Choosing courage over comfort in the climate crisis: Are our health institutions prepared to do what it takes? By Rammina Yassaie

The climate crisis is the biggest health crisis we have ever faced, having been described as a “code red for humanity”. Given both the well-established health consequences of the climate emergency as well as the vulnerability of healthcare services to the threats of climate change itself, health institutions are well placed to advocate for change.

Whilst numerous royal colleges, unions and healthcare providers have declared a climate emergency, it is not unreasonable to ponder what this means in practical terms. Some UK health institutions have also volunteered to take part in a climate health scorecard initiative, which monitors and publishes their progress annually in the realms of their climate education offers, their internal operations (getting their own house in order from a carbon footprint perspective), their commitments to divesting their investments and banking from fossil fuels, as well as their role in acting as advocates for population health in the climate context. Whilst it is worth acknowledging that not all health institutions were invited to take part in this scorecard initiative, and some either did not respond or actively declined to take part for reasons one can only speculate on, the transparency and sharing of good practice in this way can only, in my view, be a good thing, and, at the very least, a starting point for progress.

That being said, over recent years increasing numbers of healthcare professionals have begun to take action on climate change into their own hands, by taking part in nonviolent direct action, in order to draw greater attention to the urgent need for a just transition from fossil fuels to prevent the impending calamity scientists have consistently warned us of, if political leaders continue to drag their feet on this issue.

In fact, over the last 4 years, there have been increasing numbers of arrests of healthcare professionals because of them taking part in peaceful civil disobedience in the name of the climate emergency, with some facing GMC Fitness to Practice proceedings and disciplinary action from their employers as a result. It is worth noting that over recent months arrests for peaceful climate protests have been far more likely, due to draconian changes in the law, which the United Nations have called “severe” and “troubling”. Professionals choosing to act in this way have argued that it is “an act of conscience” for them, and in line with the duty of care they have for their patients because the health threats from the climate emergency are so grave. Whilst some academic medical leaders have spoken up in support of their actions, arguing that these professionals are “injecting moral force into the political debate”, it is worth exploring how UK health institutions are responding to these whistleblowers of the climate emergency.

The UK Health Alliance on Climate Change (UKHACC), which brings together representatives from some royal colleges, the BMA, The Lancet and The BMJ has offered a welcome intervention by urging the GMC to be “as lenient as the law allows”, to allow doctors facing Fitness to Practice proceedings for their climate activism the opportunity to justify their actions and to appreciate the context in which these actions have been taken.

The GMC who are admittedly somewhat constrained by the requirement of the Medical Act, have responded to this request by acknowledging doctors would be given the opportunity to  “respond fully” to the allegations made against them, with a spokesperson having also  previously stated that they would make their decision “based on the specific facts of the case”, as to “whether the doctor’s actions may have fallen seriously or persistently below the standards we set.” One would assume this would include acknowledging the standards set within Good Medical Practice itself, which mandate doctors to “take prompt action” if they think patient safety “is or may be seriously compromised” which, it would seem, is exactly what these protestors have and would claim they are doing.

It’s interesting to note that progress in the GMC’s position on the climate emergency has benefitted largely from student-led movements, including the Planetary Health Report Card initiative, which has been instrumental in advocating for education for planetary health and sustainable healthcare and led to the GMC acknowledging a need to update this in their standards and outcomes. Whilst student leadership should be rightly celebrated, powerful institutions like the GMC should not rely on students to be the lever of change we urgently need.

The BMA has made headlines with its firm position on both the recent industrial action and the profession’s legitimate concerns over expansion of physician associates and they have contributed to the UKHACC letter to the GMC urging leniency in Fitness to Practice proceedings. However, they could go further and offer guidance or support to climate activist members who are taking great personal risks in line with their conscience and in the interests of public health.

In fact, to date I have found no evidence of any healthcare organisation that has publicly supported its members or employees who have felt obliged to protest in light of the growing health threat of the climate emergency.

The parallels between the suffragettes or the civil rights movement and climate protesters has frequently been articulated. We now celebrate suffragettes for their persistence, determination and willingness to risk their personal freedoms for social change, whilst at the time they were demonised for their actions.  In fact, history tells us that civil disobedience has an important, if not crucial role, in achieving meaningful social change. It may be that these acts of civil disobedience are in fact a necessary part of enabling the change we need – but is it not right that health institutions be called upon to do the right thing and support their members who are risking their own freedoms and indeed professional registrations to raise the alarm?

I worry that health institutions including regulators, unions and employing organisations who fail to speak up courageously in support of healthcare professionals who are risking their own personal freedom for the biggest health crisis humanity will likely ever face, are, at best, upholding the status quo, which is damaging to human health and, at worst, complicit in climate collapse.

The question becomes will health leaders abandon these healthcare professionals by failing to support them as they urge for the action scientists have consistently warned is needed, or will they act now to rightfully and courageously applaud them as advocates for public health?

And how will history judge health institutions that allow our climate healthcare heroes to be vilified in this way?

Author

Photo pf Rammina Yassaie

Dr. Rammina Yassaie

Rammina is a Senior Lecturer in Leadership at the Centre for Leadership in Health and Social Care at Sheffield Hallam University. Prior to this, she worked as an NHS doctor for over a decade and is alumni of both the Yorkshire and Humber Future Leaders Programme and the FMLM NHS Regional Clinical Leadership Programme. She is an editorial fellow with BMJ Leader, curates the BMJ Leader Greener Leader blog series in light of her passion for leading for planetary health and strongly believes in doing everything we can to ensure we have a safe and liveable future for all.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.

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