Intended for healthcare professionals

Analysis Health in the Anthropocene

Making healthcare and health systems net zero

BMJ 2020; 368 doi: (Published 30 March 2020) Cite this as: BMJ 2020;368:m970

Read our Health in the Anthropocene collection

  1. David Pencheon, honorary professor of health and sustainable development1,
  2. Jeremy Wight, chair2
  1. 1Medical and Health School, University of Exeter, Exeter, UK
  2. 2Faculty of Public Health Sustainable Development Special Interest Group, London, UK
  1. Correspondence to: D Pencheon d.pencheon{at}

Health systems are large contributors to national carbon footprints. David Pencheon and Jeremy Wight examine what we know about how to reduce emissions

The climate emergency that is a key part of the Anthropocene poses substantial risks (and opportunities) for every sector of society, including health systems and professionals. There are three specific ways in which health systems are important. Firstly, patterns of morbidity are already changing across the planet as extreme weather events become more frequent, more severe, and last longer (heatwaves, floods, storms, wildfires, etc). Secondly, the changing climate is compromising how well health services can cope with and respond to both current and future demands. Thirdly, health services are themselves substantial contributors to the causes of climate change in terms of greenhouse gas emissions and avoidable ecological damage. The Anthropocene therefore affects both health and healthcare systems, but healthcare systems are also one of the causes of the Anthropocene.

This article describes how health systems and professionals can and should respond to the health and wider effects of the climate emergency—in particular, what we already know about the likely routes towards health systems that are net zero carbon.1

Avoiding a health crisis

Words are important. Calling the Anthropocene simply an environmental crisis risks compartmentalising it: the environmental crisis is also a health crisis. Health systems and professionals can respond ambitiously and visibly in three ways. We must prepare for the inevitable adverse health consequences of an overheating world (adaptation); we must seize the additional and immediate health benefits of a systematic and rapid move away from fossil fuel dependency, particularly towards more sustainable food systems, better diets,2 cleaner transport systems, cleaner air,3 and reduced pollution (health co-benefits). And we must make sure that health systems no longer contribute to the problem and become carbon neutral (mitigation).

The first …

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