Intended for healthcare professionals

Rapid response to:


Global warming must stay below 1.5°C

BMJ 2018; 363 doi: (Published 22 October 2018) Cite this as: BMJ 2018;363:k4410

Rapid Response:

Re: Global warming must stay below 1.5°C

We were delighted to read your recent editorial on global warming and fully support the call to action for the medical community.

As clinicians we are taught to value evidence based interventions that benefit health and wellbeing. We look for the causes of disease and aim to change behaviour to improve outcomes. We hold a position of respect in the community and as a collective have a powerful voice.

Interesting isn’t it that despite this, when it comes to the most important health issues of our generation, we are barely whispering?

Human health is entirely dependent on the environment to provide us with air to breathe, food to eat and water to drink in a habitable climate.

The problem is that we are destroying the Earths ability to support human life. Climate change, biodiversity loss and pollution are beginning to threaten our very survival.

As you rightly say, despite much hype, the UN climate summit, the Kyoto agreement, the Paris agreement have achieved little. Global emissions have risen year on year and stand at least 60% higher than in 1990.

Make no mistake, we are heading for at least 1.5oC of warming by the 2030’s and, unless our current trajectory changes, significantly more by the end of the century. This won’t just mean we’ll see more videos of emaciated polar bears and that it will be hotter in the Summer – it will mean famine, as crops fail, massive migrations of people, fleeing uninhabitable regions, and war over dwindling resources. Looking beyond the next thirty years gives even more cause for concern. According to a 2012 report by the World Bank, “We are currently on track for 4o warming by 2100. There is no certainty that adaptation to a 4o world is possible.” Surely with this level of threat we should be demanding urgent action from our leaders?

What can you do? The answer is - everything. We believe it is our duty as doctors to coordinate high level sustained lobbying of our governments and industries to address these issues. We are some of the most trusted voices in society and have more power than we think. So we have the ability to change the future if we have the will.

Doctors have spoken out and continue to do so. Back in 2016, fifteen health bodies, including seven Royal Colleges, called for rapid phasing out of coal. The Royal College of General Practitioners has just pledged to stop investing in fossil fuels. We have a UK Health Alliance on Climate Change which is doing fantastic work. The NHS Sustainable Development Unit has succeeded in reducing total emissions from the NHS. The Centre for Sustainable Healthcare works to embed true sustainability in the heart of NHS strategy and indeed the NHS is the world leader in reducing emissions, its water impact and waste. On the international stage the Global Climate and Health Alliance (GCHA) along with the Planetary Health Alliance are building a international movement of health professionals to drive action at a global level.

This is all very positive but, as you have read above, it is not enough! We want climate change and biodiversity loss to be amongst the main priorities for all healthcare professionals. Why? Because these are the most important factors that will influence the health and wellbeing of our population and we simply cannot afford to wait any longer.

Remember there is no economy, no health and, in fact, there is nothing on a dead planet.

The rapid transition to a low carbon economy is entirely possible. The technology exits and is proven, the economics make sense to the majority. This is about money, will and power. Currently held by the few, for the few, with little regard for the future.

We must also recognise the disconnect that exists between society and nature. This underpins a lot of the reasons why we find ourselves in this situation. We undervalue it, take it for granted and barely pay its value lip service in our strategies and policies. We need clinicians to publicly recognise the critical importance of a healthy environment. To not be afraid to speak out and to set an example to our communities. We must lobby government for a legal framework that incentivises green and penalises fossil energy sources. Our government needs to become a world leader in adopting a robust ‘polluter pays’ principle. Fossil fuel companies have never paid a penny for treating our shared atmosphere as a rubbish dump. This has been described by the Stern Review on the Economics of Climate Change as “the greatest market failure the world has ever seen”.

So what is the ask of you as a doctor? It is quite simple, be brave enough to challenge yourself and your organisations. Ask yourself is what I am doing part of the solution and, if not, what do I need to do to make it so? Sign up to and support the work of the UK Health Alliance on Climate Change and the Centre for Sustainable Healthcare. What is the worst that can happen if we invest in this work? We create a better future for our families and communities. It doesn’t seem that much of a risk to us.

We want you to listen to that uncomfortable feeling you get when you read about more rainforest being cut down, fracking starting in the UK, emissions rising. Listen to it but remember, thinking alone will not make this right – we need clear, coordinated action. The exciting thing is that together we can start to make a difference.

We are not tree huggers or fanatics. We are doctors, fathers and realists who listen to the science. This is not about saving the planet – it will continue quite happily without us – it is about saving ourselves as a species. Humans are said to have the gift of reason. Will we use it?

Can a whisper become a roar?

Dr James Szymankiewicz
Executive Partner, Combe Coastal Practice, Ilfracombe
Vice Chair North Devon GP Collaborative Board
Chair Devon Local Nature Partnership

Dr Niall Macleod
“Ambassador for Sustainability and Health - SW England”

Dr Simon Jones
GP, Litchdon Medical Centre, Barnstaple
NEW Devon CCG locality board member
STP lead for prevention

Competing interests: No competing interests

08 November 2018
James Szymankiewicz
GP, Ilfracombe, North Devon. Chair Devon Nature Partnership
Dr Simon Jones, GP Barnstaple. Dr Niall Macleod, Ambassador for Sustainability and Health- SW England
Combe Coastal Practice, Ilfracombe