How should health professionals take action against climate change?

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39538.509456.80 (Published 03 April 2008) Cite this as: BMJ 2008;336:733
  1. Anna Coote, commissioner for health
  1. 1UK Sustainable Development Commission, London SW1A 2HH
  1. annacoote{at}hotmail.co.uk

    BMA report outlines the problems, but falls short in providing solutions

    “The scientific evidence is now overwhelming: climate change is a serious global threat, and it demands an urgent global response.” This was the unequivocal message of the Stern report, published by HM Treasury last year.1 The time for debate is over—at least about whether climate change is potentially catastrophic and caused by human activity. But who should act and how? This week, the BMA Board of Science publish their report Health Professionals—Taking Action on Climate Change.2 It outlines the basic facts and figures and points to copious sources of further information.

    The report endorses Stern’s conclusion that, “urgent action is needed now at an individual, organizational, political and global level.” It summarises evidence about cause and effect, then considers the health implications. A diagram (from the Lancet) points to floods, storms, and other forms of environmental damage leading to “impaired nutrition, health, survival.”

    Turning to how the effects of climate change can be reduced, the report says that the government’s sustainable development strategy, Securing the Future, must be implemented.3 Another diagram, from the International Panel on Climate Change (IPCC), lists “key mitigation technologies and practices that are currently commercially available” and those expected to be on tap by 2030.

    Next, carbon emissions and footprints are explained. In the United Kingdom, the average emission is equivalent to 10 tonnes of CO2 each person each year. Most personal emissions come from household energy consumption and travel, with a sizeable chunk associated with purchases of consumable goods. A sustainable individual footprint is 2 tonnes of CO2 each year. That means a staggering reduction of 8 tonnes per person.

    So what solutions does the report propose? Several measures, it tells us, can reduce the amount of CO2 that we emit. These include carbon offsetting, carbon trading, and “contraction and convergence.” Each solution is briefly explained, with references so that people can find out more. No effort is made to assess the relative merits of these very different strategies.

    The report sets out what is being done globally, by the European Union and by the UK government to tackle climate change. It provides recommendations for health professionals. Measure your own carbon footprint; turn appliances off; improve ventilation and insulation; save water; reduce waste; buy fresh local produce; and cut down on meat, dairy products, and saturated fats. Avoid overly processed or packaged foods and bottled water. Use public transport, walk and cycle more, cut unnecessary flying and driving.

    Of the NHS, the report says that—as the largest organisation in the UK, with an annual purchasing budget of more than £17bn (€21.5bn; $34bn)—it must take urgent action to reduce its carbon footprint. It sets out examples of where such action might be taken—in building works and in managing energy, water, waste, and transport. It does not mention procurement, which accounts for the largest part of the NHS’s carbon footprint.

    For health professionals who want to find out more, the report provides usefully referenced summaries of evidence. Hopefully, however, it will soon be followed by a more concerted effort to confront the heavily barbed challenges of climate change. It mentions, all too briefly, that climate change can affect mental health, and that measures to reduce greenhouse gases can help reduce the risk of cancer, heart disease, obesity, other chronic illnesses, and injuries caused by road traffic crashes. These are vital themes that must be paid closer attention by health professionals and policy makers.

    It sits on the fence about methods of carbon reduction, as though they were equivalent options. Yet carbon offsetting is a highly controversial way of compensating for carbon emissions, rather than reducing them. And contraction and convergence is a profoundly radical strategy for each person on the planet to arrive at equitable and sustainable per capita greenhouse gas emissions.4

    The report offers no view on what should happen if NHS trusts fail to cut their massive direct and indirect emissions. It makes no suggestions about how trusts can make sure that their contractors give priority to mitigating climate change. It points out that health professionals “have a responsibility to highlight the public health risks of climate change as well as the numerous health benefits associated with more environmentally friendly economic activities and lifestyles.” Yet it does not discuss where carbon reduction should stand in the hierarchy of clinical responsibilities. Nor does it suggest what health professionals should do if they find their government is dragging its feet—for example, in giving sufficient priority to its own sustainable development strategy.

    Here, surely, is the crux of the matter for the BMA. We have the science. We have something approaching consensus about the causes and scale of the problem. Now what is required, from one of the UK’s most powerful trade associations that is well able to influence cabinet ministers and governments, is a sustained evidence based campaign to match the enormity of the risks to human health.



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