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The climate emergency is a health emergency

We all have a duty to tackle global heating. Professor Donal O’Donoghue, RCP registrar, discusses the responsibility of the health service, the NHS Net Zero report, and what we can do to help.

In 2014, the Intergovernmental Panel on Climate Change (IPCC) released an assessment report outlining the impact of climate change on our world. Global heating is already influencing weather patterns across the globe, and it will mean more intense storms and floods, more frequent heatwaves and increased risk of spread of infectious diseases in the future. In lower- and middle-income countries, access to clean water and food chain disruption will become significant issues.

We have a duty to tackle climate change and the good news is this will bring a huge benefit to the nation’s health. It’s estimated that if the UK reaches its Paris Climate Change Agreement ambitions, it could save over 5,700 lives per year in the country from improvements in air quality alone.

As the largest employer in Britain and responsible for around 4% of the nation’s carbon emissions, it’s clear that the NHS, and we as clinicians, have a huge part to play in helping to mitigate the negative effects of climate change.

We called attention to the responsibility of the NHS to be a lead in tackling global heating in 2017 in our report Breaking the fever: sustainability and climate change.

That’s why it is welcome news that the NHS is committed to becoming the world’s first ‘net zero’ national health service. In its recently published 'Net Zero' report, the NHS promised to reduce emissions to zero for core NHS care by 2040, and across the entire scope of NHS activity, including the whole supply chain and procurement by 2045.

I am a member of the Net Zero group. Delivering the report in spite of COVID-19 attests to our commitment and, equally important, the support of the NHS senior team. Its ambitious goal is equivalent to removing 31 metric tons of carbon dioxide equivalent from the NHS’s carbon footprint, roughly the same as the emissions profile of the entire country of Croatia. Cooperation from all areas of the health service will be required to achieve it.

This is a problem that affects the whole system, so it’s also important that social care, public health, and other public services and government departments work together for a strong response to the climate emergency.

The RCP responded to the Net Zero call for evidence with three key recommendations to help lower NHS emissions:

  • Redesign of outpatient services: alternatives to face-to-face consultations can make a significant contribution to tackling air pollution from road traffic, while also providing clinical input in a more convenient way for patients.
  • Embedding sustainability in quality improvement: providing a practical way to help lower emissions, as well as other benefits such as additional motivation for clinicians to engage in quality improvement.
  • Reducing waste through the power of procurement: transportation, production and disposal of pharmaceutical and medical devices accounts for almost 60% of the NHS’ overall carbon footprint. To find out ways in which trusts and clinicians can take action, see our report Less waste, more health.

Our work on health inequalities and air quality also point the way to a greener future for the NHS. Improving air quality and planting more green spaces will bring most benefit to disadvantaged communities who are hit hardest by poor environments. Another strategy is preventing ill health in the first place. This benefits patients, but also increases efficiency and reduces emissions. In one example from the Net Zero report, the Alcohol Care Team in Nottingham University Hospitals NHS Trust achieved a two-thirds reduction in hospital admissions due to detoxification and alcohol-related cirrhosis, saving 36 bed days per month. Over a year this adds up to a huge carbon saving, as well as improved health outcomes.

The world is not currently on track to meet the goals of the Paris agreement, and this November was set to be the date of the UN climate change conference (COP26) in Glasgow, 5 years on from when the Paris agreement was first signed. The conference has been postponed for a year because of the impact of COVID-19, which means next year COP26 will be an opportunity to coordinate global action, and it’s crucial that real progress is made.

On an individual level, it’s easy to get hijacked by climate anxiety which can inhibit action; a feeling of helplessness and dread at the scale of the problem or thinking that perhaps nothing we do will have an impact in the long run. We need to have compassion for ourselves and others when facing up to the realities of climate change.

In reality, there is much that individual clinicians and multidisciplinary teams (MDTs) can do to aid the NHS in its zero-emission ambition, and fight against climate change as a whole. For example, encouraging your trust to provide alternatives for active travel (such as cycle to work schemes), promoting the inclusion of sustainability in quality improvement and thinking about how long-term outpatient redesign would work in your clinic.

Individual action together with committed leadership from the top and a willingness to embrace change together will make a huge difference for the planet and all future generations to come.