“We cannot drink oil, we cannot eat coal, we cannot adapt to extinction,” says Greta Thunberg with her gift for plain speaking. Virtually all health professionals recognise the threat from the ecological and climate crisis and see the effects in their daily practice. The crisis is not in the future, it is here now.
Those who care for the mental health of the young see the pain that the ecological and climate crisis is causing. A recent survey in 10 countries of 10,000 people aged 16 to 25 found that 60% were “very worried or extremely worried” by the state of the planet.1 Three quarters find the future frightening, and over half think that humanity is heading for extinction. Two-thirds feel sad, afraid, and anxious. Many felt fear, anger, despair, grief, and shame – as well as hope. One 16-year-old said: “It’s different for young people – for us, the destruction of the planet is personal.”
In the face of such pain and because both the WHO and the Lancet have called the ecological and climate crisis the greatest threat to human health, health professionals have a duty to act. But they also need to recognise, as the Lancet has stated, that responding to the crisis is also the greatest opportunity to improve human health.2 A decarbonised world in which nature was restored to its full magnificence would be a much healthier world.
What then should health professionals do? How can they lead?
When we think of great leaders we may think of Gandhi, Nelson Mandela, Martin Luther-King but we might also think of Hitler and Stalin. Talk of leadership may sound grandiose and even frightening to health professionals, but opportunities for leadership arise every day in everyday life. What do you do when you hear somebody make a racist or sexist comment? Do you speak up? What about when a colleague, perhaps a senior colleague, is rude to a patient? To respond requires courage, and an easier way to lead is by example: be the person who stays the extra hour to comfort a grieving parent; be the person who cycles to work in all weathers to avoid the greenhouse gas emissions that come from driving; be the person who has the courage to talk about the ecological and climate crisis each day to one new person; be the health professional who brings up climate change with patients. Acts of leadership may be very small, but they are still important.
Perhaps one of the best examples of leadership is the teenager Greta Thunberg beginning her lone weekly vigil outside the Swedish Parliament calling for action on the ecological and climate crisis. She must have felt very alone, perhaps even foolish, but she persisted. People came to join her, and her message spread across the world.
Coming together is an important part of leadership, and I am the chair of the UK Health Alliance on Climate Change, an alliance that brings together most of the royal colleges in the UK (nurses, physicians, surgeons, GPs, psychiatrists, pharmacists, dentists, vets, etc), the BMA, the Lancet, and the BMJ.3 Altogether our members have some 900,000 members, most of the NHS workforce. We exist to do all we can to mitigate the effects of the ecological and climate crisis but also to promote the benefits that will flow to health from decarbonising our planet and restoring nature. As the damage from climate change is already here and will grow worse, we also work on adaptation.
The alliance was created eight years ago by Robin Stott, a physician and long-time environmental campaigner, and Fiona Godlee, editor of the BMJ. The two leaders persuaded the royal colleges and others to come together, and it was hard work: many of the colleges did not see action on climate change as a priority and were reluctant to pay a subscription. But Robin and Fiona persisted, and now—recognising the seriousness and urgency of our plight– organisations come to us, and the Alliance is growing.
If we are to respond adequately to the ecological and climate crisis then there needs to be change at every level—globally, nationally, regionally, organisationally, professionally, and personally. None will be enough on their own. For example, the UK cannot reach net-zero by 2045 if the NHS, which accounts for about 5% of UK greenhouse gas emissions, does not reach net-zero;4 and the NHS cannot reach net-zero if health professionals do not change their clinical practice and how they travel to work and what they eat at work.
“Be the change you want to see in the world,” said Gandhi. (As is the case with most of these famous quotes, he probably didn’t say it first but it’s attributed to him, a great leader.) I will start at the bottom of the hierarchy with personal change.
- Move better: fly less, ideally not at, drive less, walk and cycle more. All this will be good for your physical and mental health as physical exercise is the closest we can come to a panacea.
- Eat better: move from high carbon diet, one based on animal products, to a low carbon diet, one based mostly on plants. This change will also be good for your health. You might go as far as becoming a vegan, but the smallest change will produce benefits for both you and the planet.
- Buy better: consuming too much is at the heart of our unintended destruction of the planet. We must buy less, and when we do buy we should buy what is sustainable or where the value is in the thought and design rather than in the material of the product.
- Use your money better: if you have investments, divest from fossil fuels and invest in sustainable goods and services. You may not have investments, but you probably have a pension: make sure that your pension fund is invested to sustain rather than destroy the planet. Consider as well transferring to a bank that puts sustainability at the heart of its work.
- Talk better: talk with as many people as you dare, family, friends, people on the bus, and patients, about ecological degradation as a health issue rather than an environmental issue.
- Campaign better: join organisations like Greenpeace, Friends of the Earth, or Medact. You may not want to stick yourself to the office of a fossil fuel company, but it’s an easy act to write to your member of parliament, preferably with a handwritten personal letter telling of experiences you have had.
- Vote better: in every election, whether it’s to parliament or to your trade union or professional organisation, vote for the candidate who puts first responding to the ecological and climate crisis.
Although most health professionals understand the personal changes they can make and many have made them, we have been slower to recognise that it also means changing our clinical practice. The best way to start with changing clinical practice is to measure the carbon footprint of that practice and then make a succession of changes to reduce the footprint. Frances Mortimer of the Centre for Sustainable Healthcare has written on this with others, and they emphasise that preventing people needing care at all—through prevention and patient empowerment—is the best way to reduce the carbon footprint of clinical practice.5
The single largest component of the carbon footprint of the NHS is drugs, accounting for about a fifth of the footprint.4 Overall two thirds of the NHS footprint comes from suppliers.4 This means that the NHS can never reach net zero without working with pharmaceutical companies and other suppliers of equipment, food, vehicles, and much more. A study of the carbon footprint of mental health services is likely to show that drugs and travel of both patients and staff account for much of the footprint. Bearing in mind that a third to a half of drugs are never taken6 by patients and that there are many alternatives to drug treatment, there are likely to be may ways to reduce the carbon footprint attributable to drugs. More digital consulting can help reduce the footprint attributable to travel, as can walking, cycling, or using public transport to get to work.
Ascending the scale of intervention, organisations like royal colleges must measure and reduce their footprint. They must do this not only because everybody must do it but also because calling on others to change but not changing yourself undermines your call. “Walking the talk” is the essence of leadership, and failing to walk the talk, as is often seen with politicians, undermines any attempt at leadership. A large part of the footprint of royal colleges is likely to be travel and organising conferences, and we have learnt during the pandemic that greater use of online communication can reduce dramatically the emissions associated with these activities.
Tragically when the ecological and climate crisis is the major threat to health, most health systems have rising carbon emissions.7 There has been a sense that because they do such important work health systems should be exempt from reaching net zero, but if they don’t reach net zero then nor will countries and the world. NHS England is so far the only health system in the world with a detailed plan, staff, and funding to reach net zero, although at COP26 another 14 countries to get their health systems to net zero.4 It is, however, easy to make promises but hard to deliver on them. Leadership is ensuring that promises are met, and NHS England has reached its first-year target. Nobody knows, however, how to get a health system to net zero, and research and innovation will be needed.
A health system can get to net zero only if every hospital, clinic, and service within it gets to net zero. Does your organisation have a good plan, staff, and resources to get to net zero? As a leader, you should find out, support work that is underway, and lobby for more action if there is little or none.
Individuals, organisations, and health systems working to get to net zero will be pointless if regions, cities, countries, and ultimately the world do not commit to and reach net zero. The record is poor: promises made in the Paris Agreement of 2015 should have led to a year-on-year reduction of 7% in greenhouse gas emissions, but there was actually a 7% increase each year after the agreement until the pandemic caused a global shut down and a fall in emissions. Health professionals, the most trusted group in society, must speak out, and it was that thinking that led to the creation of UKHACC. We can have more influence if we join together and speak with one voice, but members of the Alliance—who are better known and have more resources—must also lead. It also makes sense for individual colleges to lead on the topics they know best and for the Alliance to then spread their learning and messages. The Royal College of Psychiatrists is one of the most active members of the Alliance.
UKHACC concentrates its efforts at a national level, playing a prominent part in encouraging Theresa May when prime minister to committing the UK to reach net zero by 2050. We are campaigning on air pollution, the food strategy, a healthy recovery from the pandemic, ending all subsidies for fossil fuels, and getting the four NHSs to net-zero by 2040.3
But the UK accounts for only about 1% of global emissions, so health professionals must play a global role. Health professionals have strong global connections, and International Physicians for the Prevention of Nuclear War won the Nobel Peace Prize for its role in reducing tensions during the Cold War. UKHACC belongs to the Global Climate and Health Alliance (GCHA), which has some 78 member organisations, and organises global campaigns. Indeed, in the run up to COP26 UKHACC led a project to get more than 220 health journals from all parts of the world and many disciplines (medicine, nursing, dentistry, pharmacy, veterinary medicine, and others) simultaneously to publish the same editorial calling for the nations of the world to keep global temperature increase below 1.5C from preindustrial levels and to recognise that that would be possible only if rich countries provided financial and technical assistance to poorer countries more vulnerable to climate change.8
My message is simple: leadership is not remote, you have an opportunity every day to lead. And when it comes to the ecological and climate crisis you have many options to lead through from making small changes in your daily life to devoting much time to joining with others to act.
This article first appeared in CAMH Journal: https://acamh.onlinelibrary.wiley.com/doi/10.1111/camh.12536
1 Marks E, Hickman C, Pihkala P et al. Young people’s voices on climate anxiety, government betrayal and moral injury: a global phenomenon. Available at SSRN: https://ssrn.com/abstract=3918955 or http://dx.doi.org/10.2139/ssrn.3918955
2 Wang H. Horton R. Tackling climate change: the greatest opportunity for global health. Lancet 2015; 386: 1798-9. DOI:https://doi.org/10.1016/S0140-6736(15)60931-X
3 UK Health Alliance on Climate Change. http://www.ukhealthalliance.org/
4 NHS England. Delivering a net zero NHS. 2020. https://www.england.nhs.uk/greenernhs/a-net-zero-nhs/
5 Mortimer F, Isherwood J, Wilkinson A, Vaux E. Sustainability in quality improvement: redefining value. Future Healthc J 2018;5:88-93. doi:10.7861/futurehosp.5-2-88 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502556/
6 National Institute for Health and Care Excellence. Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence. London: NICE, 2009.
7 Lancet Countdown on Climate Change and Health. Healthcare sector greenhouse gas emissions. https://www.lancetcountdown.org/data-platform/mitigation-actions-and-health-co-benefits/3-6-mitigation-in-the-healthcare-sector
8 Atwoli L, Baqui A H, Benfield T, Bosurgi R, Godlee F, Hancocks S et al. Call for emergency action to limit global temperature increases, restore biodiversity, and protect health BMJ 2021; 374:n1734 doi:10.1136/bmj.n1734