Physicians have been called on to contribute to more environmentally-friendly and sustainable behaviour worldwide, as part of a general appeal, but also with the argument of the link between environment and health. Authors in professional publications have repeatedly appealed for health professionals to speak to the public about the threat of climate change, also invoking impending ill effects to human health by the consequences of climate change.1,2 These appeals have left it up to individual physicians to decide how to convince the public about the urgent need to deal with the problem. Patients have not been assigned an active part in these calls, even though they may be motivated and knowledgeable partners for efforts to encourage sustainable living. Between 2010– 2011, we approached visitors to one practice to learn more about their views and their motivation regarding environmental issues.
PHYSICIANS AND THE ENVIRONMENT
The mandate of the generalist physician as being in charge of the health care of a population can be interpreted in its limited clinical meaning, but also in a more general sense, comprising patients’ living conditions. Having a favourable environment on Earth is an essential determinant to human health. Threats to the environment stem from individual human behaviour and factors outside of direct individual influence. For significant improvements to occur in the individual domain, the cooperation of a large part of the population is a necessary requirement. The universal threat of global warming has brought a new urgency into this discussion.
Some environmentally-friendly behaviour patterns, such as recycling, have become generally accepted and are widely practiced, whereas in other areas, such as in transport or industry, many practices and habits continue to be damaging to the environment. Effective environmentally-friendly action on a global scale will have to include adapting many or most of them.
PATIENT RESPONSES AND WILLINGNESS
We hypothesised that visiting a doctor’s office can promote a willingness to reflect on aspects of quality of life other than one’s health problems, such as about environmental issues. We considered the doctor’s office a setting where concern for one’s wellbeing tends to be high, so people can be brought more readily to reflect on opinions bearing some relation to wellbeing and health; even if these aren’t directly related to the patients’ medical care.
Over the course of several half-days, participants were presented with a survey in the waiting room of our practice (a group practice of four generalist physicians in Netanya, a medium-size city in Israel). Following a questionnaire on environmental issues, the participants were offered space to expand with the following open questions: ‘Other possible changes in personal habits’, ‘Other examples of areas in which, in your opinion, the environment is endangered’ and, ‘Other remarks’. According to principles for qualitative data, content analysis was conducted using the phenomenological method.
There were 107 responders to the open questions, aged 15–81 years (average 51.4 years). Some wrote a few remarks, while others expanded and wrote several sentences.
The principal findings were compiled according to subjects and worded according to the different research questions: water, recycling, air pollution, green alternatives, and education and communication. The responses to the survey questions showed various expressions of concern regarding environmental issues.
There was a clear operative component to many responses, with many calling for changes in environmental habits. For many participants, the questions evoked an emotional involvement and commitment to the environment and to society.
CREATING FAVOURABLE ENVIRONMENTAL CONDITIONS
In summary, the mandate of health professionals to improve or restore their patients’ health includes, when interpreted comprehensively, helping to create environmental conditions favourable to health. The global health community has been called on to reduce the health consequences of climate change, whether through advocacy, cooperation among professionals, or by educational efforts,3,4 most representatively by the latest World Health Organization’s conference in Geneva.5
As physicians, we may well be in a position to attempt the enormous task of motivating our patients to change their living habits on a larger scale. Participants in this survey showed significant interest in and concern for environmental issues, but specifically, willingness to contribute to their improvement. Patients have not been adequately heard in this context; we undertook a first step to hear their views.
These findings could serve as a stimulus to research and to arouse discussion, lead to practical proposals and sensitise a wider public for environmental concerns, with the goal to facilitate urgently needed larger scale changes in behaviour.
REFERENCES
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