BMJ  2008;336 (28 June), doi:10.1136/bmj.a529

Editor's Choice

Climate change: our new responsibility

With a week to go before the NHS is 60, let’s look at some real outcomes. In the penultimate article of his series (doi: 10.1136/bmj.a385), Tony Delamothe asks how the NHS scores on patient satisfaction, mortality, and overall performance compared with other countries—surprisingly well, it seems—and Nick Timmins hears from the NHS’s medical director, former cardiothoracic surgeon Sir Bruce Keogh, about plans to record more than whether patients live or die (doi: 10.1136/bmj.39618.627951.80). Sir Bruce wants to pilot and eventually publicise patient related outcomes such as pain, mobility, and anxiety to show whether patients really feel better after treatment, and by how much.

Meanwhile the NHS is facing a new responsibility: to cut its carbon footprint. As the biggest employer in Europe it emits more than 18 million tonnes of carbon dioxide a year, making it the UK’s largest public sector contributor to greenhouse gas emissions. The newly formed NHS Sustainable Development Unit has produced its carbon reduction strategy for consultation, which commits the NHS in England to reducing carbon emissions by 60% by 2050 (BMJ 2008;336:1399; doi: 10.1136/bmj.a382).

It’s hard to argue against a more sustainable NHS—saving money for health care, protecting global health, and improving health through low- carbon living. Yet last week an Ipsos Mori poll of about 1000 Britons found that many were unconvinced of the need to act on climate change (http://ipsosmori.co.uk/_assets/pdfs/public%20attitudes%20to%20climate%20change%20-%20for%20website%20-%20final.pdf). Around 60% believed that the contribution from human activity was still in doubt, and around 40% that the dangers were exaggerated. Only a small minority thought they needed to make "significant and radical" changes to their lifestyles.

All the more reason for doctors to take a lead, as Mike Gill explains (doi: 10.1136/bmj.39617.634190.59). Jenny Griffiths and colleagues list 10 things doctors can do (doi: 10.1136/bmj.39617.642720.59), and in letters to the journal, Rachel Myr and Barrie Smith suggest additional ideas (doi: 10.1136/bmj.39619.618356.3A, doi: 10.1136/bmj.39619.621736.3A). In this week’s Head to Head, Malcolm Green argues that we need to find greener alternatives to international conferences (doi: 10.1136/bmj.a358). James Drife pleads for face to face meetings in exotic locations (doi: 10.1136/bmj.a351), but even he says that if you’re going to fly somewhere you should do more than just attend a conference.

One single entity emits more carbon than the whole of the NHS in England. It’s called Drax, and it’s the UK’s largest coal fired power station. At a meeting earlier this year at the Royal College of Physicians (www.bmj.com/cgi/content/full/336/7639/298-a), speakers were asked for one thing we should do about climate change. James Hansen from NASA chose a moratorium on coal fired power stations, pending effective mechanisms for carbon capture and storage. More chillingly, Tom Burke, chief adviser on environment policy for Rio Tinto, said, "Don’t be under 40."

The G8 meets in Japan next week. We must hope that the impact of climate change on global health is at the very front of their minds.

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