined to believe it exists (despite unanimous scientific backing and the already visible effects), the fact that 7million people last year (including 29,000 in the UK, a developed country) died DIRECTLY from air pollution should make you feel that we should do something about something that just happens to cause global warming too - greenhouse gasses. 

The IPCC, the Intergovernmental Panel of Climate Change, has for years been giving independent, scientist backed analysis and projections about this issue. But they've been routinely ignored by governments all around the world, despite their worrying projections. Reasons for this include the fact that there's opposition to the idea that it's even occurring due to humans in the first place and the lack of a concerted, global political will to make things happen. And there's greater things starving countries have to worry about...  if rich countries aren't even following their recommendations, why should they?

But one other major reason these projections and reports are being ignored, is that so far they've only been focused on the problems, rather than suggesting a solution. The panel has historically been solely focused collecting data, projecting outcomes, and making recommendations on how much the world needs to decreases its greenhouse gas production, rather than suggesting universal, effective methods for dealing with the issue, which would give the world a path to follow for dealing with climate change. 

Well, this year, this has changed. The IPCC has,, for the first time ever, released a guide on the "Mittigation of Climate Change." This outlines and suggests methods, and technologies that policy makers around the world should implement to effectively tackle climate change. 
The ideal behind it, and the idea for making this report itself, is awesome. We're not only looking at what's happened and what's to come, we're setting ourselves a path forward to dealing with the issue, something I believe is key to fixing any problem. Here's a great video summarising the major suggestions they made. You can read the full report here.

Basically, they recommend that the world increase the proportion of low, or no carbon-emitting energy sources such as solar, hydro-electric or nuclear energy (where that's not achievable, a switch to natural gas based systems is recommended), decrease the already inflated amounts of carbon dioxide in the air already through afforestation (and less deforestation), the increased use of bio-fuels and the recapturing and storage of emitted greenhouse gasses (watch the video for how that works) to combat the major cause of greenhouse gasses (around 40% of them) - energy development. 

In terms of transport and industry, which together account for 53% of greenhouse gasses, they don't tell us how to achieve the targets, as they did for the energy production part of their recommendations (probably because they're more diverse issues that don't have the same end point of electricity, so can be done in many ways). In terms of reductions to industrially sourced carbon emissions, they advocated more recycling of wastes, the implementation of better technologies, the increased sustainability of buildings and their energy consumption and the sharing of technologies to make each industry most efficient for the amount of greenhouse gasses they would inevitably produce. In transport, they did recommend shifts to more efficient carbon based fuels, higher density transport through building of public infrastructure.

But in the end, these recommendations will just get ignored.
Just like the previous 24 years of scientifically backed IPCC reports.
And this is why.

These recommendations are backed by the work of over 250 scientists, and have taken years to take effect. They're a great step forward, because we've finally given policy makers a set, international guideline on how to reduce greenhouse gasses, something they can be held accountable for by their voters (in developed countries at least, we can afford to implement some of these changes)

They're great,  but they're recommendations that only look at the science... 

They neglect the basic idea that in order to get any change in the world, you need to make it cost effective, profitable, something that you can't afford NOT to do.

Right now, all these options come at huge cost. And the benefit is a cleaner, sustainable environment... something that won't confer direct economic advantage to those who implement them.

The people who fund these - governments and businesses don't stand to benefit. 
Governments will only pass bills that the people want... or they won't get reelected. not when another party  promises to give people a more stable economy, and things they need (infrastructure, jobs, security) and want (tax cuts). 
Yeah, people want change to happen in global warming (well, a good chunk of people do), and yeah a lot of people are concerned about it, but not many are willing to bear the costs of it. 
Businesses, well, they're businesses. They want to make money. And right now - green energy just doesn't translate to profits...

This cost benefit analysis, done by the German government concludes that, on the basis of cost alone, renewable energy is just not worth it.

So for change to happen - these recommendations not only have to be good for the environment - but also for the economy, and people too. 

The funny thing is, there are actual, cost benefits in their recommendations already.

This report, published in Nature in 1997, made nearly 20 years ago by the way, placed a dollar value on the services the world's ecosystems provide - a figure of 16 - 54 TRILLION, 1997 dollars. The world's ecosystems, and how we use them at the moment (including their protective "services" by the way - not just for sustaining our fishing/farming methods) will stand to change substantially for the worse due to global warming by the way - quicker than ever before.

But that's not enough. 

Putting a dollar value, even a HUGE on like that, on protecting our ecosystems, still doesn't stand up to profits that are visible to us right now. 

The recommendations that are made shouldn't only be guidelines or methods that will reduce greenhouse gas emissions, but also show direct, fiscal benefits of implementing them. 
The benefits shouldn't just be restricted to a better environment.
We've seen that not work for the past 24 years (how long the IPCC has been around) 

Not once in the whole report is the long term financial benefit of switching to these better, greener models mentioned. Though they did mention the fact that technological advances have occurred and made these changes cheaper and more affordable to implement Not once did they say that switching to sustainable, low carbon emitting energy sources, like solar and hydroelectric, will give almost free energy that will last in the long run - something that WILL offset the huge capital required to set it up. Not once did they mention, or provide analysis of the fact that the recycling of products in industry results in less resources and money spent acquiring raw materials, or that sustainable, environmentally friendly buildings and building methods will last longer, and save on energy costs than ones that aren't done in such a manner. Not once did they mention that providing financial incentives to the general public to implement environmentally friendly means of living will result in less expenditure on fixing the environment outright which is occurring right now (read this article on China's environmental problem causing direct financial harm, and an increased health burden - this is in addition to the 7million deaths, and probably many more hospitalised, by air pollution - all costs that end up directly impacting the health sector). 

All these savings will only increase as global warming begins to take a further hold. Yet these benefits aren't analysed in cost benefit analyses, and this report failed to take that into account too. 

They gave us a way to beat global warming, but they gave us no real incentive to do it.

I'm all about finding ways to fix things and I always provide solutions to the things I say, as I talked about in my last post. This report is only in draft mode right now. It can change, and I hope it does, to not only provide a guideline for policy makers to follow, but also the likely financial benefits of following them - something that will lead to more pressure on policy makers to adapt to them. And I'll outline the financial benefits to the recommendations they have made below.

Right now, reducing greenhouse gas emissions isn't cost effective, or helpful in the short term. But that's because the reasons why it is beneficial, in the long run, are not even advocated. 

Saving the environment, and ourselves is not enough. 

We need money for it to happen on a wide scale. 

Just saying that makes me sad. But it's true nonetheless. 

I believe the recommendations of that IPCC report should be "marketed" not just as a fix to the environment (which governments, businesses and people have routinely ignored in the past), but for their economic benefits as well. And most of the recommendations do have that. 

By doing it this way, we provide profitable, tangible incentive to policies and practices which help the environment. 

Making Renewable Energy More Attractive:

--> Currently, renewable energy on the grid isn't viable on a large scale, and on traditional cost benefit analyses, they don't phase out. These analyses only tend to look at the short term though. Renewable sources, though they require a large initial capital investment, are staggeringly cheaper over the long term, with no need for the continued buying of fuel to keep them running. And the overall cost of renewable resources may be decreasing too, with power storage facilities moving in leaps and bounds over the years. Especially with sustained military, space exploration and private sector investment, technology and research is only bound to increase in efficiency and become cheaper too. And this fact is why it's increasing in overall usage, and in investments constantly over the years, as seen below. 

 The cost benefit analysis of subsidies to residential and small business renewable energy is clear. More than 2.5million homes and businesses and Australia alone have installed solar panel units. With an average saving of $544 on electricity per year (the average bill in Australia per year is $1064), that's a huge amount of money that gets recirculated into the economy, for a small capital investment (which can be claimed back in a rebate for a short time only) starting from $2399, that's a great investment, especially when you consider the original investment only gets added to your home's asset value in the end. 

The other method talked about, the recapturing of carbon emitted by large generators, is also expensive to set up initially. But, especially with rising prices of coal and natural gas, and the rising price of mining fossil fuels too as they become more scarce, this could effectively provide a new, renewable source that can be almost perfectly clean too.

Making Industry Sustainable, and still Profitable:

--> Industrially, companies stand to benefit financially from making improvements that will help the environment too. These methods are mentioned in the recommendation, but again, only benefits to the environmental are mentioned, not the economic impacts. 
But there are economic improvements to many ways of reducing industrial pollution too.
Upgrading to newer boilers reduces energy use and makes manufacturing cheaper, fully utilising heat in generators and motors increases energy production and also cuts costs. Blended concrete (concrete currently accounts for 22% of greenhouse gasses produced by industry), though it takes longer to set, stands longer and is stronger than traditional limestone based concrete and reduces carbon emissions significantly in this field. Again, a very economically viable improvement that drastically reduces greenhouse gasses too. Recycling steel, which accounts for 15% of total industry greenhouse gasses, and making oil refinery processes more efficient will also add to this [source]. These methods all benefit the environment, as well as companies bottom line, and this aspect should be mentioned, and be encouraged in legislation too. They don't just benefit the environment, but also the economy in the short and long term. 

Making sure companies comply with regulations is another issue which needs to be addressed, and the direct environmental impacts, not just the greenhouse gas emissions down the line are really starting to hurt developing countries. China, which has grown exponentially over the years is starting to realise this, after crises of water pollution became apparent. Interestingly enough, the citizens of China are starting to protest against environmental issues, and these protests will only increase in frequency if industrial and overall environmental pollution keeps occurring, making the environment a genuine issue of concern, (outside of international condemnation over smog concerns during the Olympics) for the country's communist party.

Making Agriculture Sustainable, yet still profitable:

--> In terms of agriculture, again, some recommended measures to reduce the greenhouse gasses of this sector also benefits the farmers too, and again, I believe these benefits should be outlined to further compliance with the IPCC's recommendations. Improvements suggested in the IPCC include the increased use of bioenergy resources, afforestation and reduced deforestation. Increasing the use of biofuels adds to the value of fast growing crops such as sugar cane and bamboo (which can be made into fuel more quickly, as well as just for sugar) as well as reduce the reliance and burden of fuel prices, which are only going to increase over time. Increasing afforestation, which doesn't just involve planting trees, is cheap, reduces carbon dioxide leakage to the environment (as you can see in the image below) and also can be used smartly, as cheap wind breakers for better crop development, and for better grasses, which lead to better livestock production too

Deforestation to clear space for agriculture, which was also mentioned as an issue (without much emphasis of the solution) in the report, is currently occurring all over the world, and forests and trees provide the only viable carbon dioxide filtering service, making it a vital part of fighting climate change. 
The use of more efficient crops and seeds, whether by selective breeding, or genetically modified crops to produce more harvest per acre leads to more efficient use of land, which benefits both farmers and the environment. Furthering the education of sustainence farmers with more efficient agricultural methods translates to less poverty and a better economy at low cost while also reducing the need to take down forests.  In tropical rain-forests in particular (which turn over 31% of the world's oxygen), deforestation shouldn't be mandated and indeed discouraged. Though rain-forests are lush, their soils are only that way because of the huge amount of biodiversity and high density of the rainforest, always turning over proper massive amounts of energy. Establishment of a monoculture on such land, where soil is only lush about 3 inches deep, is unsustainable, and farms usually turn arid within years of farming. Thus farming practices like turning forrest into pastures, as is done widely in Brazil, often fail, while continuing to destroy valuable forest. 

A picture depicting the actual worth of a tree. 

But 70% of agricultural emissions are derived from livestock, which the IPCC's report doesn't even mention. Improving the efficiency of livestock growing methods, such as breeding faster growing livestock, more grazing on low fiber grasses and low fiber feeds, which provide more energy AND less methane production, supplementing diets with tannin, a cheap antioxidant (which leads to 10 - 30% less methane emissions), and giving supplements to dairy cows to cause them to lactate longer all lead to increased production  efficiency for farmers and lowered carbon emissions too. 

Making Transport Greener while Still Keeping it Cheap:

As mentioned in the report, and as I talked about above, the utilisation of biofuels will reduce the environmental impact of greenhouse gasses due to transportation. The advocacy and spreading of public transport is another recommendation mentioned in the IPCC report and the economic benefits of this are already clear, with good access to public transport proven to cause more productive cities and environs. Public transport provides environmental benefits too - as it provides high density transport with lower energy use per person transported. The providence of car-pool only lanes reduces private transport costs, as well as this recent announcement by the NSW government to allow lane filtering by motorbikes (motorbikes consume much less fuel per person, and encouraging their use will lead to lowered greenhouse emissions as well as quicker transport, for both bikers and car drivers alike (which also = greater productivity, helping the entire economy out).

Newer technologies, not talked about in the IPCC report but still relevant to this issue are also coming into play, and promise to provide affordable, cleaner and superior transportation too. 
Hydrogen powered fuel cell technology only has water as a waste product. While Fuel Cells are currently expensive, and heavy, the technology provides a powerful vehicle that also goes 3 times further/longer than gasoline powered vehicles can too - and Toyota is already planning on releasing it as soon as next year. The only problem, environmentally, is that hydrogen takes energy to produce. But this stands to change too, as a recent discovery of an enzyme which converts plant sugar into hydrogen fuel is being trialed on a larger scale now. Other challenges that face it include the lack of refuelling stations. But it is a promising technology. 
Solar cars are already a thing, but aren't widely used at the moment as there are challenges in storing energy and in the power of vehicles too. One way that allows school and uni kids to improve the latter aspect is solar car racing - where groups of students, ie nerds (one of them a good friend of mine - sorry for calling you a nerd Anthony) get together, design, build and race actual solar cars. 
Things like this as well as private sector investment fosters innovation (something I believe should happen more and more efficiently too, read about that here)which will all lead to more efficient, more cost effective strategies. And this IS already happening, as you'll see below.

Making Sustainable Building Profitable:

--> Building with more sustainable methods has also been proven to be worth the cost, as seen in this novel cost benefit analysis of building green. Building green, though incurring more initial investment, has been shown to increase productivity by 25%, increase a buildings asset value by 10%, increase rent by 5 - 10% and also costs less to maintain over the years. If something similar had been done in the IPCC's policy recommendations, governments would be further inclined to provide subsidies for building new homes greenly, which would increase the incidence of it, and result in a more prosperous and green country. 

The IPCC's report has taken a positive step to make suggestions on what we, as humans, have to do to mitigate the impacts of global warming. This change in focus towards suggesting solutions and not just outlining the problems will give the world's leaders a clear path forward in combating climate change. But there are direct financial motives, beyond that of saving the environment, for making policies that encourage these changes too. If these benefits were to be made more clear, then the recommendations that this paper has made will be more likely to be followed. 

Indeed, the only way you can make something happen, is to make it too expensive NOT to do it.

Why you can't afford NOT to give blood <-- Click to read.