Despite the distraction of the recent pandemic, environmental issues continue to be a central part of public discourse. After decades of work by activist groups and academics, knowledge that the climate emergency is the single biggest existential threat to face the human species is finally mainstream. But what part should doctors and other healthcare professionals play in this conversation?

In 2019, “Doctors for Extinction Rebellion” (DrsXR) emerged as a leading voice in this field. [1] DrsXR are an affinity group of the Extinction Rebellion (XR) movement, aligned with the principle philosophies, but occupying their own space in highlighting the health issues linked to climate and ecological breakdown. The group of over 600 health professionals from across the UK made positive headlines during XR’s “October Rebellion” with various actions of non-violent civil protest including the compelling planetary health march. [2] The march delivered and laid down 110 pairs of shoes on the steps of Trafalgar Square to signify the 110 excess deaths in this country every day linked to air pollution. The message was clear—climate activists are not just “nose-ringed crusties in hemp-smelling bivouacs” as Boris Johnson so elegantly described; credible professionals have joined the movement.

With many members working on the frontline of the coronavirus response, 2020 has been less active for the group. However, after a brief hiatus, we have been back in action with a campaign putting health warnings stickers on 20,000 petrol pumps around the country. As proposed by senior public health figures in The BMJ, we believe that petrol and diesel should be coupled with health warnings in light of the clear link between air pollution and excess premature deaths, much the same as other harmful agents such as tobacco and sugar. [3,4] We launched the campaign with a peaceful and considered takeover of a petrol station in Newham, London’s most polluted borough, again receiving national media coverage.

As individuals we need to think carefully about how we conduct ourselves as both activists and responsible professionals, and be mindful of how our actions and protest might interact—or be perceived to interact—with our primary duties as healthcare providers. This tension was recently described by colleagues from New Zealand in the timely Lancet viewpoint, “Should health professionals participate in civil disobedience in response to the climate change health emergency?”, which goes on to outline a helpful framework for assessing the justifiability to engage in such action. [5]

At the end of January 2020, 100 health professionals met for the first conference dedicated to the role of healthcare workers in environmental activism to discuss these issues. One useful document to emerge is a guide to how we discuss the climate emergency with three key groups; our patients, our peers, and the public. The guiding principles were the product of a workshop conducted during the “October Rebellion”, with a wide range of participants including nurses, midwives, consultants and medical students.

In addition to outlining guiding principles for engagement, the document provides a wide range of accessible resources to inform, inspire, and help the reader to facilitate change in their various spheres of influence. This includes letter templates to send to Royal Colleges and hospital Trusts, useful tips for those that want to engage with the media, and toolkits to help drive sustainability in the workplace. Aware that litigation is a legitimate concern for health professionals wishing to engage in direct action, DrsXR also outline the first document to address these concerns, particularly in relation to licencing, employment, and career progression.

January’s landmark conference was jointly organised by another group, “Health Declares a Climate Emergency (HDE).” While the group, like DrsXR, has the aim of holding our government to account on environmental issues, the strategy differs. DrsXR focuses on activism through non-violent civil protest. HDE aims to enable change by advocating within our institutions and health system, calling on organisations such as hospital trusts or Royal Colleges to take acute and long term action.

These different forms of engagement are valid and necessary. Protest movements throughout history have often utilised a range of “insider” (advocacy) and “outsider” (activism) tactics to influence change. Both methods have a rich history of driving social and political reform, from the suffragettes’ movement in our own country to the civil rights movement in America. Similarly, action on the climate crisis can take many forms: be it with a megaphone in the streets, or letter writing to the director of your NHS Trust. We recognise these actions to be complementary. Individuals will feel a natural draw to the group which most readily reflects their own views and we hope the information in our guide will help health professionals reach their own decision when considering the ways they might wish to engage.

As medical professionals, we are proud to act on the basis of scientific evidence that has passed through rigorous peer review. There is now overwhelming evidence presented to us by climate science about the very real threat of catastrophic environmental breakdown to the health of people all over the world. [6] As health professionals, we have a duty to process this message with the utmost sincerity. 

We hold a unique position within society; our profession is among the most trusted, and probably more so than ever since the coronavirus pandemic. As scientists, as frontline staff, and as citizens, our children and their children will recall how we conducted ourselves in 2020, when the message and evidence base was clear; that we have a limited window of opportunity to act. 

If not you, then who? If not now, when?

• For more information on Doctors for Extinction Rebellion, see the website.
• To work a locum shift at your local hospital to help fund their activism, see here.
• For more information of Health Declares an Emergency, see their Twitter feed
• If you’d like a member of Doctors for XR to speak at an event, make a request here.

References:

1. Doctors for Extinction Rebellion [Internet]. Available from: https://www.doctorsforxr.com/
2. Martin H, Eckersley P. Doctors and Nurses join Extinction Rebellion – Daily Mail. Available from: https://www.dailymail.co.uk/news/article-7565963/Doctors-nurses-join-Extinction-Rebellion-demo-Shells-London-HQ.html
3. Gill M. We need health warning labels on points of sale of fossil fuels. Available from: https://blogs.bmj.com/bmj/2020/03/31/we-need-health-warning-labels-on-points-of-sale-of-fossil-fuels/
4. RCP. Every breath we take: the lifelong impact of air pollution. Available from: https://www.rcplondon.ac.uk/projects/outputs/every-breath-we-take-lifelong-impact-air-pollution
5. Bennett H, Macmillan A, Jones R, Blaiklock A, McMillan J. Should health professionals participate in civil disobedience in response to the climate change health emergency? The Lancet [Internet]. 2020 Jan [cited 2020 Jan 27];395(10220):304–8. Available from: https://linkinghub.elsevier.com/retrieve/pii/S014067361932985X
6. Watts N, Amann M, Ayeb-Karlsson S, Belesova K, Bouley T, Boykoff M, et al. The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health. The Lancet [Internet]. 2018 Feb [cited 2020 Jan 27];391(10120):581–630. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673617324649