The BMJ Awards 2020: Outstanding contribution to healthBMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m1613 (Published 23 July 2020) Cite this as: BMJ 2020;370:m1613
David Pencheon, founding director of the Sustainable Development Unit (SDU) for NHS England and Public Health England, is the worthy winner of this year’s BMJ outstanding contribution to health award. He helped set up the SDU in 2007, at a time when few others had the foresight to make sustainability and climate their top priority. Securing the funds to do this from a perennially cash strapped NHS was a remarkable achievement in itself—especially when so few people shared those concerns.
Starting the conversation
The SDU devised a way of measuring the carbon footprint of every aspect of healthcare in England and helped organisations redesign how care is delivered to reduce emissions. He says his greatest achievement during the decade he headed the unit was simply starting the conversation. “Because there was an NHS body dealing with sustainable development, it legitimised it as a mainstream issue.” He is also proud of engaging people in the issue in a friendly and productive way. “We were not jabbing fingers at people,” he says.
Pencheon has been interested in the health of the planet “for as long as I can remember.”
After qualifying as a doctor at Oxford University he went on to the London School of Hygiene and Tropical Medicine and moved into public health medicine. He was joint director of public health in North Cambridgeshire, a public health training director with the NHS Research and Development Programme, and director of the Public Health Observatory in Cambridge from 2001 to 2007.
He describes being appointed as founder director of the SDU as “quite terrifying.” While it is easy to bang against a door and rant and rail about what should be done it is much harder when you are the person on the other side of the door that has carte blanche to actually do things, he says.
When the unit was set up nobody—including him—thought it would have much impact. “Everyone thought it was a tick box exercise. I was quite surprised when it started to get a momentum of its own.”
He is modest and self-effacing about his achievements. “I don’t think it was me; it was timing, luck, and a great small team.” He describes appointing fantastic people who taught him not so much about climate change and sustainable development but about how you effect change in a large system. “What you do to get things done, to change norms, start addressing dogma, and start questioning assumptions.”
Pencheon thinks that the net zero target for the NHS, set by Simon Stevens, is pretty ambitious. “Changing the habits of large institutions is not easy,” he points out. But he believes it is vital that healthcare gets its own house in order. “One in 20 vehicles on the roads are on NHS business and the health sector is the biggest buyer of food or energy. If we work together we could have a big effect.”
He adds: “Health professionals are still very well trusted. So the ability of the NHS to normalise climate change and sustainable development as a health issue—not just an environmental issue—is incredibly important.” There are numerous examples of good practice across the health service, but it is not being done systematically and it is not being done at the scale and pace you would wish, considering the evidence of the potential nightmare we are sleepwalking into, he adds.
Pencheon left the SDU on 1 January 2018 thinking it was time for fresh blood to take over. “I wouldn’t have left if I didn’t feel it would continue and was in good hands,” he says. He also wanted time to reflect on what he had learnt over the 10 years and help other countries avoid going down blind alleys.
He is an honorary professor at the Medical and Health School at the University of Exeter, which allows him to contribute to research and teaching. Officially retired, he describes a lot of what he does now as brokering—putting the right people in contact with each other.
Pencheon is extremely well respected and has inspired and encouraged the next generation of doctors working in the field of sustainability. Nicolas Watts, executive director of the Lancet Countdown, says: “He works quietly and leads from behind, driving pivotal decisions, supporting us when we feel isolated or lost, and ensuring the pace of our response matches the scale of the challenge. He has worked selflessly, tirelessly, and with boundless energy for a better future.”
Isobel Braithwaite, public health registrar and former national coordinator of Healthy Planet, says: “David Pencheon has had a profound impact in shaping healthcare’s response to the climate crisis, not only in the UK but also internationally. He has also been immensely influential in inspiring many early-career health professionals, myself included, to work on the crucial challenges he has helped to draw attention to over so many years.”
And Caroline Jessel, a general practitioner and sustainability leader, says: “I can honestly say that David Pencheon made more impact on my sense of priorities than any other leader. I first heard him speak at a medical event in 2004, and I realised immediately that I must learn far more about the environment and health in order to help far more patients than I ever could in my surgery.”
Pencheon lives in Dorset and enjoys getting involved in local sustainability initiatives. He also enjoys walking, often with his friend Richard Smith, chair of the UK Health Alliance on Climate Change, who recalls: “After years of knowing him I still think of what he told me the first time I met him. He described how when teaching medical students he would ask increasingly difficult questions until one of them said ‘I don’t know.’ He would then give that student a Smartie and say, ‘Those are the three most important words in education.’”
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