{"id":51092,"date":"2021-10-07T09:42:11","date_gmt":"2021-10-07T08:42:11","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=51092"},"modified":"2021-10-12T08:18:40","modified_gmt":"2021-10-12T07:18:40","slug":"talking-to-patients-about-the-climate-emergency","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/10\/07\/talking-to-patients-about-the-climate-emergency\/","title":{"rendered":"Talking to patients about the climate emergency"},"content":{"rendered":"<p><i><span style=\"font-weight: 400\">If the NHS is to reach net zero, we need to talk about the climate emergency in every part of the healthcare service<\/span><\/i><\/p>\n<p><span style=\"font-weight: 400\">The <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/33278353\/\"><span style=\"font-weight: 400\">c<\/span><span style=\"font-weight: 400\">limate emergency is the single greatest threat to human health<\/span><\/a><span style=\"font-weight: 400\">,<\/span><span style=\"font-weight: 400\"> 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 <\/span><a href=\"https:\/\/www.carbonbrief.org\/guest-post-calculating-the-carbon-footprint-of-the-nhs-in-england\"><span style=\"font-weight: 400\">UK healthcare system contributes around 5% of the UK\u2019s carbon footprint<\/span><\/a><span style=\"font-weight: 400\">. In October 2020, the <\/span><a href=\"https:\/\/www.england.nhs.uk\/greenernhs\/a-net-zero-nhs\/\"><span style=\"font-weight: 400\">Greener NHS Net Zero report<\/span><\/a><span style=\"font-weight: 400\"> 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.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The climate emergency and ecological degradation are already having a <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/33278353\/\"><span style=\"font-weight: 400\">major effect on people\u2019s mental and physical health<\/span><\/a><span style=\"font-weight: 400\"> and this is predicted to increase in the coming years. The covid-19 pandemic may be linked to the way <\/span><a href=\"https:\/\/www.carbonbrief.org\/q-and-a-could-climate-change-and-biodiversity-loss-raise-the-risk-of-pandemics\"><span style=\"font-weight: 400\">humans interact with nature<\/span><\/a><span style=\"font-weight: 400\">, and <\/span><a href=\"https:\/\/www.gov.uk\/government\/publications\/health-matters-air-pollution\/health-matters-air-pollution\"><span style=\"font-weight: 400\">air pollution directly affects health<\/span><\/a><span style=\"font-weight: 400\"> worldwide. <\/span><a href=\"https:\/\/www.imperial.ac.uk\/grantham\/publications\/all-publications\/the-impact-of-climate-change-on-mental-health-and-emotional-wellbeing-current-evidence-and-implications-for-policy-and-practice.php\"><span style=\"font-weight: 400\">The mental health effects of the climate emergency are significant<\/span><\/a><span style=\"font-weight: 400\"> and more and more people, especially the young, are reporting <\/span><a href=\"https:\/\/www.rcpsych.ac.uk\/docs\/default-source\/improving-care\/better-mh-policy\/position-statements\/position-statement-ps03-21-climate-and-ecological-emergencies-2021.pdf\"><span style=\"font-weight: 400\">anxiety about the climate<\/span><\/a><span style=\"font-weight: 400\">. For all these reasons, we need to learn how we can engage our patients in discussion about the climate and ecological emergencies.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Bringing up environmental issues during consultations is not easy. Climate psychologists refer to a \u201c<\/span><a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1111\/zygo.12407\"><span style=\"font-weight: 400\">socially constructed silence<\/span><\/a><span style=\"font-weight: 400\">\u201d 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. <\/span><span style=\"font-weight: 400\">We need to understand that our colleagues and our patients are all at different stages in their willingness to talk about the climate emergency. <\/span><span style=\"font-weight: 400\">Widely accepted<\/span><a href=\"https:\/\/journals.sagepub.com\/doi\/10.1177\/0030222819869396\"><span style=\"font-weight: 400\"> theories about the grieving process<\/span><\/a><span style=\"font-weight: 400\"> may offer a <\/span><a href=\"https:\/\/climatepsychologyalliance.org\/handbook\/321-grief\"><span style=\"font-weight: 400\">model<\/span><\/a><span style=\"font-weight: 400\"> 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.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Anxiety about the environment is a normal reaction to the climate and ecological emergency. It\u2019s 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.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Environmental issues are relevant in many areas of medicine.<\/span><a href=\"https:\/\/www.nice.org.uk\/guidance\/ng80\/resources\/inhalers-for-asthma-patient-decision-aid-user-guide-pdf-6727144574\"><span style=\"font-weight: 400\"> Guidance from the National Institute for Health and Care Excellence <\/span><\/a><span style=\"font-weight: 400\">on inhaler choice for asthma now includes the relative carbon footprint of metered dose versus dry powder inhalers. <\/span><span style=\"font-weight: 400\">General Medical Council (GMC) guidance on prescribing is that <\/span><a href=\"https:\/\/www.gmc-uk.org\/-\/media\/documents\/Prescribing_guidance.pdf_59055247.pdf\"><span style=\"font-weight: 400\">clinicians should discuss common side effects<\/span><\/a><span style=\"font-weight: 400\">. 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. <\/span><span style=\"font-weight: 400\">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.<\/span><\/p>\n<p><span style=\"font-weight: 400\">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 <\/span><span style=\"font-weight: 400\">Green Impact for Health toolkit<\/span><span style=\"font-weight: 400\">, and that their social prescribers offer green therapies and nature activities will legitimise the topic.<\/span><\/p>\n<p><span style=\"font-weight: 400\">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 (\u201cis this doctor more interested in the environment than my health?\u201d) 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.<\/span><\/p>\n<p><span style=\"font-weight: 400\">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 \u201cclimate change journey\u201d 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 \u201ceco-distress\u201d and providing information and links to community groups to enable people to engage in meaningful action.<\/span><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Guy Harvey<\/strong>, consultant psychiatrist CNTW NHS Trust, member of the Planetary Health and Sustainability Committee, RCPsych and lead for sustainable models of care, CNTWClimateHealth.\u00a0<\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Mike Tomson<\/strong> is a clinically retired GP, active in Greener Practice nationally and in Sheffield, the RCGP\u2019s Climate Emergency Action Group, and is an associate with Centre for Sustainable Healthcare.\u00a0<\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Amelia Cussans<\/strong> is a psychiatry core trainee, co-founder of CNWL Green Group and Healthcare Arts Collective. Twitter: @DrAmeliaCussans\u00a0<\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Helen Twohig<\/strong> is a GP and Wellcome Trust Primary Care Doctoral Research Fellow at Keele University. <\/span><span style=\"font-weight: 400\">Member of the Sheffield Greener Practice group.<\/span><span style=\"font-weight: 400\"> Twitter: @H2Norman<\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Angela Wilson<\/strong> is a GP in West Oxfordshire and is climate and sustainability lead for Thames Valley Faculty RCGP @angemwilson @ArtsHealthcare<\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\">Written on behalf of the members of the GP, Psychiatrist and Pharmacist Short Life Working Group on reducing the environmental impact of pharmaceuticals.<\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\">Competing interests: none<\/span><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>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 [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2021\/10\/07\/talking-to-patients-about-the-climate-emergency\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":66,"featured_media":51116,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[266],"tags":[],"class_list":["post-51092","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-climate-change"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - 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DECEMBER 17: Carol Patrick before receiving her Covid-19 vaccination from Dr Gianni Domgo at the Bodmin Treatment Centre Covid-19 vaccination clinic on December 17, 2020 in Bodmin, England. Bodmin GPs were among the first three primary care network-led GP surgeries to run local vaccination services in Cornwall. 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