Medical ethics in the anthropocene – the health sector must divest from industries impacting planetary health

By Christian M. Schulz.

The fifth mass extinction began 66 million years ago after an asteroid, measuring 10 kilometers in diameter, hit the peninsula of Yucatán. At the end of this huge loss of biodiversity, caused probably by ocean acidification, the most prominent victims were the dinosaurs. Currently, biodiversity is declining faster than at any time in human history, i.e. the sixth mass extinction has begun. It’s driven mainly by increase of and changes in land-use, climate change, ocean acidification, pollution of water and air, growth of both human population and the economy, wrong economic incentives and increasingly less natural habitat being stewarded by indigenous peoples. As human activities are the main drivers of these changes in planetary systems for the first time in our planet’s history, a new geological epoch has been proposed: the Anthropocene.

To stop loss of biodiversity and climate warming well below the 2° Paris agreement, a quick transformation process to a resource-neutral, fossil-free economy is needed. Unfortunately, for a long march of Greta Thunberg’s Fridays for Future movement through the institutions there is not enough time. In contrary, this transformation has to be performed as quickly as possible, before any climate tipping points (e.g. the loss of ice sheets) are surpassed that result in uncontrollable acceleration of global warming.

For this purpose, social tipping interventions must be used. They contribute to a rapid transformation of the current world system to a system of net zero anthropogenic greenhouse gas emissions.

Two social tipping interventions are combined in our paper: 1) divestment, which is a social tipping intervention in the financial system and 2) the extension our understanding of medical ethics to planetary health as an inherent target, which is a social tipping element in in the system of norms and values.

With respect to medical ethics, the rationale is clear and not any longer negotiable: planetary health is a prerequisite of human health and life. If the physicians account for the side effects impacting planetary health during their daily routine, several obligatory fields of action emerge: setting the carbon footprint of the health sector to zero, increasing the resiliency of the health sector for consequences of climate change, reducing their negative impact on planetary health as private persons, using their role as an important political voice in any society and educating the patients. And finally, physicians can influence how capital is invested, which refers to divestment as second important social tipping point in this context.

Physicians must argue that their own pension funds and even private health insurers capital has to be invested according to medical ethics. In Germany, physicians’ own pension funds account for more than €100 billion and are controlled by themselves. Last year, we commented in Lancet Planetary Health that we were not able to get quantitative data about the application of environmental, social and governance criteria in these funds.

In the private health insurers, our results were different at the first glance. They also manage significant capital reserves (€353 billion) but, in contrast to the physicians’ pension funds, they are under competition that is the patients can elect between them. As illustrated in the paper, we received data from 11 insurers about capital reserves of €66 billion. For this money, environmental, social and governance (ESG) criteria are applied only in part and, for example, no insurer excluded the production of oil from their assets although it is well known since many decades that burning oil is harming. Well, perhaps we were all misled by the oil industry.

The remaining insurers did not provide data or did even not respond to our query, illustrating a lack of transparency, equally to the physicians’ pension funds. As a consequence, we fear that ESG criteria are not generally applied so far when health insurers elect the investments for their portfolio. Of course, our investigation is limited to Germany.

The result of this narrative is, in face of the sixth mass extinction in the planet´s history and the first one (and maybe also the last one) made by ourselves, that physicians must foster the public discourse on this topic. Currently, about 9 million physicians worldwide care for 8 billion planet inhabitants, we have responsibility for them – and we have power. We must publicly debate whether harmful investments in tobacco, arms or fossil fuels are ethically acceptable. Furthermore, we must promote the divestment from industries whose business model is not likely to increase planetary health. And finally, being the social tipping intervention number two, let´s make planetary health become a central part of medical ethics.


Paper title: Do private German health insurers invest their capital reserves of €353 billion according to Environmental, Social and Governance Criteria?

Authors: Frederick Schneider1; Julia Gogolewska2; Klaus-Michael Ahrend3; Gerrit Hohendorf4; Gerhard Schneider1; Reinhard Busse5; Christian M. Schulz1,2


  1. Technical University of Munich, School of Medicine, Department of Anaesthesiology and Intensive Care, München, Germany
  2. KLUG – Deutsche Allianz Klimawandel und Gesundheit e.V., Berlin, Germany
  3. Faculty of Business, Hochschule Darmstadt – University of Applied Sciences, Darmstadt, Germany
  4. Technical University of Munich, School of Medicine, Institue of Ethics and History in Medicine, München, Germany
  5. Faculty of Economics and Management, Technical University Berlin, Berlin, Germany)

Competing interests: None.

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