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The climate crisis can feel overwhelming. During a busy workday as a clinician when you’re juggling time constraints, hygiene requirements, patient requests, and administrative demands, prioritising planetary health can feel like one thing too many. However, as we increasingly witness the predicted harms of the climate crisis manifest, it has become clear that clinicians who prioritise the health of their patients must prioritise the health of the planet. In this perspective piece we — a general practitioner (GP) and a climate health researcher — challenge all clinicians to understand, prioritise and practice planetary health. A rapid scan of the literature alongside GP clinical observations have identified four key reasons for this.
1. Our patients cannot be healthy if our planet isn’t healthy.
Planetary health reminds us that human health is intricately connected to the health of Earth’s natural systems and that the health of all life on Earth is deeply reliant on it. A concept of interconnectedness that is deeply entrenched in First Nations ways of knowing and being, planetary health recognises that “the health of the land and Peoples are synonymous.” In short: our patients, and ourselves, cannot be healthy if our planet isn’t healthy.
Planetary health care be quantified through the ‘planetary boundaries’ framework. The planetary boundaries are nine processes that regulate the state of the Earth system: climate change, novel entities, stratospheric ozone depletion, atmospheric aerosol loading, ocean acidification, biogeochemical flows, freshwater change, land-system change and biosphere integrity. Each of these can be tracked quantitatively, allowing for indication of when its “safe operating space for humanity” has been breached. These breaches impact human health, and can be a helpful way for clinicians to understand and measure the ways that planetary health impacts the health of their patients.
For example, the climate change boundary has now been breached, indicating that the Earth’s temperature has increased due to increased greenhouse gases (GHG) in the atmosphere. Heat exposure is linked to several health impacts, such as heatstroke, myocardial infarction, and preterm birth. Exposure to plastics and associated chemicals (novel entities boundary) is increasingly being associated with adverse health outcomes. Clinicians may have already unknowingly witnessed the manifesting of this. For example, Bisphenol A (BPA) is associated with type 2 diabetes, polycystic ovarian syndrome, obesity and hypertension.Atmospheric aerosol loading, or air pollution, is estimated to contribute to 8.34 million global deaths per year. Those interested in the human health impacts of planetary boundary breaches are encouraged to read the work of Myers et al.
2. Healthcare is a part of the problem.
Healthcare is a major contributor to climate change, with the sector accounting for 4.2% of global greenhouse gas emissions. The Australian healthcare sector’s emissions are even higher, estimated as up to 7% of national GHG emissions. Much of this is thought to be avoidable, particularly through unnecessary tests, procedures or interventions (‘low value care’), poor use and management of materials, unmanaged energy use and inadequate preventative health programs. The major share of emissions (71%) are primarily derived from the health care supply chain — the manufacturing, delivery, consumption and disposal of products and services.
3. Clinicians are well positioned to be a part of the solution.
Healthcare professionals hold substantial social and political capital that can be leveraged to raise public awareness of planetary health and to encourage individuals and organisations to implement strategies that safeguard both human and environmental health.
At an individual level, clinicians can demonstrate leadership by reducing their personal carbon footprint. Actions such as limiting air travel, reducing meat and dairy consumption, transitioning to renewable electricity providers, and prioritising active or public transport contribute meaningfully to emissions reduction. Many of these actions, such as adopting a largely plant-based diet or using active transport, have the co-benefit of benefiting individual health while also reducing greenhouse gas emissions. These behaviours can therefore be modelled and promoted to patients as a part of routine practice.
Commentary on planetary health often focuses on reducing unnecessary care to reduce the carbon footprint of healthcare. Low value, or unnecessary care is estimated to account for up to 30% of investigations and treatments in health care, with an additional 10% resulting in harm to patients. Shojania (2024) argues that decades of research and attention to reducing unnecessary healthcare has not yet resulted in any reductions in common, costly examples of overuse, and that we should instead focus our attentions on preventative care and advocacy. But why not do both? Continuing efforts to “choose wisely”, reduce inappropriate antibiotic use, avoid overuse of radiology, and wean unnecessary long-term medications are some of the most important ways to reduce our environmental footprint, and can occur alongside other strategies to improve.
Shifting the focus of healthcare to prevention, rather than resource-intensive secondary and tertiary medical treatment, is an important approach in reducing the footprint of the healthcare sector. Despite strong evidence demonstrating the health, social, environmental, and economic benefits of preventive care, only around 3–4% of total health expenditure across Organisation for Economic Co-operation and Development (OECD) member countries is allocated to prevention. Investing in health promotion and disease prevention is fiscally responsible, supports greater equity, and is a key strategy for improving the environmental sustainability of healthcare systems.
4. Climate care will become a part of our practice — if it hasn’t already
Many among us have already treated patients affected by climate disasters. As heatwaves, fires and floods become more frequent, responding to these events will become regular practice at all levels of the healthcare system.
Heatwaves have the greatest mortality rate of disasters in Australia and globally. Floods rank second, with increases in mortality rates of up to 50% in the first year post flood. In disaster affected communities, increased presentations for hypertension, diabetes, respiratory disease, renal disease, routine scripts, and drug dependence place additional pressures on medical facilities already overcrowded by acute injuries and infections. Mental health impacts can persist long-term, with women, older people and lower socio-economic populations at higher risk.
As the number of climate disasters increase, so too does the requirement for clinicians to respond to and manage the associated health burden. Over the coming years, climate disaster response and planetary health will increasingly be a part of our routine practice.
Embracing planetary health as a core clinical responsibility
The late-great environmental conservationist, Jane Goodall, famously said, “we have the choice to use the gift of our life to make the world a better place — or not to bother.” The trust our patients place in us to care for their health is a gift. Whilst the climate crisis can feel overwhelming and unfixable, a part of that gift means safeguarding them against the health harms of environmental degradation by practicing with planetary health in mind. This is because:
- The health of all life on Earth relies on a healthy planet, through access to safe drinking water and uncontaminated food, inhabitable climates, and clean air to breathe.
- Healthcare itself is one of the worst emitters, contributing around 4-7% of GHG emissions.
- Clinicians are well placed to reduce their personal and professional carbon footprints, by eliminating low value care, modelling behaviours with dual health/planet benefits, and advocating to prioritise preventative care over resource-intensive secondary and tertiary treatments.
- As we increasingly experience extreme weather events and the health consequences of environmental pollution, clinicians will be faced with responding to these crises, and will no longer have a choice to look away.
Like many of our responsibilities as clinicians, embracing planetary health won’t always be easy, but it will be necessary if we wish to safeguard the ongoing health of ourselves, our patients, and our planet.
Dr Jessica van den Heuvel is a practicing general practitioner and senior lecturer in the medical school at the University of Queensland.
Associate Professor Nina Lansbury is based at the School of Public Health at the University of Queensland. Her climate change and health research involves a role as coordinating lead author of the Intergovernmental Panel on Climate Change, with a focus on Australia, and a particular focus on the representation of Indigenous perspectives and Knowledges in climate change responses. She teaches undergraduate and postgraduate public health students on environmental health, climate change impacts on health and wicked problems in public health.
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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