You don't need to be signed in to read BMJ Blogs, but you can register here to receive updates about other BMJ products and services via our site.

David Pencheon: Climate change—knowing so much and doing so little

22 Jan, 14 | by BMJ

David PencheonAlthough I like to think I am a rational person who can consider most issues objectively, I know this is rubbish. I am biased, prejudiced, and a prisoner of my experience, although perhaps acknowledging this is better than denying it. Not easy, as the ability to deny is probably our most powerful coping mechanism, and extremely useful for people like doctors who spend much of their working lives dealing with constant uncertainty, suffering, and stress. There is only so much reality with which the human frame can cope, and many people do appear to be very skilled (maybe too skilled) at detachment, denialism, and clever ways of dealing with more than their fair share of pain, suffering, and death. Perhaps this explains why we sometimes seem so poor at understanding the effect of our behaviour and actions (or lack of them) on others.

It is the exception, not the rule, that doctors become visibly and collectively very engaged about the future. And although almost everyone finds it difficult to make much sense of the future, we might consider health professionals to have a particular responsibility and opportunity to wave the flag on behalf of the health and wellbeing of our children. This is very apparent in our ambivalence to take visible and collective action towards what the evidence now confirms is almost undoubtedly the largest health threat of the 21st century: namely our unsustainable behaviours and lifestyles leading to significant and well understood health threats. These range from obesity and global inequalities, to runaway and irreversible climate change (and the civil and health threats to everyone that will ensue). Ignorance is no excuse: health professionals know how to take a visible stand against global challenges to health. Witness the collective and vocal stand against other health threats from cholera to tobacco to nuclear war.

I have just been reading a book called Engaging with Climate Change lent to me by Caroline Jessel, a wonderful colleague from Kent.  It’s written by a group of psychoanalysts, so much of it is beyond me, but it does have a very good section on denial, particularly its different forms. The most dangerous sort is not the one concerned with active and malicious misinformation for ideological or commercial reasons (“denialism”), nor the sort, as in grief, where we initially wish to disbelieve the truth (“negation”). The most worrying form (“disavowal”) is when we casually accept the best estimates of the truth, but skilfully justify actions that avoid its obvious implications. So many doctors rightly claim that they don’t have time to address the health of the environment as they are too busy dealing with the health of their patients. Perfectly true, but it does sound a little like the person who needs to spends all their time rescuing people from the river so that they don’t have time to go upstream and stop them falling in. Pragmatism or disavowal or both?

I was reminded of this whilst listening to some guru on the radio saying that self doubt is important, natural, and mostly good as long as it does not become crippling and provoke paralysis or worst. I like the definition of a professional as someone who is constantly worried (but not paralysed) by the chance that one day they will be rumbled—something we should all be alert to, and perhaps something that medical revalidation is there to address. But remember that the sins of omission can be far more damaging than the sins of commission. When the history books are written about the 21st century (if there is anyone left to do this), it may be that the most vocal, respected, and influential parts of civic society in the early part of the century (us, now) will be rumbled, for knowing so much and doing so little.

If you haven’t done so already, you can pledge to take more action, by visiting the Climate and Health Council at an international organisation of health professionals and others dedicated to combating climate change and its impacts on health and wellbeing.

David Pencheon is a UK trained public health doctor and is currently director of the NHS Sustainable Development Unit (England).

By submitting your comment you agree to adhere to these terms and conditions
  • Woody Caan

    Well put, David.
    What last week’s climate & health meeting at UCL impressed on even this procrastinating American is the short time window we have. Food and water security will become health issues much sooner than I imagined… the parallel is early intervention for colorectal cancer, where there is a window of at most 3 months for Curative action, and any further delay really means care will be Palliative.

  • steve black

    The warming world is far from the largest threat to health in our futures and, if past comment is anything to go by, won’t have much if any direct effect on human health.

    Many campaigners on the issue have declared the danger of catastrophic change in climate but this is not the mainstream view. It is easy to believe their jeremiads are driven by the need to encourage people to take action rather than the science.

    There is a risk when medics jump on the campaigning bandwagon that they will devalue science in their eagerness to contribute. The BMJ has more than once had articles proclaiming how many health issues are affected by warming. But most fall apart on analysis and diminish the credibility of their authors. Will malaria spread? Not likely since its containment has little to do with climate. Yet medics have have naively included it in the costs of a warming world. Will we all starve? Nope, we are currently gaining from warming via more rainfall (climate models predict this not desertification) and carbon dioxide fertilisation of plant growth. Will many die from heat stress? Nope, we still have more deaths from cold than heat.

    If we elevate climate to the biggest issue facing the world and panic because of overblown predictions of imminent catastrophe, we will harm the world not help it. Only calm rational assessment of whether mitigation actions are worth the cost will improve human wellbeing. For example, spending on carbon reduction to combat the spread of malaria is billions of times less effective than spending the same money on public health.

  • Sarah Crowe

    Hi David
    Martin spotted this and sent it on.
    Hope you are well,
    Sarah (nee Leslie)

You can follow any responses to this entry through the RSS 2.0 feed.
BMJ blogs homepage

The BMJ

Helping doctors make better decisions. Visit site



Creative Comms logo

Latest from The BMJ

Latest from The BMJ

Latest from BMJ podcasts

Latest from BMJ podcasts

Blogs linking here

Blogs linking here