First, do no harm
Why healthcare professionals must step up and take responsibility for the climate disaster
It’s hard to think of a profession that carries a heavier burden of responsibility than that of the healthcare provider. Life and death decisions are often made with little information and limited time, and although harm is never intended in the action of saving life, the means of doing so can be bitter and painful—medicines have side-effects and surgery hurts. Whilst we often think of harm as applying to individuals, thinking of it in this way can mean we fail to recognise the broader fallout of therapies. Increasingly though, discussions are emerging from climate and health communities that expand on this patient-provider understanding of harm reduction in healthcare to ensure the most vulnerable members of our global community are not exponentially affected.
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Whilst much is made of the economic cost of providing care, less is made of the broader ill-effects of the industry on the environment. However, we know that healthcare is estimated to contribute at least 4.4% of net global emissions. Focusing on the goal of reaching net-zero emissions globally, the member parties of COP26 have chosen health as a science priority with two key objectives: to build climate-resilient health systems, and to develop carbon-sustainable ways of working. The prioritisation of health systems is essential both for its imperative role in responding to the climate crisis, and because politicians and policy-makers have failed to recognise the urgency of this relationship. A 2021 World Health Organization (WHO) survey found that fewer than one in five countries have conducted an evaluation of the health benefits of national climate mitigation policies. Healthcare providers everywhere should be involved in these climate decisions—especially those who work and live in communities at the most immediate risk.
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To achieve the specified climate goals, health professionals need to understand the vulnerabilities of their countries and be empowered in reducing the environmental impact of their activities through mitigation and adaptation. The WHO estimates that air pollution kills approximately 7 million people worldwide every year. No nation is immune to the negative consequences of the climate crisis—99% of people globally breathe air that exceeds WHO guideline limits. As the climate crisis is now a reality, and no longer simply a worst case scenario to be avoided, mitigation (referring to actions aimed at preventing and minimising climate destruction) and adaptation (adjusting to a world already impacted) are complementary and mutually important.
“Air pollution kills approximately 7 million people worldwide every year.”
The reciprocal relationship between health and the climate crisis can be described as one of negative feedback, in which healthcare harms the environment, and consequences of the climate crisis detrimentally impact health. At present, healthcare providers inadvertently contribute to the negative environmental health consequences that they are on the frontlines of treating. With potential for this relationship to worsen, it is important to acknowledge the agency of health professionals and promote their power in contributing to a more symbiotic cycle. A concerted effort needs to be made to educate and train care providers to competently engage and lead in climate action within their own communities around the globe; after all, they have the advantage of being trusted local voices. These efforts will look different across the world as individual countries face unique challenges with varying access to resources. There is no one-size-fits-all approach, but countries who contribute the most to global healthcare emissions—for example, the United States—should be aware of their contributions and be proactive in their interventions.
Whilst it’s easy to rattle off statistics about toxic chemicals, supply chain demands, and waste management, health providers are not always able to prioritise this knowledge when working on the front lines. Immediate patient safety is always the highest priority and as a result climate-consciousness goes by the wayside. Health systems have successfully implemented policies and procedures to eliminate provider choice in certain elements of care to reduce patient harm; why not do the same with waste to mitigate environmental harm? Healthcare providers are capable of addressing these challenges through on-the-ground entrepreneurship—although providing frameworks for doing so can help to stimulate change and foster responsibility.
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There have been several excellent frameworks proposed in training physicians on the health impacts of the climate crisis. However, many of these are based on western requirements: they focus relatively narrowly on the clinical practice aspect of professionals’ engagement with the climate crisis, instead of on activism for instance. As realities on the ground vary across countries, it is critical to develop global climate training frameworks that broadly organise competencies for healthcare professionals without being too prescriptive in nature.
In addition, western-centred views inherent in these frameworks can be amplified and reproduced unintentionally, so caution is required when applying them in different settings. Some of the key competencies that healthcare providers—both practicing and in-training—could be taught related to climate-health intersection include: climate-informed clinical practice; climate advocacy; climate communications; and climate leadership training.
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Moreover, depending on the geographical context of a community’s needs, priorities, and concerns, there are some key areas of climate action that health professionals on the ground can immediately start exploring, including: healthcare waste reduction through climate-informed guidance at the organisational and national level; energy use reduction; and engaging the non-clinical stakeholders within the healthcare ecosystem to reduce or eliminate climate emissions from supply chains. Further, many current health systems lack both effective recycling programs and staff education on the importance and procedure of proper waste disposal—both areas of great potential for improvement.
“Healthcare professionals in countries with lower incomes will have a key role to play in future climate action.”
Traditionally, healthcare has focused on direct health outcomes and financial cost as markers of success and efficiency. It is time to consider environmental cost-effectiveness as equally, if not more, important than financial cost-effectiveness. Given the increasing number of deaths associated with air pollution, the climate crisis places a burden on healthcare systems that is too high to manage effectively. This burden has been exacerbated by the COVID-19 pandemic and increasing respiratory related admissions, meaning hospitals globally have been stretched dangerously thin. The incentives for restructuring climate-conscious health systems are abundant and health professionals must continue to be at the forefront of policy design and implementation. Healthcare professionals in countries with lower incomes will have a key role to play in future climate action, and there is a strong argument that global climate leadership be rooted in the needs of these communities, who suffer disproportionately from climate catastrophes.
International governments are capable of building climate-resilient and carbon-sustainable health systems, but to do so, the momentum for change needs to carry on far beyond COP26. Health professionals will continue to be prominent in this movement—their voices must be heard and taken seriously.