Dr George Crisp lays out the case for the role of doctors in the climate change debate.
A few years ago, American doctors were warned to “stay in their lane” by the politically powerful National Rifle Association when it spoke about gun-related deaths and injuries. Their swift response was “this is our lane”.
There is no longer any doubt that climate change is one of the most serious and urgent health challenges we face – both in how it will affect our lives and practice as doctors, and in how we respond in preventing and managing those growing impacts.
The UN observed that health impacts were “unequivocal” in 2018, and a succession of peak health agencies around the world, including our AMA, have declared climate change a health emergency.
An editorial published in 200 health journals called on governments to take emergency action to tackle the “catastrophic harm to health” from climate change in the lead up to COP 26, where health is now a central theme.
Heat exposure has been implicated in as many as 2% of deaths in Australia; air pollution from the recent bushfires resulted in 417 deaths and over 3000 hospital admissions; and the 2011 Queensland floods resulted in mental health costs estimated to amount to $5.9 billion.
We have passed a one degree celsius increase in average global surface temperature and on our current trajectory are headed for 2-3 degrees.
The direct effects from more intense and prolonged extreme weather events and higher temperatures are relatively easy to envisage, while the indirect effects that arise through compromise of ecological and human systems and disruption of the global hydrological cycle are generally not.
The consequences of “business as usual” include failure of critical infrastructure, spread of infectious diseases and escalating freshwater and food insecurity, and the projected displacement of many millions of people over coming decades.
Furthermore, there are tipping points within the climate system – temperature thresholds where positive feedback loops can be triggered resulting in self-sustaining acceleration of warming.
To have a good chance of preventing a 1.5C increase in global temperature, we need to reduce emissions by about 7.5% every year from now.
Quite simply, if we are to maintain anything like our current health outcomes, we must immediately start phasing out fossil fuels that account for three-quarters of our greenhouse gas emissions.
This is not politics but scientific fact.
In addition to greenhouse emissions, coal, oil and gas-related pollution is causing untold health damage around the world.
An estimated 8 million people die annually from air pollution from burning fossil fuels and there are many other toxic chemicals such as polyaromatic hydrocarbons and heavy metals released into the environment from their extraction and use, with long lasting health implications.
As highlighted in Lancet Countdown 2015 – many of the actions we can employ to mitigate climate change, such as renewable energy with electrification of heat and transport, more sustainable food systems and greener cities, have significant health and economic co-benefits.
If viewed through the prism of health, acting on climate change becomes an opportunity to maintain and improve our health.
That is why we, as doctors, are central to action on climate change.
As with other major public health matters, to be effective and credible we need to understand the underlying scientific rationale. We must upskill and incorporate climate change and effects of pollution into medical school and college curricula.
Our health services produce around 7% of national emissions, and therefore contribute considerably to ill health. We have the same role and responsibility in making them healthier and safer by phasing out fossil fuels in healthcare as we did with tobacco.
We can choose socially responsible investments. It makes no sense to work to promote health every day and put out money into schemes that undermine it. We can ‘divest’ or pressure our superannuation funds and banks to offer healthier investment options.
Understanding vulnerability in our patients and healthcare infrastructure to heat and other extreme events will be increasingly needed across healthcare facilities, from small practices to tertiary hospitals to prevent avoidable illness and interruption of service delivery.
And, perhaps even more importantly, we should be speaking out in public and to decision-makers about the necessity for urgent adaptation in healthcare and essential services, about mitigation to prevent increasingly unmanageable harm and suffering, and about the health benefits that come from reducing pollution, and more sustainable diets and active lifestyles.
That is why climate change is absolutely ‘our lane’.