Let’s get practical: how we can heal the planet and our patients

WE present six practical measures doctors can take, and can encourage their patients to take, which will have a positive impact on emissions and climate change while also improving health outcomes.

The global scientific consensus on anthropogenic climate change is now unequivocal.

The 2015 Lancet Commission article Health and climate change: policy responses to protect public health emphasised that “tackling climate change could be one of the greatest global health opportunities of the 21st century”. Within this response, the health community has a vital role to play.

The United Nations Environment Programme Emissions gap report 2019 found that we are still on course for a 3.2°C temperature rise by the end of the century, leading to severe health, social, economic and environmental impacts. Extreme weather events, changing disease vectors, food and water scarcity, air pollution and major social and economic impacts have far-reaching implications for the health of communities on local and global scales, highlighting the social and ecological determinants of health.

The health care system accounts for 4–6% of global greenhouse gas emission, meaning if it were a country, it would be the fifth largest emitter on the planet. Given the enormity of this challenge, what actions for therapists and patients are pragmatic, achievable and have potential for major positive impacts?

Here we review six practical changes health professionals can do themselves and recommend to their patients. The following six points are not a complete list, nor a complete examination of the nuances of each point. They are, however, what we consider to be simple changes with high yields resulting in a “win–win–win” situation for individuals, the health system and our planet.

Deprescribing versus lifestyle and social prescribing

The sectors responsible for the greatest proportion of total greenhouse gas emissions are hospitals (44%) and medications/pharmaceuticals (18%), with pharmaceutical prescriptions being the largest contributor in general practice. Non-communicable chronic diseases are now the greatest disease burden in Australia, with about 80% being preventable with lifestyle interventions.

Here is a clear opportunity for replacing medication, where appropriate, with evidence-based lifestyle interventions for common chronic diseases such as type 2 diabetes, hypertension, major depressive disorder and anxiety disorders. Evidence-based guidelines from Primary Health Tasmania are available to assist with sensible deprescribing and reduction of polypharmacy.

Where deprescribing is not an option, prescribing low carbon alternatives — such as dry-powder inhalers (eg, accuhalers, handihalers and turbohalers) instead of metered-dose inhalers — may be considered. A 2017 assessment of GSK respiratory inhalers by the Carbon Trust showed that the lifecycle carbon footprint of DPIs is around 24 times lower than a propellant-based inhaler for one month’s treatment.

Access to medical appointments

The Kings Fund calculated that 17% of the UK’s National Health Service carbon emissions are linked to health staff and patient travel. Hence, greater use of telehealth appointments and lower carbon alternatives to transport (eg, walk, ride, public transport) are effective strategies, where safe and appropriate. What’s more, active transport in a clean environment is good for health.

Food choices

The EAT–Lancet Commission report indicated that food production is responsible for up to 30% of global greenhouse gas emissions and 70% of freshwater use. Food sourced from animals, especially red meat and grain fed livestock, has relatively high environmental footprints per serving compared with other food groups, affecting greenhouse gas emissions, land use, and biodiversity loss.

Replacing 100% of beef intake with poultry reduced mean dietary greenhouse gas emissions by 35.7%. When replacing all beef, pork or poultry intake with plant-protein foods, the greenhouse gas emissions decreased by 49·6%, the mean Healthy Eating Index increased by 8·7%, and dietary costs decreased by 10·5%. When choosing meat, the EAT–Lancet Commission recommends sourcing meat from farmers that practise regenerative agriculture. This type of farming contributes to carbon storage in the soil, keeps water away from pollutants, and provides room for local biodiversity to flourish.

Dr Charles Massy, agricultural scientist and author of Call of the reed warbler, offers inspiring insights for the role of regenerative agriculture in Australia.

“The common ground amongst these sources, which allows for a variety of eating styles personalised to individual and cultural needs, is minimal processed food (like sugar and refined grains) and industrialised meat, more plant foods and when choosing meat then to make it from regenerative agriculture and permaculture sources.”

Furthermore, between 20% and 40% of fruits and vegetables are rejected before they even reach the supermarket shelves, and Australians discard at least 20% of the food they purchase. Hence, utilising what food we produce and buy is a simple and easy measure to achieve a more sustainable impact.

Switch to renewable energy

The energy sector continues to be the dominant source of Australia’s greenhouse gas emissions, accounting for 74% of net emissions and a major source of air pollution, both largely due to fossil fuels. Air pollution is a major health risk, accounting for almost 800 000 deaths a year in Europe. In Australia, the health costs from air pollution-associated mortality alone are estimated to be in the order of $11–24 billion per year. There are now multiple energy providers that source 100% of their energy from renewables and are similar in price as standard providers, hence an easy switch. Installing renewable energy sources, such as solar power and batteries are also options, but require more initial investment.

Invest ethically

Moving our money to align with community and planetary health is a very effective strategy. Unless specifically requested otherwise, money placed in superannuation and investment portfolios will be in a “default” fund that is invested in industries that undermine human health, such as tobacco, alcohol, fossil fuels, gambling and weapons manufacturing.

Multiple superannuation and investment organisations solely focus on ethical and socially responsible investment and many mainstream funds now offer ethical and socially responsible portfolio options. A 2020 analysis by the Responsible Investment Association Australasia showed that responsibly invested Australian share funds produce comparable outcomes to mainstream funds, and responsibly invested international share funds outperformed their mainstream peers over 3-, 5- and 10-year time frames.

Offsetting emissions 

Per person, Australia’s carbon dioxide emissions in 2013 were 16.8 tonnes per year, the second largest of countries in the OECD, 75% higher than the OECD average of 9.6 tonnes. Greenhouse gas emissions associated with our personal and professional lives or medical practice are easy to calculate online. It is then possible to donate to an organisation that offsets those emissions with various projects, such as tree planting, soil sequestration projects, renewable energy projects and sustainable farming education.

The cost to offset these can be less than $10 per tonne to up to $50 per tonne depending on the project supported, which equates on average to about $170–$850 per year or $14–$70/month per individual, an expense well within the grasp of most health professionals. The majority of carbon offset providers in Australia are now legitimate as a result of stringent standards.

Another option for donations is to organisations that empower women with education and autonomy (including sexual autonomy). The greater the education and autonomy that girls and women have the better the outcomes for them, their children, the society and natural world at large. They are more likely to decide if and when to have a family, have lower rates of infectious illness (e.g. HIV), marry later, have the choice to pursue careers, have fewer children with higher childhood survival rates, leading to the stabilisation of populations.

We have reached a time in human history when we are called, as health professionals, to truly understand that human health is intimately related to, and dependent upon, the health of the earth. We are faced with a great challenge: an impetus to act. As we join the global movement of health professionals who are practising planetary health, we invite you to join too. Why? Because everyone’s health depends on it.

Dr Sam Manger is a GP, host of The GP Show podcast, Senior Lecturer with James Cook University and President of the Australasian Society of Lifestyle Medicine.

Dr Nicole Sleeman is a GP and active member of Royal Australian College of General Practitioners Climate and Environmental Medicine special interest group and Doctors for the Environment Australia.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.