When I was at school, I remember having a vague sense I wanted to do something to do with either health or the environment. Medicine was a more established path than anything environmental, and seemed more people-focussed, so it wasn’t hard for me to decide to apply for medicine. But I certainly had no idea upon starting at medical school that before the year was out I’d end up getting involved in a British Council project on Climate Change and Health! It has been one of the most interesting things I’ve done all year, and has given me a much better idea of the sort of medicine I want to work in.
The project, which 15 students across the country are taking part in, is headed by Mustafa Abbas, a very influential student in MedSin’s health planet campaign. We attended a great training weekend at UCL, learning about the health effects climate change is likely to have, health co-benefits of sustainable lifestyles and what is currently happening in the NHS, before being launched back into our medical schools. Our goals were to try to improve sustainability in our local trusts, secure more formal teaching on climate change and health content and if possible make links with medical students abroad to share ideas, materials and experiences. Needless to say, it’s proving far more difficult to make real changes, especially when you’re only a student, than to discuss all the exciting possibilities we’d like to put into action!
Partly because I’m at the wrong stage to be making changes within the NHS itself, I’ve become involved in climate and health education, helping put together an open-access resource pack – finally online on the Campaign for Greener Healthcare’s website! - as part of a great Sustainable Healthcare Education (SHE) team. I’ve had to read up on some topics that I previously knew very little about, and have still only scratched the surface, but it’s been genuinely fun. Admittedly, the topic means it’s at times also depressing and challenging, but it’s been really motivating to talk about it with lots of others who see things the same way and whose wish to change things. Not to mention that it’s much more enjoyable learning about something when it’s your own choice!
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There is already ample evidence that reducing our emissions now will save many lives in the future, and that people’s health is starting to be affected in numerous parts of the world. But perhaps this is a case where our moral intuitions are failing us. It’s a bit like the paradox in medical ethics that people often choose to save one life where the dying person is identified, rather than use the same resources to save several ‘statistical lives’ with a preventative drug or screening. Somehow we know that saving more lives makes more moral sense logically – but we can’t really bring ourselves to follow that through. Likewise we know we should care when we’re told ‘climate change is killing 300,000 per year’, but unless we actually know some of those people, most of us sadly aren’t really affected by what seems just another terrible statistic to add to the numerous others.
What I found difficult to work out was why we, collectively, aren’t that good at understanding risk, scientific information, or caring about people we haven’t met. Are we really too stupid, selfish and short-termist to meet the climate change challenge responsibly? I don’t know, but I hope not. Sometimes it seems that our world and way of life has changed so rapidly we just don’t know what we’re doing or where we’re heading. Part of that is because a couple of hundred years ago we discovered how to access and harness an incredibly cheap source of energy, stored from solar energy over millions of years, and now we’re just throwing it on the bonfire to make our lives easier, without thinking of longer-term consequences.
Anna Coote said in the BMJ in 2006, “if medicine is about saving lives, not just by last ditch interventions but by trying to avert illness, then working to alter patterns of behaviour that contribute to climate change could arguably become a priority for clinicians—as an urgent preventive measure.” And this basically sums up why I think the medical community can’t just sit back and say that reducing the damage we’re doing is someone else’s job. Furthermore, it might help encourage others to make the transition that we need, since doctors’ opinions are often well-respected. But there are also more practical reasons, to do with efficiency and making the health service more resilient to external shocks and able to respond to changing needs.
I know several people who think that because the worst effects will be felt elsewhere, we shouldn’t change our way of life significantly or quickly in the West because we’ll be comparatively ok. What shocked me was that several of these people were medical students or doctors – and yet this stance is essentially equivalent to saying that smokers shouldn’t stop smoking if their smoke is only likely to kill other people elsewhere and in future generations, as long as the smokers know they’re not going to get lung cancer. Unlike those affected by climate change, at least the taxes on cigarettes are significant enough to help pay to treat the diseases suffered by passive smokers. With smoking, it was only when doctors stopped that the public were prepared to accept that tobacco was a real threat to health, and perhaps the same will prove true to an extent in adopting sustainable lifestyles.
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In any case, the idea that we will be unaffected is completely at odds with the scale of the threats likely in a ‘business as usual’ scenario, especially the indirect ones such as economic instability, mass migration and civil unrest. What is even weirder is the number of medical students who persist in denial – in spite of the fact that evidence and science is supposedly the foundation of clinical practice and the evidence for AGM is higher than that for the efficacy of many regularly prescribed drugs.
Receiving the "Knowledge Market" prize from Dr Charlie Tomson (President of the Renal Association) at the Green Nephrology Summit in September 2010
Last week I read Mike Berners-Lee’s book ‘How Bad are Bananas? The carbon footprint of everything’ which was great at just giving fairly accurate numerical information about which lifestyle choices which would let you to save the most carbon with the least effort or cost, without making value judgements. But one bit that really hit home for me was his rough back-of the envelope style calculation of how much CO2e we’d need to save to prevent a climate-change related death (he thinks about 150 tonnes, and his calculation is interesting but just a guesstimate). That made me wonder whether a real figure like that, more accurately assessed of course, could change people’s behaviour more than just saying ‘climate change is starting to cause lots of deaths and disease and it’s getting worse.’
If I were a doctor deciding whether or not to do a high-carbon intervention that I wasn’t sure was necessary, having a sense of the impact in terms of how many statistical lives a few hundred tonnes of carbon could cost might well help me make a better informed decision. In medicine it’s definitely a thorny question – but many healthier lifestyle changes are better for both the patient’s health and the environment, so a transition to a more preventative style of medicine rather than a highly drug- and carbon-dependent one could give us the best of both worlds. Hopefully the learning pack we’ve put together will at least get medical students talking about these dilemmas and maybe put them in a better position to get our healthcare system where it needs to be for the coming century.
Isobel Braithwaite is a medical student at Cambridge University
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