The recent Cambridge University Leadership Programme looked at sustainable development in health services worldwide. It was an opportunity to hear the evidence and arguments which were both persuasive and alarming. The link between population growth and our reliance on a carbon-based economy, leading to rising levels of CO2 in the atmosphere, and the consequent changes in climate was compelling. This is relevant to healthcare systems, and the professionals that work within it, not only because climate change itself is having significant consequences on the health of populations, but because healthcare systems themselves have a significant carbon footprint. more…

Three separate images from the recent 17th conference of the parties (COP 17)  in Durban, where I was as an observer on behalf of the climate and health council, frame my view of how we can rescue the COP process from its terminal decline. We might then have a better chance of rescuing the globe from a three degree increase in temperature, with the 70% predicted species extinction and the unimaginable human catastrophe that this will produce.

The first is the widely distributed photo of The UNFCC executive secretary Christiana Figueres, the EU chief negotiator Connie Hedegaard, and the South African chair of the conference Maite Nkoana-Mashabane, turning the tables in the last few hours of negotiations. The caption could well have been “It takes the efforts of three women to rescue some semblance of progress from the negotiations, and to avert catastrophe.” more…

When I used to teach public health to medical students and other health professionals, I tried to set myself the challenge of helping people learn about populations, prevention, screening, social determinants of health, quality of healthcare, and such things without mentioning the words public health at all. You may know why.

A great paper by Dror Etzion, assistant professor, Desautels Faculty of Management, McGill University (Sustainability by Stealth: four ways to make sustainability more attractive) addresses the same approach with sustainable development, another area that elicits various emotional responses. With his permission, I have taken this excellent paper and expanded it to help us engage others in issues like sustainable development and climate change: areas that make us question our values and beliefs as well as our actions, areas where we should use the precautionary principle: where action is needed when the evidence is sufficient but neither perfect nor complete. more…

Recently, you heard from Johnny Meldrum about why health professionals should care about climate change, and their role in the climate change negotiations. More than ever before, health professionals were present and engaging with the UN climate talks in Durban. During this conference there has been: a health summit, 6 official side events, two health-related actions, and numerous other informal and peer-to-peer education sessions. But how far have we really got at having health meaningfully included within the climate change negotiations? more…

Change may be the new constant, but it is always important to understand who embraces change most readily, and where. Doctors in general are traditionally conservative, as those outside the profession will be only too happy to confirm. We like to think we pioneer change both via behaviour (witness the change in smoking prevalence amongst doctors in the UK that preceded the change in prevalence in the wider population) and via technology (transplants, genetic research, new drugs). The resistance many doctors are showing to the current NHS reforms in England, suggests we are less engaged with that third pillar of large scale change: governance; the rules, regulations, laws, and incentives that determine how the system runs. more…

On 17 October, I was fortunate to attend a daylong seminar at BMA House on “the health and security perspectives of climate change.” Uniquely, this programme pulled together medical and military professionals along with climatologists, zoologists, and politicians. The morning focused on threats to global climate, health, and security whereas the afternoon sessions focused on the way forward.

The health risks from climate change might seem more obvious than the security risks, but what I learnt is that situations in Darfur and Somalia are the perfect storm examples of the intersection of climate change, health and security. In Bangladesh, if we project forward to a world without improvement and with increased violent weather and rising sea levels, we will encounter a situation in which some 75 million Bangladeshi people (half of the population) are at risk of displacement along with the stability of the nation despite long term excellence in disaster planning and management. more…

I am still proud to be a doctor. This used to be because I looked up to inspirational mentors, tutors, and role models. I still do, although my inspiration is increasingly derived from younger doctors and medical students (a cohort effect). We have a young inspirational medical student working with us currently doing research in his elective period. He is asking a sample of medical leaders in the UK how appropriately we are training the next generation of medical leaders – to address the forthcoming challenges we face (to add to the plenty we already have). This presupposes that formal training in this area actually works. I suspect it does and we should certainly support Peter Lees and colleagues in establishing the Faculty of Medical and Management. It is what every profession and professional should do – although I wince every time I use the word professional – we should be training people for competence in tasks, not for memberships of professions. What’s your definition of a professional? I think mine is probably someone who is alert to the likelihood that they will one day be rumbled. If you sympathise, you’re probably fine. If it irritates you, you may want to ask yourself why. more…

Chris Ham’s article in last week’s Observer newspaper (“Politicians have ducked hard decisions on the NHS for far too long” Sunday 19 June 2011), and a news story in this week’s BMJ (BMJ 2011;342:d3921), claim that up to 20 hospitals, around 10% of the total in England, may not be financially sustainable. 
 
This is highly probable on the current evidence of what is happening, even in well led hospitals like Leicester. Later in the article Chris Ham extends the issue of sustainability into the second of its three dimensions in healthcare: clinical sustainability. With better IT, more empowered patients, more need for collaboration with other agencies such as social care and primary care, and with good evidence of better specialist care in fewer, higher quality tertiary centres, business as usual is not an option for our traditional district general hospital (DGHs). 

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Until very recently the Western Highlands of Kenya (once known as the White Highlands) were thick with forest, but many of those forests have been cut down. A friend in her mid 20s pointed out to me fields on the edge of Eldoret, the main city in the region, that were forest when she was a child. An older friend said that the region was covered with forest just 20 years ago.

It’s not surprising that forests are disappearing in Western Kenya. Many people are hungry and need land, and traditionally people cook with wood. It used to be, my older friend told me, that the forest produced enough dead wood for everybody, but now there are more people and less forest. more…

(IR) Although I cannot be certain, I suspect that humans are unique amongst animals in the ability to contemplate their own death. We all know that death is waiting. We might rage against the dying of the light but we know that the darkness will win. We scrutinize death solemnly and earnestly as we would examine a swollen lymph node. Montaigne believed that by practicing an awareness of death we rip off its fearful mask and since we can never know where death awaits us we should “wait for it everywhere.” more…