Intended for healthcare professionals


Mobilising hope to overcome climate despair

BMJ 2022; 379 doi: (Published 12 October 2022) Cite this as: BMJ 2022;379:o2411

Read our special issue on the climate emergency

  1. Howard Frumkin, professor emeritus1,
  2. Sophie Cook, editor in chief2,
  3. Juliet Dobson, managing editor3,
  4. Kamran Abbasi, editor in chief3
  1. 1School of Public Health, University of Washington, Seattle, WA, USA
  2. 2BMJ Medicine, London, UK
  3. 3The BMJ, London, UK
  1. Correspondence to: H Frumkin frumkin{at}

Hope is prerequisite to achieving change

It is impossible to ignore the damage humans have inflicted on our planet. 2022 brought new record temperatures, floods, storms, wildfires, and droughts across the world.1 These events threaten the health of humans, wildlife, and habitats and are wreaking permanent and irreversible destruction on earth systems.2

The effects of climate change on human physical health are well established. They include traumatic injuries, respiratory and cardiovascular diseases, infectious diseases, and hunger and emerge through diverse pathways.3 But evidence is growing that the climate crisis threatens mental health and wellbeing as well.45 This is exacerbated by an increase in highly visible, extreme, prolonged, and frequent climate related events. On a global scale, and across age groups—with perhaps a heightened effect on young people—climate change increases the risk of post-traumatic stress disorder, anxiety, depression, and suicide.67 Climate effects that may not seem directly health related, such as crop failure, loss of livelihood, and displacement, also undermine mental wellbeing. Degradation of living and working environments, forced migration, and displacement all disrupt communities and cause long term psychological distress.8 Disadvantaged communities are more affected by the negative mental health effects of climate events.5

Growing media and social media coverage of the situation, including a growing genre of “doomer” literature, promotes a sense of despair, hopelessness, and sealed fate. Government inaction adds to this loss of hope, especially when governments make decisions that are detrimental to the climate in the face of strong evidence of harm.

Younger people are prone to climate related negative mental health because of their increased awareness of the climate emergency and a lack of support to help manage their concerns.9 The climate crisis is already playing into the life decisions of young people, some of whom are opting out of higher education or choosing not to have children.10 In an international survey of 10 000 16-25 year olds across 10 nations, 75% agreed with the statement that the future is frightening, 56% agreed that humanity is doomed, and 68% reported sadness, feeling afraid, anxious, and powerless.11 In England, 57% of a sample of child and adolescent psychiatrists reported seeing children and young people who are distressed about the climate crisis and the state of the environment, and 47% of participants aged 18-34 in an American Psychological Society survey of 2017 adults in 2020 reported that the stress they feel about climate change affects their daily lives.1213

These feelings of distress go by many names: eco-distress, eco-anxiety, climate anxiety, pre-traumatic stress syndrome. There is not yet a formal diagnosis, but what is clear is that these feelings are widespread and that doctors will need to develop strategies to support patients who present with these symptoms.

Power of hope

While hope may seem quite abstract, there is longstanding evidence that it is an important tool to protect wellbeing and foster activism in the face of adversity.1415 Hopelessness, on the other hand, is associated with withdrawal, disengagement, and a sense of passive acceptance of the here and now. Evidence shows that hopeful people are happier than hopeless people.16 Hope doesn’t close any doors and leaves the future open to possibilities. In the context of the climate crisis, a hopeless outlook sees a foregone conclusion, whereas a hopeful one can foster change and action.1718 As understandable as hopelessness is given the state of our world, hope offers a route to changing our future.

Hope is also different from optimism. Optimism is a certainty that things will turn out well; this may lead to complacency and failure to take appropriate action to ensure a desired outcome.19 Hope, on the other hand, is more action focused. Hope inspires people to make plans to reach their intended target. This is valuable in a clinical context, and hope can be used as a therapeutic tool with clinical benefits.19

We should take inspiration from young activists who are harnessing hope to drive positive change.20 There is precedent in history with the success of civil society movements advocating for change on health concerns. In the 1980s, AIDS advocacy groups were crucial in raising awareness, pushing for change, and challenging attitudes.21 What these movements show us is that hope is a powerful driver to achieve change. We must remember that grassroots movements have a vital role in influencing government actions as the 2022 UN climate change conference (COP27) approaches.

Finally, hope is an act of defiance. It suggests resilience, power, and a will to change. In the face of government and corporate inaction to mitigate the climate crisis, when many governments across the world are acting in ways that worsen the climate crisis, maintaining hope suggests an alternative future and a drive to overcome opposition. Hope will not solve the deep seated problems or realities that humans face. But hope, individual and collective, for young and old, is an indispensable asset in tackling the climate crisis.


  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare HF is a member of advisory boards (or equivalent committees) for the Planetary Health Alliance, the Harvard Center for Climate, Health, and the Global Environment, the Medical Society Consortium on Climate Change and Health, the Global Consortium on Climate and Health Education, the Yale Center on Climate Change and Health, and the European Centre for Environment & Human Health at the University of Exeter—all unfunded positions. He is employed by Trust for Public Land, an environmental NGO which has action on climate change as one of its strategic priorities. JD is on the executive of the UK Health Alliance for Climate Change.

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