In paediatric medicine, denial of impending disaster prevents us from recognising when a child’s medical condition is deteriorating. Someone uncertain of their role, or afraid to speak up because of rigid hierarchies, may choose to say nothing. Delay in starting the right treatment may be caused by fear of appearing to over react. We instinctively wish to find a simple technical cause for an alarm, with a simple technical fix. We are trained in this bad habit by incessant alarms, while they initially sound worrying, they usually turn out to be false and we hit mute. Thus, we may miss the fact that the oximeter cannot get a signal due to hypoperfusion from septic shock and impending cardiovascular collapse.

In much the same way humanity and the medical profession have denied our role in human-caused global heating and the destruction of nature for several decades. Now that the vast majority of the world’s population recognises that the anthropogenic climate health emergency is happening, those still unconvinced or unable to act have pivoted from denial to delay. The correct prescription for climate action is well known and universally accepted by science—the immediate and just transition from fossil fuels to renewables, the reversal of destruction of our natural habitats and restoration of biodiversity in nature—we still focus on unproven and potentially unscalable technological fixes such as carbon capture. What is more, the success of victim blaming that has occurred through the promotion of personal carbon footprinting has successfully diverted attention away from the correct treatment which is to stop extracting and burning coal, oil, and gas. Just to make certain that no one puts their head above the parapet, the ubiquitous use of personal responsibility, has become deeply entrenched in discussions around the climate health emergency. It would be unusual to have a discussion about the climate without being asked if you still eat beef or drive a diesel car (open disclosure my answer is; occasionally and no). 

So, because the adults have left the room, the burden is placed on children and the younger generation to do the advocacy, to miss school, and to be trolled by the political leaders of the free world. 

But as healthcare professionals we can understand science. We have experienced the impact that the tobacco industry and “big pharma” can have with their vast financial and lobbying resources when they choose profit over the survival of their customers. We would (now) never consider taking bribes from big tobacco to pretend that cigarette smoke doesn’t cause lung cancer. But what have we said about the same particulates that come from our car exhausts and wood burning stoves?  Not nearly enough according to one coroner. 

It is time we stopped worrying about our inadequate skills and knowledge in the science of air quality and the climate health emergency. We don’t have time to become experts in climate science before speaking up about the health harms of the climate emergency. Whenever you are told that this is not in your job description and what you are saying is political, look at their motives for saying that. Are they in children’s best interests or the status quo?

The Climate Health Emergency is the greatest threat to child health in human history. We need to declare an emergency and then act as if there is an emergency, not sit back and wait for someone else to take charge. We need to use the skills we have at once.

If we work as a team and use all our individual strengths to achieve a common goal, we can give “the climate policy ratchet a healthy turn.”

We need team leaders who;

• Name and clearly articulate goals
• Set specific targets and the methods to achieve them
• Know their own and our team’s strengths and weaknesses.

And other roles are equally important:

• “Finishers” who see errors and fix them 
• “Coordinators” who see opportunities and allocate resources. 
• “Evaluators” who can stand back and prevent task fixation errors.

Teams can achieve major feats that individuals cannot.

But they need leadership, cooperation, coordination, and communication. Nothing will happen until we all speak the truth. Denial, and its best friend, delay, do not lead to good outcomes.

Mark Hayden is a paediatric intensivist working in London. He is taking part in the Ride for Their Lives from London to Glasgow ahead of COP26. He knows that this action will not reduce the concentration of carbon dioxide in the atmosphere, but hopes that this action will inspire other actions that will.

Competing interests: none declared.