If the NHS is to reach net zero, we need to talk about the climate emergency in every part of the healthcare service
The climate emergency is the single greatest threat to human health, with the potential to cause global devastation through extreme weather events, air pollution, food shortages, and changing patterns of emerging infectious diseases. The effects of the climate emergency disproportionately affect the most vulnerable in society and will worsen health inequalities. The UK healthcare system contributes around 5% of the UK’s carbon footprint. In October 2020, the Greener NHS Net Zero report committed the NHS to becoming net zero over the next two decades (by 2040 on emissions the NHS controls directly, and 2045 on emissions the NHS can influence). To achieve this, we need to talk about the climate emergency at every level of the healthcare service.
The climate emergency and ecological degradation are already having a major effect on people’s mental and physical health and this is predicted to increase in the coming years. The covid-19 pandemic may be linked to the way humans interact with nature, and air pollution directly affects health worldwide. The mental health effects of the climate emergency are significant and more and more people, especially the young, are reporting anxiety about the climate. For all these reasons, we need to learn how we can engage our patients in discussion about the climate and ecological emergencies.
Bringing up environmental issues during consultations is not easy. Climate psychologists refer to a “socially constructed silence” and a disconnect between what we know about the climate and environment, how we feel about it, and how we act. Talking about the issues can help connect these. We need to understand that our colleagues and our patients are all at different stages in their willingness to talk about the climate emergency. Widely accepted theories about the grieving process may offer a model to help patients manage their anxiety. Like any psychological process, this is not a rigid sequence and people may move back and forth through the stages at different times.
Anxiety about the environment is a normal reaction to the climate and ecological emergency. It’s not an illness, but those who are experiencing it need to be validated and supported. Providing an opportunity for people to talk can help, and a clinical consultation is a good place to start. Anyone in the practice with an understanding and an acceptance of the situation can do this. The climate emergency should be embedded within medical curriculums so that clinicians are confident in responding to climate anxiety.
Environmental issues are relevant in many areas of medicine. Guidance from the National Institute for Health and Care Excellence on inhaler choice for asthma now includes the relative carbon footprint of metered dose versus dry powder inhalers. General Medical Council (GMC) guidance on prescribing is that clinicians should discuss common side effects. It is unclear whether the GMC intends side effects to apply only to the person or whether this should also include side effects for the planet, but this warrants consideration, bearing in mind that patients must not be made to feel guilty about accepting treatment. Often, what is good for the health of the individual is also good for the planet. Preventive actions, such as active travel, encouraging self-care, plant based diets, reducing waste (including over-investigation and over-prescribing), and finding non-pharmacological alternatives such as social prescribing, are all central tenets of sustainable and good quality healthcare.
How and when to introduce the environmental value of these interventions needs thought. Individual staff may worry about how they will be perceived by colleagues and employers if they raise the topic, so it is important for health service leaders and regulators to support guidance for the inclusion of sustainability and environmental concerns in consultations. Practices can facilitate such conversations by making it known that environmental issues can affect health and are necessary topics for discussion. Practices advertising their engagement with the Green Impact for Health toolkit, and that their social prescribers offer green therapies and nature activities will legitimise the topic.
The effect that environmental conversations could have on the therapeutic relationship needs exploring. Some may be more motivated to make lifestyle changes if they think they are improving their health and helping the environment at the same time. Others may suspect a conflict of interest (“is this doctor more interested in the environment than my health?”) or feel a sense of guilt about taking treatments they need. Parallels can be seen with doctors 30 years ago as they learnt to talk about the evidence for efficacy and financial costs of medicines. Reducing waste is safe ground and may be a good starting point. Providing simple information about recycling packaging, returning unused medicines, and safe disposal can reduce waste and pollution of waterways.
For clinicians and patients to be empowered to discuss environmental issues, several conditions are needed. Firstly, discussions need to be seen as a valid use of clinical time by services and service users. Health service leaders, clinicians, and practices should make it clear that they are. Secondly, it may be helpful for clinicians to consider where they are on their own psychological “climate change journey” and where the patient is on theirs. Unconsidered discussions when people are not ready could be counterproductive. Thirdly, a range of responses and interventions should be available. These should include validating emotions associated with “eco-distress” and providing information and links to community groups to enable people to engage in meaningful action.
Guy Harvey, consultant psychiatrist CNTW NHS Trust, member of the Planetary Health and Sustainability Committee, RCPsych and lead for sustainable models of care, CNTWClimateHealth.
Mike Tomson is a clinically retired GP, active in Greener Practice nationally and in Sheffield, the RCGP’s Climate Emergency Action Group, and is an associate with Centre for Sustainable Healthcare.
Amelia Cussans is a psychiatry core trainee, co-founder of CNWL Green Group and Healthcare Arts Collective. Twitter: @DrAmeliaCussans
Helen Twohig is a GP and Wellcome Trust Primary Care Doctoral Research Fellow at Keele University. Member of the Sheffield Greener Practice group. Twitter: @H2Norman
Angela Wilson is a GP in West Oxfordshire and is climate and sustainability lead for Thames Valley Faculty RCGP @angemwilson @ArtsHealthcare
Written on behalf of the members of the GP, Psychiatrist and Pharmacist Short Life Working Group on reducing the environmental impact of pharmaceuticals.
Competing interests: none