Consciousness and concern about the climate emergency are growing across society – the evident impact on the health and wellbeing of global populations is acknowledged by healthcare institutions underscored by robust evidence. Articles about the response to the threats we face feature with increasing frequency across medical literature and this is to be welcomed. However, the majority of such articles revolve around personal lifestyle choices and sustainability leadership within the NHS. Sustainability makes sense philosophically and economically – of course leaders should make systematic efforts to reduce consumption and carbon emissions within the NHS. Similarly, personal lifestyle choices to reduce our individual carbon footprint are consistent with a sustainable future. And yet, I contend that this is not enough. The narrative that delivering a net zero NHS will make a difference to the trajectory we are on is fiction – it will not.
The climate crisis is a global health emergency and our leadership ambitions must extend beyond NHS sustainability efforts. National emissions of carbon dwarf the 4-5% of the UK climate footprint generated by the NHS, and yet our government is on course to open new fossil fuel infrastructure in direct contravention of its own net zero targets. Health professionals and institutions have a duty to exert pressure on a political system that is both unwilling and unable to mandate the fundamental structural changes we need. Exactly how such pressure should be exerted is up for debate. The evidence-based alarms that scientists have been sounding for decades have failed to translate into meaningful policy. Similarly, a collaborative call for emergency action from the trusted voices of hundreds of medical journals, including the BMJ, in 2021 went unheeded.
Given the urgency of the situation, I believe leadership on the climate crisis must include breaking out from conventional professional and academic constraints that have been insufficient to drive rapid carbon reductions. In my view, this extends to acts of nonviolent direct action (NVDA), now being undertaken by groups including Scientists for Extinction Rebellion and Doctors for Extinction Rebellion and supported by academic leaders such as Richard Horton, editor of the Lancet, and Fiona Godlee, previous editor of the BMJ. This is potentially a controversial issue for largely rule-abiding professionals who might rather remain in the comfort zone of local sustainability projects, but true leadership in the context of a crisis requires personal and professional risk.
Nonviolent direct action has a number of goals. Firstly, to keep the climate emergency in the public consciousness in a context where mainstream media has little interest in covering the scientific basis for this situation or the pending health implications. Secondly, to put pressure on the government to take the immediate steps laid out by the Intergovernmental Panel on Climate Change (IPCC) and the United Nations; namely, to guarantee no new fossil fuel projects and rapidly transition to alternative energy sources. NVDA has a successful track record of prompting governments to change – consider US civil right and Indian independence. The third, and perhaps lesser-known demand of Extinction Rebellion is the creation of citizen assemblies. The carbon reductions required to address the climate emergency will require mandatory changes to lifestyle that will not be universally popular. Citizens assemblies devolve power from the political parties who have financial and electoral reasons not to impose restrictions on individual liberties, even where this is necessary for human wellbeing. Rather, a representative sample of the population determine how carbon reductions, and public spending on sustainable infrastructure can be most equitably disseminated across society. Despite evidence that citizens assemblies can help to resolve contentious issues, the UK government have rejected their role – NVDA may help to drive these forwards, and push towards a collective leadership approach for change.
Exactly what actions to take, particularly in the changing context of legislation around protest, is a challenge in itself; the law and morality are not synonymous. Deciding to break the law requires professionals to weigh up potential sanctions from employers and regulators with their conscience – several have already taken this courageous decision despite the personal risks that this entails. NVDA actions taken by healthcare professionals thus far include road-blocks, damaging windows of fossil fuel financiers such as JP Morgan, and aggravated trespass. The General Medical Council (and other regulators such as the HCPC) are likely to be faced with increasing numbers of professionals self-referring in relation to criminal charges and convictions related to protest as the climate emergency unfolds, and will need to decide if these transgressions are ethically justified.
As healthcare professionals we have a duty to our patients – the GMC states that we must “protect and promote the health of patients and the public” – but to do this we must protect our planet. We know that the climate emergency is already killing people and threatening the health of millions more. We must go beyond restating the facts about the climate emergency, making individual sustainable lifestyle choices, and education about sustainability. For professionals who are understandably scared, frustrated or despairing about the lack of progress, it may be worth considering if true leadership could also involve moving out of your comfort zone to take action outside of the NHS. This might mean joining a group engaged in NVDA. If we genuinely care for the health of our patients and the wider population, I believe we must reconsider our leadership strategy to have the best chance of changing policy beyond the NHS.
Dr Ellen Tullo, Geriatrician
Dr Ellen Tullo combines clinical sessions at a district general hospital with a role as Academic Career Development Lead for Sunderland Medical School. She is involved in undergraduate and postgraduate teaching about geriatric medicine, academic careers and medical education research. She also works with Health for Extinction Rebellion to raise awareness of the climate emergency.
Declaration of interests
I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: I am a member of Extinction Rebellion and Health for Extinction Rebellion (previously Doctors for Extinction Rebellion).