The greatest global health threat of the 21st century is climate change (1). In the last two years we have seen all of the major Australian medical colleges, along with the Australian Medical Association, declare climate change a health emergency. I was lucky enough to be present when my College, the Australasian College for Emergency Medicine, publicly declared a Climate Emergency at the 2019 Hobart ASM – and I have never felt so hopeful that the health community can come together to combat climate change as I do today.
Climate change, and the inextricable intersection with health, is a critical issue for junior doctors – you will increasingly be seeing the health effects of climate change in daily practice, whatever your specialty. This reality of climate change was seen recently in the devastating effects of extreme heatwaves and bushfires of 2019-20 on patients, communities and health care systems (2). In addition, the co-benefits of climate action for health are myriad, with climate action initiatives leading to better outcomes in mental health, cardiovascular and respiratory disease, and lower rates of cancer and obesity (3).
We know that we have less than 10 years to limit the warming of the planet to 1.5C, and we can see the impact of climate change already in the recent catastrophic bushfires in Australia and the US, droughts, the ‘freeze’ occurring across the US, the loss of polar ice, and increased cyclone and hurricane activity across the globe. Currently, civilisation is on track for a 3.2C temperature rise, which will lead to planetary climate conditions that are incompatible with inhabitation (1,4). If we are to meet the 1.5C target as stipulated by the Paris Climate Agreement, carbon emissions must be reduced by 7.6% every year from 2020 to 2030 (4,5).
All of this shows us that climate change is a desperate and time critical emergency for the health community, and that this is firmly ‘our lane’. By far the most important thing for you to realise is that there is still hope that we can do what needs to be done, and even more than this, that you have a vital role to play in turning things around for humanity.
A good starting point for climate action is to make sure that you are well informed on climate science and health impacts, so that you can educate those around you. Make decisions in your own life that reflect your appreciation for the seriousness of climate change, and the knowledge that you can play a part in fixing the problem. You don’t need to go as far as buying an electric car, but your actions need to go further than just using a Keep Cup. Appreciate that as medical professionals in a wealthy country we are part of a society that contributes more to global emissions than do the countries that will suffer disproportionately more from climate change, and that we have a social responsibility to act to address this inequity. Analyse your own carbon footprint, and act to combat the effects of your daily lifestyle – apps such as Climate Clever will assist you to do this (6). Have a realistic look at the waste that you generate on a daily basis – use reusable containers, straws, and cups. Endeavour to buy food that has less packaging – or even better no packaging. Evaluate your mode of transportation – do you really need to drive to work? Explore other options such as cycling or walking, or public transport. If you are in a position to do it, then explore more costly ways to reduce your environmental impact, such as installing solar panels or buying an electric car – but do not be distressed if this is beyond your financial abilities at present, do what you can within your limits. We should all be endeavouring to live a carbon-neutral life as much as possible – but just doing this yourself is not enough, you need to look at how you can have a broader impact (7).
The healthcare sector in Australia is responsible for 7% of carbon emissions , so it is vital to look at what we as the medical community are doing to address the issues in our own backyard, and to work with governments to develop carbon-neutral plans for our health care systems (8). Combating the carbon footprint of a health system includes addressing obvious factors such as waste, medical gases and energy usage but also less appreciable factors such as the medical supply chains and food and catering.
There are many opportunities for junior doctors to be involved in promoting better sustainability practices in their hospitals and health care settings. The NHS – and its aim of producing a net zero national health service – is a great example to reference for evidence that sustainability in healthcare is achievable (9). The Global Green and Healthy Hospital network is a network of hospitals and health care systems that are committed to ‘using innovation, ingenuity, and investment to transform the health sector and foster a healthy future for people and the planet’ (10). Is your hospital on this list? If they are, get involved with the actions that are driving them towards sustainability. If not, now is the perfect time to look at what you can do, and who you need to engage at your hospital to get things moving.
Do not underestimate the difference that you can make at a local practice or hospital level on health care emissions. Broadly, an 80% reduction in the healthcare sector’s emission from 2014/2015 is needed to protect health, and limit global temperature rises beyond 1.5C (11). To achieve this it is generally assumed that the creation of a national Sustainable Health Care Unit will be required to coordinate initiatives, drive innovation and enable dissemination of information and collaboration Australia wide (12). This does not mean that you cannot drive action locally, and at the very least, each hospital or private practice should have a Sustainability Officer to guide greening practices. I suggest you find out who yours is, or if you do not have one at your institution, contact the stakeholders to encourage creating such a position. Even at a departmental level, it is possible to influence practices. In the emergency department in which I work we now have bins to recycle PVC tubing, and are currently conducting an audit of all equipment that is used in emergency department to enable better purchasing decisions (i.e. avoiding items that create unnecessary waste, and exploring reusable items where clinically appropriate).
Finally, the power of the voices of medical professionals, and especially young doctors, in public advocacy cannot be underestimated. This can include joining organisations active in the climate advocacy space, taking writing and speaking opportunities, or lobbying politicians. Youth, combined with the perception of legitimacy that comes with a medical degree can be especially effective in persuading those in positions of power. Speaking up with your own powerful stories can be the most effective way to combat climate change (13). This does not necessarily mean taking your voice to the United Nations, or the parliamentary floor. I recently spoke for to a classroom full of 6 year olds about the personal changes our family had made, and what we were doing in our hospital to combat climate change, and the positive feedback I received from the students, and the school community, was immense and reverberating. There are many organisations that you can join if you want to elevate your voice – Doctors For The Environment and the Climate and Health Alliance are examples of organisations that will give you valuable opportunities to influence policy, undertake training in advocacy, media and lobbying, and meet with government officials and policy makers from local through to federal levels. The reach of your voice and your ability to influence change through climate action is immense if you have the will to do it.
The science is indisputable, and we know that climate change and health are inextricably linked. There is no question that this is your lane – and your time to act is now. Doctors hold a uniquely trusted position in society (14) and a powerful voice in advocacy that has only been amplified by the COVID-19 pandemic. Young doctors are perceived as being particularly legitimate in climate action advocacy, because it is your futures, more than that of established physicians, that is at stake. You have substantial power to create change – go out and do it.
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