We have a key role in combating climate change
Around the globe, health professionals are on the front line of mitigating climate change impacts, whether by supporting patients and communities to prepare for and respond to extreme weather events or by undertaking low-key but practical steps to reduce CO2 emissions such as reviewing prescribing patterns, for example with inhaled medications.
As Dr Sarah Mollard, GP and member of Doctors for the Environment Australia (based in Port Macquarie), reports, ‘The propellants used in some pressurised metered-dose inhaler (pMDI) devices are highly potent greenhouse gases, and switching to dry-powder inhalers (DPIs) or soft-mist inhalers (SMIs) where clinically appropriate can greatly reduce the carbon footprint of managing asthma and COPD.’
As Dr Mollard points out, in the general practice setting, pharmaceutical prescribing is estimated to contribute between 65-90 percent of CO2 equivalent (CO2e) emissions.
‘Broadly speaking the response to climate change requires two types of action,’ she explains, ‘mitigation, which focuses on drastically reducing CO2 emissions so that further heating is limited, and adaptation, which involves consideration of how to best prepare for and respond to impacts from the heating which has already occurred.’
‘This action can take place at individual, community or organisational, and state or national policy levels, and health professionals can contribute to both types of action at all levels.’
The seldom raised carbon footprint of health care is a key factor.
In Australia, health care is responsible for an estimated 7 per cent of Australia's CO2 equivalent emissions (CO2e), these being driven by hospital care (particularly intensive) and pharmaceuticals.
Individual action is an accessible entry point for many health professionals to contribute to climate action, often leading to co-benefits for the practice and/or patient.
At home or business, choosing energy efficient appliances, installing solar panels and switching to electric vehicles can lead to reductions in operational expenses alongside reduced CO2 emissions, due to the majority of the energy load for private practices occurring during daytime hours.
Reduced travel-related CO2 emissions can be achieved through appropriate use of telehealth, and through reducing carbon intensive travel, including air travel, for continuing professional development and other events.
Clinical interventions oriented towards reducing unwarranted intensity or episodes of care (especially reducing preventable hospital admissions) can benefit patients and contribute to reduced CO2e emissions.
Other measures with significant co-benefits for patient health and climate change mitigation include lifestyle interventions that promote and support patients to use active transport, make dietary changes to increase the consumption of plant-based foods and reduce exposure to air pollution through changing from gas to electric appliances.
Adaptation at an individual or professional level can include activities such as practice disaster planning, addressing needs of practice staff and patients during heat waves and periods of poor air quality, and providing action plans for patients to use during heat waves, periods of poor air quality or natural disasters.
Doctors and other health professionals are well positioned to work with stakeholders at a regional or community level and through inter-professional and inter-organisational relationships to advocate for and support climate change responses.
As respected voices in the community, doctors can make valuable contributions to local conversations about climate change and provide direct support to community-based activities.
Health professionals can influence mitigation and adaptation efforts by politicians, government bodies and industry through a variety of mechanisms.
When our position enables direct contributions to policy development this can be a particularly powerful mechanism, however doctors also hold considerable capacity for indirect contributions, e.g. by supporting and influencing the advocacy efforts of the RACGP, ACCRM and other colleges around climate change and through policy submissions and letter writing.
It has been argued, and I agree, that there is a professional obligation for doctors and health professionals to address climate change both with individual patients and through health systems and advocacy – these issues were explored in depth in the December 2017 volume of the AMA Journal of Ethics.
This is an edited version of Dr Sarah Mollard’s paper on the role of health professionals in mitigating climate change. Click here to access the complete article on the Nordocs website.