Intended for healthcare professionals

Editorials Christmas 2018

Medical organisations must divest from fossil fuels

BMJ 2018; 363 doi: (Published 12 December 2018) Cite this as: BMJ 2018;363:k5163
  1. Adam Law, board president1,
  2. Deidre Duff, fossil fuel free health lead2,
  3. Patrick Saunders, visiting professor of public health3,
  4. John Middleton, president4,
  5. David McCoy, professor of global public health5
  1. 1PSE Healthy Energy, Ithaca, NY, USA
  2. 2Medact, London, UK
  3. 3University of Staffordshire, Stoke on Trent, UK
  4. 4Faculty of Public Health, London, UK
  5. 5Queen Mary University, London, UK
  1. Correspondence to: D McCoy d.mccoy{at}

Rapid divestment would break our dangerous dependence on this industry

The UK’s largest medical royal college, the Royal College of General Practitioners, recently committed to fossil fuel divestment. It joins several other healthcare organisations that are divesting, including the American Medical Association, the Royal Australasian College of Physicians, the Canadian Medical Association, the Australian Medical Students’ Association, the UK Faculty of Public Health, and the British Psychological Society.

Evidence that fossil fuels pose serious threats to public and planetary health is overwhelming. The Intergovernmental Panel on Climate Change recently reported that “rapid, far-reaching and unprecedented” action is required to limit global warming to 1.5°C.1 Exceeding this will have catastrophic effects on human health.

The fossil fuel industry has a long record of undermining climate science and continues to spread misinformation and obstruct climate action.23 Fossil fuels are a major contributor to air pollution, killing seven million people every year.4 WHO estimates that air pollution is responsible for one third of deaths from stroke, lung cancer, and heart disease. Extraction techniques—for example, fracking and enhanced oil recovery—are also associated with water pollution, posing additional risks to health.5

Fossil fuel and petrochemical industries are at the root of the plastic crisis. Their business model drives greater volumes of plastic to market.6 Evidence is emerging that microplastics may contribute to conditions such as cancer, cardiovascular disease, obesity, and reproductive and developmental abnormalities.7

The amount of carbon in known fossil fuel reserves is about five times more than we can use if global warming is to be limited to 2°C.8 Despite this, the fossil fuel industry continues to explore for more. This sobering reality sparked the global fossil fuel divestment movement, which has led to institutions managing over $7tn of investments committing to divestment.9

The fossil fuel industry spends large sums donating to and influencing politicians and society leaders, who, in turn, continue to promote the industry.310 The industry requires a level of public acceptance to be allowed to pollute the planet and damage health. Divestment is important because it reduces the industry’s social acceptability and erodes its political power.

The healthcare community played a leading role in the tobacco divestment movement, paving the way for stronger anti-tobacco legislation. Divestment can also be used to enable legislation against fossil fuels10 and accelerate the transition to renewable power. In its 2018 annual report, Shell acknowledged that continued fossil fuel divestment could present a material risk to the company.11 Its chief executive has identified loss of public acceptance as the company’s “biggest challenge.”12

Economic case

Fossil fuel assets are increasingly considered to be overvalued. The governor of the Bank of England has stated that a carbon budget consistent with a 2°C target “would render the vast majority of reserves ‘stranded’—oil, gas and coal that will be literally unburnable.”13 Even in the absence of new climate policies, modelling suggests that some fossil fuel assets will become worthless given the low carbon technological trajectory.14 Estimates of returns on fossil-free investments have performed well or better than those that include fossil fuel investments in recent years. Modelling has also found that fossil fuel divestment in the past would not have impaired portfolio performance over longer periods.1516

Decades of shareholder engagement with fossil fuel companies has failed to shift their core business models from fossil fuels. Their business plans are still aligned with hazardous levels of warming; the charity ShareAction estimates that the core planning scenarios of just two leading companies (BP and Shell) are consistent with 3-5°C of warming.1718

Promoting divestment may be one of the most effective social and political tools to help break our dependence on fossil fuels, control the power of the fossil fuel industry, and weaken its grip on political institutions.

The healthcare community has a professional mandate to protect society from harm to human health. We have a responsibility to help society move away from fossil fuels and accelerate the transition to renewable energy.

United front

Health professionals should urge their professional institutions to divest through direct lobbying or by joining finance committees. We should meet national politicians to emphasise the harms to health from a fossil fuel economy and request support for divestment in pension funds. We should support public demonstrations, encourage our organisations to host events, and urge peers to demand rapid transition to clean energy. If large numbers take a stand, our professional voice will be difficult to ignore. We cannot afford to remain silent when the health of so many is at stake.


  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare that PS is an expert witness for a community group opposing fracking and is the director of an environmental consultancy; DMcC was previously director of Medact. DF works for advocacy organisations Medact and Friends of the Earth, where her work is funded by the Sainsbury charitable trust. All three support fossil fuel divestment.

  • Provenance and peer review: Commissioned; not externally peer reviewed.


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