A 27-year-old primigravida at 11+1 weeks’ gestation by menstrual dating presents for her first visit for routine prenatal care, accompanied by her husband. While discussing the comprehensive medical history with you before you meet the couple, your obstetric trainee mentions that the patient is allergic to penicillin.

To understand why so little is being done about climate change, we need to draw on political economy: Who would pay the cost of adhering to a carbon budget, and what say do they have over policy? The cost of capital write-offs discussed in Chapter 5 will be borne primarily by wealth-holders, who have disproportionate political influence in nearly all countries. Although public attention has focused on fossil fuel industries, a wide range of businesses have quietly resisted emission-cutting regulations and ensured that adopted policies would have ample loopholes. The other main cost, much higher energy prices, would be borne regressively by households. To forestall their opposition and protect living standards, it is essential that most carbon revenues be returned to them, ideally as per-capita rebates. The net effect of carbon pricing and rebating would be strongly progressive. Since it is neither feasible nor desirable to compensate wealth-holders for capital losses, however, effective action against catastrophic climate change requires broad, determined collective action to rebalance political power away from control by capital.

Effects that the pandemic will have can scarcely be predicted yet. Many will doubtless pass once the disease has been tamed. Others are likely to become permanent. It seems unlikely that air travel will remain entirely as it was before. Or that work will not have been affected. Will cities recover? Many of the pandemic’s effects will probably be ambiguous. The environment will be helped by the decline of travel but hurt by the shift of travel to private means from public. Deficit financing by governments will have been increased, perhaps permanently. Our toleration of statutory intervention may have increased; indeed, many are disappointed by its lacks, while others decry its excesses. Zoonotic diseases will finally have become recognized as a serious threat to humanity.

Climate–sincere citizens are frustrated with three decades of global and national failures to reduce greenhouse gas emissions, so they are receptive to arguments that they can make a difference by changing their own behavior – consuming less, flying less, driving less, becoming vegetarian. However, if our economy is dominated by fossil fuels, individual behavioral change has to be radical to reduce emissions, and few people are willing to do that. But if we change our behavior as citizens to increase the chance of electing climate–sincere politicians and supporting their policies – through civil actions – we actually create the conditions where our consumer behavior can also contribute. If our politicians forced coal plants to close, then our use of an electric vehicle and of an electric home heat pump for heating and cooling will reduce emissions and provide a model for others.