Hopeful not helpless: How doctors are combating climate change
BMJ 2022; 379 doi: https://doi.org/10.1136/bmj.o2429 (Published 10 October 2022) Cite this as: BMJ 2022;379:o2429Read our special issue on the climate emergency
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Dear Editor,
As co-chairs of RCPE’s Advisory Forum on the Environment, we read the article, Hopeful not Helpless: How Doctors are Combating Climate Change, with interest and enthusiasm. Our RCPE Group was formed in 2021, recognising that as healthcare professionals we play a pivotal role in advocating for health, in influencing healthcare practice, and in modelling more sustainable ways of living in our own day to day lives.
There is a clear link between climate change and public health. Globally we are experiencing negative health impacts as a consequence of extreme weather, polluted air, food and water shortages, forced migration, and the aggravation of disease. We must do all we can to ensure the health and care services that people turn to during ill health, are not among the major contributing factors to that ill health, and that we can deliver a sustainable service that enhances wellbeing and reduces health inequalities.
Access to more localised services and better integration of care will be essential in enabling success, along with sufficient workforce resource to deliver these services. Staff across the NHS are already stretched with workforce shortages across the system an ongoing concern.
Engaging with people – communities, patients, and staff – will also be critical to the success of climate mitigation.
We believe the need for a sustainable approach needs to be embedded into all aspects of the delivery of care, not as an add-on to existing practice. It can be easy to feel overwhelmed by the enormity of the task, and many of us feel we are not experts and don’t know where to start. We can all play a role however, no matter how small, and RCPE has produced a resource, Ten Things A Doctor Can Do. This suggests immediate, achievable changes we can all make. Our place in society as patient advocates and role models cannot be underestimated and we can all do our bit and make a difference.
1. Practise good preventative medicine
2. De-prescribe unnecessary medication and consider what you do prescribe
3. Reduce the number of investigations you request
4. Use telephone consultations and low carbon meetings
5. Reduce unnecessary use of disposable PPE
6. Switch things off and close doors
7. Walk or cycle to work or use public transport
8. Bring your own (local plant based) food and drink in reusable containers
9. Learn more - understand the link between climate and health, and audit your practice
10. Join discussions in your board/trust about the big things (procurement, energy, recycling, etc )
Competing interests: No competing interests
Dear Editor
There was only brief mention of recommending patients change to a whole food, plant based diet amongst all these other good ideas, but it should be much more prominent given diet is thought to be the biggest single contributor to personal GHG contribution (EAT Lancet, WHO, etc)
It simultaneously very significantly reduces chronic disease risk a great deal so for health professionals and patients it is a big win-win. We need better training to help health professionals do this, such as provided by the Plant Based Health Professionals UK. Behaviour change is possible and health profs should both demonstrate it themselves and lead the way in filtering a whole foods plant based or plant centred diet. You can’t separate personal from planetary health these days and this is the only diet that makes this dual difference.
Competing interests: No competing interests
Re: Hopeful not helpless: How doctors are combating climate change
Dear Editor
I agree with Hannah Chase’s suggestion that health professionals are among the most appropriate and potentially effective group of people to communicate the threat of climate change on human health. They are also well placed to take a lead in advocating for, and demonstrating in their actions, the fundamental cultural and societal changes that are needed to protect both human and planetary health. And they are among the best people to communicate and promote the many opportunities that exist in mitigating and adapting to climate change in a way that both prevents ill health, enhances wellbeing and reduces health inequalities.
It is surprising the article did not mention the UK Health Alliance on Climate Change, which was founded by former editor of the BMJ, Fiona Godlee, and is currently chaired by another former editor, Richard Smith. The Alliance brings together 35 health organisations, representing about 970,000 health workers across a wide range of caring professions including doctors, surgeons, nurses, paramedics, psychologists, and many more. The Academy of Medical Sciences, the Royal Society of Medicine, the British Medical Association, the Lancet, and the BMJ are members, as are most of the Royal Colleges, and student organisations including Students for Global Health and the Planetary Health Report Card.
The UK Health Alliance has demonstrated the impact of health professionals coming together from across different areas of care with a coordinated and consistent message. This has been evidenced in a number of initiatives, including calls for amendments to embed targets for net zero in the Health and Social Care Bill, which was passed into law in July this year. Members of the Alliance came together to call for a fifth domain on sustainability to be built into GMC Good Medical Practice and to call on the UK government to set safer targets for air pollution than it is currently proposing.
As well as its work in the UK, the Alliance has demonstrated the effectiveness of global action, most recently by the coordinated publication in more than 250 international journals, including BMJ, of an editorial authored by 16 health editors from across the African continent.
Significant progress is being delivered in redesigning the health service to make it more sustainable, and here, the Greener NHS in England has been recognised globally as leading the way. Since announcing in October 2020 a commitment to reach net zero carbon, every hospital and Integrated Care Board in England has now published a Green Plan setting out their aims, objectives, and delivery plans for carbon reduction. The Greener NHS net zero supplier roadmap has also resulted in some of the NHS’s largest suppliers following their lead and committing to meet net zero emissions by 2045 or earlier. As the supply chain is the biggest contributor to the overall carbon footprint of health services around the world, the global impact of this is significant. At COP26, fifty countries committed to develop climate-resilient, low-carbon health systems; 14 set a target date to reach net zero emissions on or before 2050.
At a Ride For Their Lives cycle around London coordinated by the UK Health Alliance earlier this month, many presidents, chairs, and representatives from UKHACC member organisations came together to raise awareness of the health impacts of climate change and air pollution. At the panel discussion that followed the cycle, the message about the importance of the voice of health, and the need for collaboration and leadership came out strongly – as did one of hope.
Competing interests: I am Director of the UK Health Alliance on Climate Change