David Shearman: The climate “tide” is still rising

My beautiful pictureTime 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.

  • anthony seaton

    Since retiring 10 years ago I have been lecturing to medical and scientific colleagues and students, and writing in the lay press about this subject, in an attempt to inform them of the hard science behing it and to demonstrate that we all can do something. The obstacle is the comfortable life that people have got used to in the greedy West and that we do not wish to give up. This is recognised by all our political parties save the Greens and thus they have no incentive to address the matter with any urgency. I’m afraid even doctors drive large fuel inefficient cars and fly round the world to conferences as much as ever. I am less and less optimistic

    Prof Anthony Seaton

  • Dr Niall D.C. Finlayson

    Prof Shearman, whom I know well, asks why a well organised campaign based on good evidence and relevant to the public health should fail to galvanise as well educated a profession as medicine. The problem has not been to generate interest but to produce action. There is no single reason. No doubt important factors include the presence of everyday commitments, where in the hierarchy of time for outside interests the environment comes, the realisation that a threat is not immediate, the implications for uncomfortable changes in personal lifestyles, and how much we really care for future generations. There are further factors that limit the effectiveness of any educational campaign. Where the object is to win “hearts and minds”, education may convince the minds without winning the hearts, and winning both is important to effecting change. In addition, there are those who actively oppose the campaign, either from conviction or from vested interest. Prof Shearman mentions how long it took to effect change over smoking, and it may be that the environment is heading for a similarly long time along with alcohol use, exercise, obesity and other matters. So what can be done in the case of the environment where the portents are that action is needed now to protect the environment more fully if irreversible degradation is not to occur. We should be grateful to Doctors for the Environment Australia (DEA) for their efforts on our behalf, and particularly important is the presentation of evidence about environmental hazards to political and civic leaders as well as to the public. Of course, full reports are needed, such as those of DEA, but very important is a steady stream of evidence condensed into short messages that a public always on the move will take time to read or hear, and promoted by people they are likely to stop for!

  • Dr George

    It is difficult to know why Doctors are not generally becoming more involved in this debate. There have been many articles in medical journals and the general media regarding the current and future health impacts relating to climate change and other environmental factors. In lectures and talks with colleagues and students, there is often a good response to this discussion (other than a few vocal nay-sayers).

    A few initiatives have developed around the sidelines, but it has not translated into coherent action. Part of this reticence maybe due to perceived ‘scope’, in that we might consider climate change to be outside of our responsibility or our locus of control particularly as we tend to focus onto immediate problems and treatment rather than prevention,it may also be partly the result of ignorance, contrived or otherwise, and partly due to fear of entering this space in a world where climate change discussion has almost become a taboo.

    Whatever the cause, time, as Prof Shearman points out, is running out. We have to strive harder to find a way of better communicating the problem and what it means to us, and the urgency of action.

    [dislclaimer: I am a Representative of Doctors for the Environment Australia]