Ian Gilmore: What is good for environmental sustainability is good for health

Welcome to a series of blogs on sustainable healthcare that will look at health, sustainability, and the interplay between the two. The blog will share ideas from experts across the healthcare field, some of whom are speaking at a major European conference looking at Pathways to Sustainable Healthcare in September 2013. More about the conference can be seen at www.cleanmedeurope.org.

I “toiled at the clinical coalface” for the best part of 40 years without giving sustainability in health and healthcare a second thought, and I suspect I was not alone. Indeed advocates for issues linking health and the environment are in short supply, but I was lucky to come across several while I was President of the Royal College of Physicians who helped me make that link. Hugh Montgomery of UCL, Ian Roberts of the London School of Hygiene, and Frances Mortimer are three wonderful advocates who come to mind. There is hardly a day that I don’t try out on someone the startling and sobering fact that Ian Roberts gave on the Today programme one morning last year—that the extra weight carried by the obese western world is equivalent in carbon terms to an extra billion people on the planet.

My main “professional” interest in recent years has been alcohol policy, which I wandered into through a clinical interest in liver disease. It was when I was college president that I discovered something amazing—instead of being largely ignored for most of my life, people suddenly paid attention to what I said and were happy to write it in articles or broadcast it!  This was both exciting and sobering—and I started to apply the “Daily Mail” test to things I did or said—how would I feel if it was in the next day’s Daily Mail?  But it gave me a platform to talk about developing evidence-based alcohol policy through tackling the triad of price, availability, and marketing, and this led me into the wider arena of medical leadership and advocacy.  The idea of doctors advocating for their patients is not new (The physicians are the natural attorneys of the poor, and social problems fall to a large extent within their jurisdiction—Rudolf Virchow), but has perhaps fallen out of fashion. Areas where I have tried to do this along with alcohol include health inequalities. Here we have the wonderful advocate and leader, Michael Marmot, and I was fortunate to be a commissioner when he produced a report on health inequalities in England commissioned by the then Prime Minister Gordon Brown. It was then that I began to understand that the real causes of ill-health have very little to do with what we learn in medical school.  Of course we knew of the importance of smoking, obesity, drugs and so on, but it was only working with Michael that I realised the fundamental “causes behind the causes”—the education, housing, income, and environment into which people are born, brought up, and die—where we need to advocate for our patients.

And we should not tire of pointing out that health is one of the good news stories around environmental sustainability, because what is good for one is good for the other—such as more exercise, less meat, and so on.

I have quickly applied the “Daily Mail test” to this blog, and think it passes…. and anyway some publicity for the conference in a few weeks time would be welcome.

I declare that that I have read and understood the BMJ Group policy on declaration of interests and I hereby declare the following interests: Board Member, BMA Publishing Group, Chair, Alcohol Health Alliance, Chair, Liverpool Health Partners

Professor Ian Gilmore is an honorary consultant physician at the Royal Liverpool University hospital. He is the immediate past-president of the Royal College of Physicians (RCP) and is currently president of the British Society of Gastroenterology and chairman of Liverpool Health Partners, created to promote an Academic Health Science System. He chairs the UK Alcohol Health Alliance and is a member of the Climate and Health Council. He is also a member of the National Quality Board. He will be appearing at the CleanMed conference.