Despite what Donald Trump may say, climate change is really happening.
Most of us have seen pictures of polar bears stranded on melting icebergs. Dramatic wildfires in Australia and California in the past year have stopped not just Kangaroos in their tracks. Newspaper articles describe how we are on the verge of the sixth mass extinction with a loss of much of our planet’s biodiversity most notably in the Amazon. However this may seem far from our doorstep.
What does this mean to me, a GP working in Ireland?
We may have heard that the atmospheric carbon dioxide levels that remained below 300 parts per million(ppm) for 800,000 years until the industrial revolution and have risen consistently above 400ppm since 2013.
These greenhouse gases, along with methane, nitrous oxide and hydrofluorocarbons are warming our atmosphere. Most are generated from the combustion of fossil fuels, waste degradation and agriculture. We have made gains since ‘The Great Acceleration’ started in the mid-20th century with reductions in infant mortality, poverty and increased life expectancy. But at what expense to our oceans, rivers, forests and other natural resources? The global population has increased by an average of 1 billion every 12 years since 1950 with a projected 10 billion on the planet by 2050. How do we propose to feed and care for this many people?
Climate Change in the 21st Century
The western way of life and eating pattern is being very successfully exported around the world raising expectations in developing countries of a better standard of living with significant planetary consequences. However, the current average Irish diet would require more than two planets if everyone on earth was to eat like us.
Climate change is the biggest health concern of the 21st century according to the World Health Organisation. The hottest years on record have been in the last decade. Europe has witnessed excess mortality with more frequent heatwaves over the past two decades. More unpredictable weather patterns and severe storms with increased precipitation have caused physical and psychological damage to whole communities. Air pollution has increased in Ireland in parallel with the increased consumption of fossil fuels. It has been shown that this unclean air is associated with increase in both cardiovascular and respiratory mortality rates. Even the Covid-19 pandemic, as with other recent viral epidemics, has been causally linked to the proximity of humans to both wild and domesticated animals facilitating cross species spread.
Health Care Without Harm have calculated that if global healthcare itself were a country then it would be the fifth largest producers of greenhouse gas emissions. Many of these come from the use of carbon intensive secondary care resources and from medications.
The Role of GPs
Our unique role as a gatekeeper puts our choices of inappropriate routine screening tests or ‘just in case’ investigations into a new light. The other unique role as prescribers requires a responsibility to dispense tablets judiciously and possibly for limited periods or with regular reviews. 80% of prescribing occurs in primary care.
Metered dose inhalers (MDI) use hydrofluorcarbons with >1000 the global warming potential of dry powdered inhaler (DPI). So, the change from a Ventolin Evohaler (MDI) to a Ventolin Diskus (DPI) is the equivalent of decreasing the emissions of a car journey from Tralee to Dublin down to the emissions of a 4mile trip to the local shop, and importantly, with no change in clinical outcome! Four percent of the whole NHS carbon footprint is from MDI inhalers.
GPs are also well-respected professionals widely dispersed within communities. They have great penetrance into the population with over 100,000 patient contacts a day in Ireland. As patient advocates, GPs work to protect and enhance the lives of their populations. They develop long term relationships with individuals who look to them for advice and as trusted sources of information.
The difference primary care has to public health is the personalised message from a trusted professional to a specific patient at a moment in time when their symptoms, concern or diagnosis prime or motivate a patient for a behaviour change. The delivery of a message to increase exercise or consume a more plant- based diet will have the double benefit of improving the health of the patient and the planet. For a triple win we could even consider the positive financial implications of reducing disease or complication rates through the practice of real prevention by motivating lifestyle enhancements in our patients.
We, as GPs, have a vital and indeed powerful role to lead by personal and professional example. Our work place and our influence with our patients provide us ample situations where sustainable options can be discussed and heralded. We have been granted a privileged position in society to assist, protect and lead – let us not miss this opportunity.