Why should doctors be interested in climate change?

Smoking and Health was published in 1962,¹ but 45 years passed before smoking was banned in enclosed public places in England. We have a small fraction of that time to cap carbon emissions globally to avoid serious risk of irreversible climate change.² Smoking cessation has long been a recognised, legitimate, clinical aim—yet personal carbon footprint reduction is not. Why not?

Health professionals were powerful catalysts to society changing its view about smoking. Smoking is no longer seen as a normal lifestyle choice, but an addiction that has harmful effects not just for the individual but for others. Most of us do not yet think of our high carbon lifestyle as an addiction that is more destructive than tobacco, and irreversibly so.

We have not yet developed the professional attitudes, language, or conceptual framework needed to make it easy and legitimate to tackle this addiction in the clinical setting. Just as doctors smoked in front of patients, many of us still drive to work in large cars. But there are strong echoes from the challenges posed by tobacco control—if you stop smoking by 35, your risk of harm and life expectancy return to normal within a few years, and nobody else is exposed to your smoke. If you drive your car less, take more exercise, and eat less meat, you will avoid the effects of obesity and help mitigate the effects of climate change. Both sets of changes will help you to enjoy your grandchildren, and if you reduce your carbon footprintyour grandchildren will have a planet to enjoy.

Imagine that all doctors in the United Kingdom halved their car driving and flying, reduced energy consumption at their workplace by 20%, halved their meat consumption, and enthused 10 colleagues each year to reduce their carbon footprint by 5%. Imagine also that every general practitioner persuaded three patients a week to halve their driving and meat consumption and catalysed increases in fuel efficiency in 10 homes a year. What would the net effect on carbon emissions be?

Under certain assumptions the reduction might be 2-4 million tonnes of CO₂ a year, against an estimated annual footprint for the NHS in England of 18 million tonnes and a total in the United Kingdom of around 600 million tonnes.^{3 4} Of this, the biggest single component comes from the energy industry (all industries involved in the production and sale of energy). We are committed to reductions of at least 60% by 2050, and it has become clear that they need to be greater still.⁵ Rapid and profound changes in behaviour are needed.

Arguably, the most recent equivalent “health emergency” in the UK was the arrival of the HIV epidemic in the 1980s. That justified mass action at every level—setting up a government awareness campaign that included shock tactics on the television, establishing national surveillance of the effects of behaviour and the behaviour itself, earmarking of funds, and rapidly accepting that this was a problem that demanded the attention of health professionals.

What is different about climate change? After all, as with HIV in the 1980s, no cure is available at a global level for the effects of high carbon behaviour; people who are already the most vulnerable in society are affected most; and we know how to tackle the problem.

One crucial difference exists, though. When health professions recognised the need for action to tackle HIV, it was not public infrastructure that was responsible for the spread of the virus. In contrast, public infrastructure and government policy are responsible for controlling CO₂ emissions.

So, whatever part health professionals can play in helping to change behaviour at the individual level, collective resilience requires collective action, as for example with immunisation. Even nations with a more libertarian political philosophy than the UK disallow school entry for children who have not completed their immunisations. One of those nations, the United States, is responsible for the highest per capita CO₂ emissions in the world. Although such examples may not seem related to those of tackling climate change, the underlying principles are entirely generalisable.

In the short time before the UN conference on climate change in Copenhagen in December 2009 we need to encourage governments and the international community to join up what we know, think, and do if we are to succeed in meeting the emission reduction targets vital to our survival. In practice, this means that firstly we should initiate a stepwise change in our focus on reducing health threats related to high carbon lifestyles—mainly obesity, injuries from road crashes, and seasonal deaths. We should be doing much better on these anyway. Secondly, we should show ourselves, our patients, and our politicians how seriously we are taking the challenge, and how much more seriously we would take it if governments showed the necessary determination to get international agreement to a global carbon cap at Copenhagen.