Time and tide wait for no man published in the BMJ 10 years ago detailed a vital role for the medical profession in addressing climate change and was used in Australia to form Doctors for the Environment Australia (DEA) in 2001.

The article could be reprinted today with updated references as the current report card—except that the tide is rising faster. What are the causes for this apparent failure?

DEA focused on education of the medical profession, the public, and parliamentary representatives. Educational posters and pamphlets were repeatedly sent to 24,000 general practitioners for waiting rooms. There were numerous articles and grand round presentations, and contact with the community through talks, press articles, and many briefings for parliamentarians. Use of the educational material by the profession was modest. More interest was generated through schools.

The scientific evidence on climate change is soundly based, so surely we could succeed in educating our profession?

Although DEA recruited hundreds of members who spent thousands of hours on education only a few doctors became committed. They had an academic interest, the lecture hall was full, many questions were asked, but there was little personal or collective commitment.

Climate change needs decisive action in this decade. We cannot wait for education. In retrospect, DEA forgot that decades were needed to curtail smoking—an issue much closer to our professional imperative than the future health impacts of climate change.

We also overlooked that the profession shares with the community the uncomfortable realisation that the world needs radical change to arrest climate change; this carries unacceptable consequences for many of us (particularly the conservative minded) with stakes in maintaining the current economic and social systems. Climate change became a “left” or “green” concept, to its detriment.

In what ways has the DEA changed focus? We act to reduce greenhouse emissions this decade and this requires curtailing coal and gas usage and development. The health costs of coal are huge and on full cost accounting it is arguably the most expensive fuel.

In Australia, DEA (the lead medical organisation acting on coal) uses analysis of pollution data and process to find fault with approval processes and contest government decisions. Health concerns stopped a brown coal project in proceedings at the Victorian Civil and Administrative Tribunal.

DEA was granted “standing” in a “court of law,” possibly the first time a health organisation has legally opposed a new coal power plant due to health concerns in Australia, and possibly the first time globally. Other DEA actions on the health impacts of coal are detailed here.

There are growing health concerns about coal seam gas (CSG) which is attractive to governments because it is developed quickly and gives almost immediate revenue. It has been sold as “clean” because of reduced emissions compared to coal, but emerging data suggests the escape of “fugitive” emissions make it only marginally better. Even more concerning, aquifers can be contaminated with fracking chemicals and with noxious hydrocarbons from coal seams. Emissions from well heads may also be toxic. Our representations commenced with a submission to the Australian Senate in July 2011.

Our successes can be followed at dea.org.au.

David Shearman is emeritus professor of medicine at the University of Adelaide South Australia and previously held faculty positions at Edinburgh and Yale University medical schools. He is honorary secretary of Doctors for the Environment Australia. 

Competing interests: I have read and understood the BMJ Group policy on declaration of interests and declare I have none.