Intended for healthcare professionals


Balancing climate anxiety with hope: learning from collective climate activism

BMJ 2023; 383 doi: (Published 06 October 2023) Cite this as: BMJ 2023;383:p2316
  1. Richard Antony Powell12,
  2. Mala Rao12
  1. 1Ethnicity and Health Unit, NIHR Applied Research Collaboration Northwest London, London, England
  2. 2Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, England

Bold, transformative governmental actions must supplement individual and collective activism and courage, argue Richard Powell and Mala Rao

The climate emergency continues to progress with relentless severity.1 Every day brings news of further environmental disasters, with the most economically and geographically vulnerable countries bearing the heaviest toll. The rapidity with which global warming is translating into climate extremes, and the scale of environmental disasters,2 surpass early scientific predictions, compelling experts to warn that climatic breakdown may be inevitable. Scientists now predict the 1.5C threshold will be breached by 2027.

While advances in attribution science have rapidly improved the accuracy of estimates of the impact that the climate emergency has on physical health, the mental health impacts of the climate emergency have received comparatively less attention.3 Climate emergency-related events—from flooding and wildfires, to drought and resulting food insecurity—are associated with a wide spectrum of mental health impacts, including post-traumatic stress disorder, depression, anxiety, extreme psychological stress and distress, substance use, and suicidality.4

As the climate emergency accelerates, and to avoid a paralysing downward spiral of despair, it is critical that legitimate concerns over environmental calamity are balanced with the hope necessary to manage and overcome its challenges. Indeed, while hopelessness, despair, and powerlessness are associated with poor mental health and wellbeing, hope and meaningfulness appear protective to wellbeing, enabling psychological and emotional responses to the climate emergency to be transformed into action. In this respect, climate psychologists highlight the positive role played by “practical anxiety,” an emotion and adaptive coping strategy that engenders information-seeking and problem-solving and “leads people to re-evaluate the situation and to make changes in individual and collective behaviour,” according to Panu and colleagues.5

Three quarters of adults in Great Britain are worried about the climate emergency and say that they are more likely to act in response.6 Indeed, practical climate anxiety is increasingly driving protest activism of the direct and disruptive kind. Protesters sitting on public highways, glueing themselves to roads, and throwing paint over works of art in public galleries, have become common sights. These actions can draw public attention to the climate emergency, and offer like-minded individuals the energy, agency, and social connectedness to focus on climate goals and reduce what has been called the “burden of knowing.”7

The history of environmental activism illustrates that much is owed to Indigenous peoples, especially women, for paving the way to eco-protests of recent times. An early record of conservationism is from 1730, when 363 women of the Bishnoi community in India sacrificed their lives in defence of trees in their village earmarked for felling for the construction of the local king’s palace.8 Their courage resulted in the tree cutting being permanently banned by the king. Two hundred years later, the Bishnoi inspired tribal women in northern India to adopt similar tactics—tree hugging and refusing to move—to combat the threat of deforestation. Now popularised under the title of the Chipko movement (meaning to hug or embrace in Hindi), this strategy has attracted international attention, shaped protests against environmental exploitation worldwide,9 and publicised the interdependence between humans and the natural world to a global audience. While such activism may have significant effects, it is not without risks, including threats to individual physical wellbeing and damage to professional reputations and career prospects.

The alternative form of protest activism entails the non-violent, non-cooperative model, which rests on mass change in personal behaviour and lifestyles. It carries little risk of censure, but has the potential to be as impactful by influencing other people’s behaviours. The desirable changes may include stopping flying, driving less, eating less meat and dairy, disinvesting from fossil fuels, cutting general consumption and waste, and reducing energy use and bills.10 School Strike for Climate, also known as Fridays for Future11 has firmly placed youth at the forefront of climate-related campaigns and demand for greater political action worldwide. Launched by Greta Thunberg in 2018, it builds on earlier school climate strikes in countries such as the UK and Australia, and generations of activism from the global South, which is home to 90 percent of the world’s youth12 and where protests against political oppression and socioeconomic upheavals of past decades have given way to demands for nature conservation. This model of activism, which encompasses shared learning and behaviour change is augmented by digital technology with the power to connect individuals, communities, and civil society organisations into a global alliance. It also demonstrates the kind of mobilised power necessary to initiate a transformational shift from growth economies based around unfettered consumerism, to alternative systems that balance essential human needs and planetary boundaries.13 It carries fewer penalties for the individual, but has the potential to compel mass social change.

Institutional activism is also a growing phenomenon. In the UK, several non-governmental organisations, Wildlife Trusts, the Royal Society for the Protection of Birds, and the National Trust, mounted a fierce backlash against the government’s proposals to proceed conditionally with fracking.14 Such challenges to negative government actions are likely to make people hopeful and give them greater agency and empowerment to work with these organisations in shaping the climate response. These actions can also take their inspiration from notable achievements in the global South aimed at mobilising mass action for a common environmental cause. One example is the Green Belt Movement (GBM) founded in Kenya by Wangarĩ Maathai in 1977, in response to rural women who reported environmental degradation, deforestation, and food insecurity.15 Realising these hardships were underpinned by the wider issues of disempowerment and disenfranchisement and a loss of the traditional values on nature conservation, she launched the movement which has since enabled the planting of millions of trees and enhanced the agency of the poor to change their socio-economic, political, and environmental circumstances.16 A movement which has grown into an institution, the GBM has become an influential voice for building community resilience and hopefulness through effective policies for protecting forests and ecosystems across sub-Saharan Africa.

Health professionals, too, are recognising their crucial role in supporting their patients and the public to address their despair about the climate. Unsurprisingly, it is mental health professionals in some of the most climate vulnerable countries who are leading the way. In the Philippines, for example, mental health professionals are developing training and education, capacity building strategies and plans for systemic change to adequately tackle the mental health needs resulting from the climate emergency.17 Bangladesh, too, is an exemplar, having developed its national Crisis Preparedness and Management for Mental Health plan to build resilience in its population and ecosystems.1819 The UK is arguably also a leader in this regard, with the NHS becoming the first national health system to embed net zero into legislation.20 However, it could do much more to lower its carbon footprint and optimise resource use by learning from and adopting innovations from lower resource settings. Examples range from standardised high volume high efficiency processes for a spectrum of routine healthcare interventions21 to lower cost equipment, such as replacing commercial mesh with mosquito net mesh for inguinal hernia repair.22

Such individual and collective effort must be matched by equally enlightened governmental and organisational commitments to decouple economic wellbeing with rising emissions, sharing hard truths with the public about how climate mitigation and adaptation are to be achieved, encouraging and supporting households to become active agents of decarbonisation,23 and leading decisive action at the national and global levels.

The climate emergency is an existential global threat that demands a global understanding of its impact and sharing adaptive lessons. Balancing hope for the future with the legitimate anxieties generated by devastating climatic changes is imperative. COP27 has alerted the world more starkly than ever that the need for equitable action on the climate emergency has never been greater.24 It is within this context that bold, transformative governmental actions must supplement individual and collective courage and activism, forging a future that is hopeful not pessimistic.


  • Competing interests: None

  • Provenance and peer review: commissioned, not externally peer reviewed.