Climate change and sustainability: leadership, action from doctors

We are in a long-standing climate emergency and if you are not frightened, then you should be

DOCTORS, medical specialty colleges and the Minister for Health, the Hon Mark Butler MP, last week joined the Australian Medical Association (AMA), represented by the new President Professor Steve Robson, and Doctors for the Environment Australia (DEA) for the second annual meeting of Climate change and sustainability: leadership and action from Australian doctors.

The webinar, held on 9 August, put the spotlight on our changing climate and on the paramount importance of minimising its impacts.

Much can change in a year – politically, socially, scientifically (we’re seeing a continual rising of global temperatures and attributable extreme weather events) and professionally. It was therefore very encouraging to see increasing galvanisation for action on climate change from the Australian medical profession.

As outlined in this communiqué from the AMA, DEA and 11 medical specialties, the time to act is now. To get our own house in order, we need to equip health care professionals to care for patients and populations impacted by adverse health effects and to significantly cut the emissions of Australia’s health care sector, which is 7% of Australia’s total, by 2030.

Minister Butler acknowledged the huge physical and mental health impacts of climate change, emphasising how vulnerable Australians’ health was to heat impacts, vector-borne diseases and bushfire smoke and trauma. He reaffirmed the government’s commitment to a National Climate Change and Health Strategy, which will have three priority areas:

1. reducing the health care sector’s emissions;
2. preparing the health sector for the impacts of climate change; and
3. maximising the synergies between good public health and good climate policy, such as active transport, green energy supply and sustainable dietary choices.

Professor Steve Robson said that as President of the AMA he would endeavour to set the health agenda and push for strong action to protect Australians and the next generation from the health effects of climate change, which he described as “a crisis so enormous that it’s almost impossible to grasp”.

Laureate Professor Nick Talley, Editor-in-Chief of the MJA, and Professor Alexandra Barratt from the University of Sydney presented key addresses to an audience of over 300.

Professor Talley left no one in doubt that “every single one of us (medical practitioners) has a duty of care to be involved” in climate advocacy.

“We are in a long-standing climate emergency” and “if you are not frightened, then you should be”, he said. He outlined the reasons for this urgency and pointedly asked all of us, as medical professionals, to consider whether we are doing enough to mitigate climate change and “to act”.

Professor Barratt leads the University of Sydney’s Wiser Healthcare research collaboration for reducing overdiagnosis and overtreatment. She highlighted the significant carbon footprint from harmful and low value care, estimated at over 20% of the health care sector’s emissions, and drew attention to the connection between low value care and increasing demands on the health care sector (as well as a financial burden).

Professor Barratt called for a systems approach to solutions, reminding us that while we may all be part of the problem, we are also all part of the solutions, including considering the culture in which we practice at the micro (individual), meso (institutional) and macro (government) levels. This is an enormous task but as Prof Barrett pointed out, “there is something for everyone”. We all need to be involved.

Leadership and action from our specialty colleges.

The majority of Australian medical colleges are showing leadership in climate action, as was evident with presentations from 11 organisations at the webinar.

Points included (but in no way limited to):

• the association between air pollution and exacerbation of skin diseases from the Australasian College of Dermatologists (ACD);
• the very real and present impact of extreme weather events on emergency departments from the Australasian College for Emergency Medicine (ACEM);
• how the effects of the climate emergency are being especially felt by rural and remote communities from the Australian College of Rural and Remote Medicine (ACRRM);
• the association with increasing severe weather events and increase rates of anxiety, depression and post-traumatic stress disorder from the Royal Australian and New Zealand College of Psychiatrists (RANZCP);
• how climate change is affecting physical activity and sport at all levels from the Australasian College of Sport and Exercise Physicians (ACSEP);
• increased advocacy, resources and establishment of special interest groups/networks from the Australian and New Zealand College of Anaesthetists (ANZCA), the College of Intensive Care Medicine of Australia and New Zealand (CICM), the Royal Australian College of General Practitioners (RACGP), the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) and many others;
• leadership in political advocacy by initiating the Healthy Climate Future Campaign from the Royal Australasian College of Physicians (RACP) and;
• the development of an Environmental Sustainability Strategic Plan from the Royal Australasian College of Surgeons (RACS), with the salient point from Emeritus Professor David Fletcher that even the “surgeons are starting to surge”.

Dr Kate Charlesworth, Senior Advisor, Climate Risk and Net-Zero Unit at NSW Health synthesised the evening’s presentations.

Dr Charlesworth reiterated that climate change is a threat multiplier, exacerbating existing disease, that Australia is at the frontline of climate change impacts, that as doctors we have a duty of care, and that the response to climate change needs to be similar to our pandemic responses, as called for in this editorial published in over 200 medical journals including the MJA in 2021.

Dr Charlesworth suggested that every specialty consider how they can advocate and work towards advancing in their area by following the overarching principles of prevention, mitigation (including the reduction of low value care) and adaptation (preparing for the unavoidable by building resilience into our health care system). There are calls for an “assertive public health campaign”.

As Convenor of DEA’s Sustainable Healthcare Special Interest Group, Dr Eugenie Kayak also emphasised the need to lead the change we want to see. Doctors working collectively are a powerful and respected voice. We should all be supporting net zero health care emissions by 2040 with an 80% reduction by 2030, as endorsed by the AMA, DEA and the Australian Nursing and Midwifery Federation, sending a clear message to federal and state governments and industry of the need for coordinated approaches to decarbonising our sector with the development of national and state-based sustainable health care units, as outlined in DEA’s National Proposal.

Doctors can advocate to ensure all new hospitals eschew gas infrastructure and are all electric (net zero) and continue to support our colleges and institutions to act and educate present and future doctors to be equipped to care for patients whose health is affected by climate change, while simultaneously moving rapidly towards environmentally sustainable practices.

Dr Eugenie Kayak is Convenor of DEA’s Sustainable Healthcare Special Interest Group, Enterprise Professor of Sustainable Healthcare at the University of Melbourne, and an Anaesthetist.

Dr John Van Der Kallen is Chair of Doctors for the Environment Australia and a Rheumatologist.

Professor Stephen Robson is the President of the Federal AMA.

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

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