Becoming a parent is an extraordinary thing. Few will forget the moment they held their baby for the first time, and the countless humdrum yet astonishing moments that followed as their child learned, smiled, walked and talked. Parents of young children often spend hours outside, perhaps deepening our sense of connection with the natural world. Seeing it through our children’s eyes, we appreciate anew the wonder of the world around us. All parents have some sense of the future we want for our children – and we begin to wonder what that future will look like.
For many parents, this is when the reality of the climate crisis hits us. Rising sea levels, extreme weather events, mass displacement, food shortages: the painful, probable (but not inevitable) world in store for our children. We start making changes; perhaps we think more about our energy usage, consumer habits, travel, and the food that we eat. We desperately want to protect our child from a future we can clearly see if global emissions continue to rise.
It is important to note that anxiety about the future can be seen as a relative privilege; in many parts of the world, people are already living with the painful reality of the climate crisis, including fires, flooding, and disruption to food and water supplies. These people are more likely to experience hypervigilance and trauma responses than anxiety. Climate change exacerbates preexisting inequalities, both within the UK and globally, and the drivers of climate change are also the drivers of health inequality. Children are already disproportionately affected by climate change due to their vulnerability to infectious disease, pollution, food and drinking water shortages, and extreme heat, which makes the role of parents in the climate movement even more pressing.
The authors of this article are also doctors, and the role of the doctor and the parent overlap. This is never truer than when seen through the climate lens. Many parents feel guilt at the thought of compounding our own carbon footprint by bringing a child into the world, along with guilt about the life our children potentially face. Doctors are often acutely aware that the NHS, despite our mantra of “First Do No Harm”, contributes to 4% of the UK’s national yearly CO2 emissions. We care deeply for our children and our patients but are helplessly complicit in a process that will cause great suffering. This is now increasingly recognised as a form of occupational moral injury: a response when those working in a field (often in an emergency or combat setting) contribute to, or feel unable to prevent, actions that “violate deeply held moral principles”. Moral injury is linked to psychological distress and associated emotions such as anger, guilt and disgust, along with an erosion of trust and a sense of betrayal from those in positions of leadership and authority.
In turn, it is not surprising that many of us feel overwhelmed by the scale of the problem and our own limitations. However, beyond fear and guilt, strength can be drawn from being a doctor, parent and leader during this period of crisis. The privilege of being a parent and a doctor allows us to lead from a position of true motivation: fighting for those who are most vulnerable and have no voice. Caring is a fundamental component of medicine, parenthood and effective leadership; these roles require empathy and an ability to look beyond ourselves and what we immediately understand.
Thinking about climate change can evoke a strong emotional response. A broad range of terms can be used to describe this, including eco-anxiety and eco-distress. Specific vulnerable groups (such as indigenous people and young people), who are most likely to be impacted, are unsurprisingly the most likely to suffer from feelings of anxiety, grief, or hopelessness related to the climate crisis. Healthcare professionals and parents play an important role in recognising and supporting those experiencing eco-distress. Creative communication is fundamental: Doctors and parents are already experienced in talking to and listening to people who are scared, angry, or may not initially wish to hear what we have to say or feel able to express their opinions and feelings. We can provide validation for these difficult feelings, which may empower people to take their own steps towards climate action. Leaders responsible for championing sustainable care or raising awareness must in turn ensure they and their colleagues find a way to support one another.
A reflective group, “Living with the Climate Crisis”, was recently co-led by one of the authors for medical mothers as part of a wider piloting project. Using a structured format, it aimed to support participants to understand their complex emotions around the climate crisis and to find a way to move forwards with positivity and empathy. Over a series of twenty hour-long sessions, themes such as anger, guilt and fear were explored, along with our role in a wider system and changes we could make as individuals. An interesting finding from the group was how many participants were directing their ideas for change to their local schools, parent groups, or council buildings – the spaces they occupy first and foremost as parents. They commented that the complexity and vastness of the NHS can feel overwhelming, although we know that small changes may make a lasting difference.
As parents, we have an instinct to sacrifice personal gain in the interests of our children’s safety and wellbeing. In becoming doctors and parents we have, willingly or not, become leaders both inside and outside our work. We have drawn on skills we did not know we possessed and found wells of patience and stamina that ran deeper than we knew. There is no right or wrong way to tackle the climate crisis; there is only the way that works for each person, at a particular time in their life.
As healthcare professionals, we have the opportunity to lead change within the NHS and the organisations in which we work. We have scientific fact, and expertise on disease and suffering. We know that the climate crisis is also a health crisis, and that the drivers of climate change are the drivers of illness and health inequalities. The GMC Good Medical Practice has now been updated to include sustainable healthcare, but given our ever-growing understanding of the full implications of climate change, it can be argued these guidelines do not go far enough. The UK Health Alliance on Climate Change recently issued a statement emphasising our ethical duty as a profession to highlight the need for urgent, radical, systemic change.
Taking action can give us a sense of hope, reduce feelings of isolation and moral injury, and may provide the motivation to overcome the paralysis of eco-anxiety. We can manage our own eco-distress by playing our part in the response to the climate crisis. We have the ability to demand and to build a more sustainable National Health Service, and world, for ourselves, our patients, and most importantly, for our children.
Our children are the future generation, and the decisions we make today will affect them tomorrow. We need to make the right decisions and to lead, as parents and as doctors.
The authors would like to acknowledge their privilege in being able to write this article from the perspective of parenthood, and extend compassion towards those readers who may be struggling with infertility or have suffered loss.
Authors
Dr Kathryn Speedy, MRCPsych, Cardiff and Vale University Health Board:
Kathryn is a higher trainee in Child and Adolescent Mental Health, based in South Wales, and a Health Education and Improvement Wales Sustainability Fellow.
Having always had a love and concern for the environment, in 2020 Kathryn applied for an RCPsych Green Scholarship and joined the RCPsych Planetary Health and Sustainability Committees and EcoCAMHS groups. Kathryn is also a member of Green Health Wales and PsychDeclares.
Kathryn’s main areas of interest are raising awareness and education for healthcare professionals about climate, nature and well-being, delivering more sustainable mental health services, and incorporating nature-based therapies into clinical care.
Dr Melanie Knowles, MRCPsych, Cornwall Partnership NHS Foundation Trust:
Melanie is a newly qualified consultant in Old Age Psychiatry, and has recently moved from North London to Cornwall. She has always had a deep-seated love of nature and a strong attachment to the beautiful region of the Southwest, and in response to growing concern about the climate crisis became a member of both the Climate Psychology Allowance and Health for Extinction Rebellion. During her final year of Psychiatry Training she held the role of RCPsych Leadership and Management Fellow for Camden and Islington NHS Foundation Trust, as well as being LNC Representative throughout her higher training. She is passionate about the use of activism, reflection and peer support to combat the paralysis of eco-anxiety and distress, as well as delivering more sustainable healthcare services in the NHS. She is the mother of an energetic toddler who shares her love of the great outdoors.
She recently cofacilitated a reflective group for doctors, as part of a wider pilot: “Living with the Climate Crisis”. There is scope for this group to continue on a wider basis, tailored for healthcare professionals in particular.
With thanks to Dr Kate Dufton, Medical Psychotherapist and co-facilitator of “Living with the Climate Crisis for Medical Mothers”.
Declaration of interests:
We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.