Intended for healthcare professionals

Fiona Godlee's carbon blog

Carbon blog
9 June 2006

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Fiona Godlee: Confessions of a climate criminal

Ian Roberts got us into this. Ian’s a professor of epidemiology and public health at the London School of Hygiene and Tropical Medicine and has pulled the BMJ into campaigns before – to get unpublished trials published, to stop the use of albumin in critically ill patients, to highlight the international carnage from road traffic crashes. But these all pale into insignificance beside what he sees as the biggest of all challenges to human health, climate change. He thinks doctors, and the BMJ, must take a lead. I agree.

Not that climate change is news to BMJ’s readers. The journal has covered it for as long as it’s been an issue. In 1991, Richard Smith suggested a series on Health and the Environment, which Alison Walker and I co-wrote. The following year we covered the Earth Summit in Rio. Enter “climate change” into the search box on and you’ll find a stream of articles published since 1994 (where starts its archive) – news, editorials, research, analysis, letters, commentaries.

But sometimes it has felt as though we and our contributors were whistling in the wind. Almost exactly 10 years ago in July 1996 I wrote in an editorial, “Global warming can no longer be dismissed as a catastrophe theory dreamt up by scaremongers. In the past few months two reports from internationally renowned organisations have offered grave warnings of the threat that climate change poses, within current lifetimes, to humans and ecosystems 1 2; and last week, in the face of frantic lobbying from the fossil fuel industry, 134 nations, including the United States, agreed to work towards ‘quantified legally binding’ cuts in emissions of the main greenhouse gas, carbon dioxide. What is surprising is how little these concerns have impinged on the media and on our daily lives.” (BMJ 1996;313:184).

Have things changed since then? In some respects I think they have, especially in the past six months. Climate concern is suddenly mainstream. You can’t turn on the television without hearing David Attenborough describing in urgent tones the impact of climate change on the planet. The BBC is running a series on the five disasters waiting to happen. The leader of the UK’s conservative party, David Cameron, has been to the Antarctic to witness the ice caps melt. He’s taken up conspicuous cycling around London and promises to raise public funds through tough environmental levies. The UK’s other two main parties are dusting off their environmental credentials ready for the next election. Al Gore is taking the message to Americans – perhaps the people who most need to hear it – and is breaking the box office with his film, An Inconvenient Truth (BMJ 2006;332:1397). China is building sustainable cities. The publisher Blackwell has said it has become carbon neutral ( And the MD of the pharmaceutical company Johnson and Johnson tells me that being environmentally sustainable is something they now take for granted.

There will be those who say it's all rubbish, that CO2 emissions are only exaccerbating a natural cyclical warming trend and that another ice age is on the way. But I'm not convinced that means we should do nothing. Apart from anything, there are the health benefits and financial savings of using less carbon. Over lunch around the corner from the BMJ’s offices, Ian Roberts manages to make me feel desperate about how little we are actually doing, as individuals and collectively. He tells me that reading Mayer Hillman’s book, How we can save the planet has changed his life (BMJ 2006;332:1398-a). Hearing him talk about it gives me an uncomfortable feeling that I may have to change mine.

Stalling for time, I make a plan. We have an article from Robin Stott about carbon rationing that’s about to go in the journal (BMJ 2006;332:1385). We’ll build other content around it and devote the next editorial team brainstorm to thinking about how we can raise our game on climate change. We’ll invite Ian and Mayer Hillman and see where we go from there.

Mayer arrives by taxi. His bike had a puncture and he had to abandon it somewhere in north London. The taxi ride has put up his week’s carbon emissions so he’s not pleased.

But he holds us spellbound for 20 minutes. This is a defining moment in history, he says. Carbon emissions have gone way beyond what we know the planet can support. The target of reduction of 60% by 2050 is far too little far too late. By then levels of atmospheric carbon dioxide will have reached 550 ppm. Like Robin Stott  (BMJ 2006;332:1385), Mayer believes that “contraction and convergence” is the only solution: contraction of the overall amount of green house gas production, and convergence so that energy consumption is shared equally across the world’s population. This means we need to get down to an average of one tonne of carbon emissions per person globally, against a current average in the UK of 10 tonnes per person and in the US of 20 tonnes. The only way to achieve this is, he says, through government intervention. Carbon rationing is equivalent to food rationing in times of war, but this is far more serious than war, he says. The consensus from climate scientists is clear that even if we act now, life on earth can be maintained only for a few hundred years.

Mayer is scathing about the hypocrisy of the media and of government. The Independent newspaper carries dramatic front page headlines about the threat of climate change, and then runs its travel section laden with adverts for cheap flights. Governments around the world say we need environmentally friendly policies but are expanding road and rail infrastructure and continuing to push for economic growth. He lists four common fallacies: that economic growth can be maintained indefinitely; that there are technological solutions to climate change; that “every little bit helps”; and that we can rely on voluntary action to save the planet. He worries that focusing on individual voluntary action makes people feel better without making any real difference and stops them putting pressure on governments to act.

Anna Coote has joined the brainstorm too. She’s commissioner for health at the UK’s Sustainable Development Commission ( and agrees to write us an editorial (BMJ 2006;332:1343) to go with Robin Stott’s article. She talks about the power of the health sector to impact on CO2 emissions through its policies on waste management, transport, and building design and construction. “Hospitals are being thrown up across the UK as icons to the heroic rescue approach to medicine, giving the signal that everything is alright with the world,” she says. But they are not designed with any concessions to the environment. And as health care moves out of hospital into the community, they will soon become white elephants with huge ongoing impact on the health if individuals, populations, and the planet.

Anna disagrees with Mayer on one point. She thinks it’s worth encouraging individual action. She says we should be charitable to other people’s efforts, otherwise there’s a sense that whatever people do is not enough. She wants us to focus on what can be done, and to encourage people to be good corporate citizens.

Mayer obviously believes that there is some use in focusing on one’s individual carbon emissions, because the commentary he writes for us (BMJ 2006;332:1387) carries a simple questionnaire that allows you to calculate your own carbon footprint. He’s got his own footprint down to around three tonnes a year. He won’t fly, even to his son’s wedding this month. It’s about setting an example. It’s about integrity.

I fill in his questionnaire over supper with Zach. There are only 10 questions and they’re straightforward, asking for estimates of your annual heating and electricity costs and your mileage by car, bus, train, and plane. I can make a good stab at the mileage questions, but the household fuel consumption is harder as we’re borrowing my parents’ boathouse while the house we’ve just bought is renovated. I threw away the bills from our old house a few weeks ago in a glorious purge of paperwork. So I call my brother – newly environmentally aware since deciding he wants to buy a windmill on the North Norfolk coast, which is highly vulnerable to rising sea levels. First he wants to know whether you can recycle cling film. Zach (the family’s recycling guru) doesn’t know. “Hopeless,” says my brother.

Using his bills we calculate his household energy consumption and then halve it because his house is bigger than mine and he has a swimming pool. This comes to three tonnes of carbon a year. Add in the train commute from Cambridge to London and other personal travel and my annual tonnage comes out at 14.6. Aaagh. Even with his two sports utility vehicles, my brother’s is less at 12.8. “Yah boo sucks,” he says. “Goodbye.” So I look up the actual mileage from Cambridge to London. It’s 60 miles not 100. My tonnage comes down to 10.5. I call back and leave a message “Yah boo sucks to you.” Who said competition between siblings is a bad thing?

But 10.5 is not good. According to Mayer Hillman, it’s double the UK average for personal use. And if you add in my travel by train and plane for work (22 tonnes), my tonnage is 32.5. Other people on the BMJ are calculating their footprints. There’ll be a prize for the lowest, and for the most improved at the end of the year.

By the end of the brainstorm meeting we’ve decided we won’t run a theme issue because this implies that climate change is something to tick off and shelve and feel that we’ve done our bit for a while. Instead we commission some pieces to join Robin Stott’s article and publish them on June 10, in time for the Medact meeting on 17 June ( And we agree to recruit a Carbon Council, an international group to advise the BMJ on what we should do as a journal and as a business. (If you want to apply to join the council, e mail editor{at} and put “Carbon Council” in the subject line). The council can also judge the prizes we’ve just announced for the BMJ subscriber with the lowest personal carbon footprint and for the primary and secondary care providers with the lowest carbon emissions per patient. Even as I announce this in Editor’s Choice I know this isn’t going to be straightforward. How will we verify people’s emissions? And how will we factor in quality of care? It’s easy enough to have low emissions per patient if you do almost nothing for them. Hey ho.

As for me, I’m working with our publishing group executive to develop a sustainability strategy for the BMJ, and I’m putting climate change on the agenda for the next International Committee of Medical Journal Editors meeting because we’ve got to get the Americans on board somehow. I didn’t fly to Edinburgh on Tuesday; I took the train. And I’ve resolved to sell the car. Well, one of them at least.

Fiona Godlee
Editor, BMJ