David Pencheon: Beware off-set

David PencheonWhen something is everyone’s problem, it so often gets treated as though it is no-one’s problem. Although climate change is now widely accepted as the most serious health threat to face us, you would not immediately see health services or health professionals as the most vocal or active. The journals have taken the issue on board, as have many of the Royal Colleges, with vision and gusto. However, despite some notable exceptions, for most NHS organisations and professionals, this is seen as yet another inconvenient addition to the to-do list. At last two attitudinal issues stand in our way. Firstly, too many of us see climate change only as a problem, and indeed it is. But when taking a more holistic approach around the sustainable development of health services and health, the ways of addressing climate change and sustainability are so congruent with so many other changes we need to make: smarter use of information technology, more empowered chronic disease management, more care closer to home, less reliance on fossil fuel, more movement of knowledge and less movement of people, and of course, more prevention (notice the way Andy Burnham added the P of prevention onto the current Quality, Innovation and Productivity drive in the NHS). However, there is a second, more insidious attitudinal barrier we face in the health professions. We devote our careers to cure and care, and then someone comes along and says: oh, by the way, can we help save the planet too? The response is naturally: aren’t we doing enough to promote health already? Of course we are, but as one young person said to me last year: what’s the point of providing health care in a way that makes us all into patients? Thinking we are already doing “our bit” (ghastly phrase) is arguably the most dangerous sort of off-set. We all know that truly addressing climate change is not easy, but many people worry that doctors are notoriously quiet on this subject, despite the heroic efforts of the Climate and Health Council, and despite the impending opportunities to raise awareness and accelerate action as the Copenhagen negotiations approach. Rightly or wrongly, doctors are influential: what we say and what we do, changes the attitude and actions of others. We need to make every effort to ensure we are a leading part of the solution. “All that is necessary for the triumph of evil is that good men (sic) do nothing”