The meaning and modern relevance of the 2005 graduation speech “This is Water” by David Foster Wallace, an American writer and university professor in the disciplines of English and creative writing, continues to drive debate and derive solace well beyond the scope of his intended audience. The speech commences with the following parable; two young fish are swimming along when they happen to meet an older fish swimming the other way, who nods at them and says “Morning, boys. How’s the water?”. The two young fish swim on for a bit, and then eventually one of them looks over at the other and says “What the hell is water?”.

Whilst the issue of climate change was first noted in the scientific literature in 1896, the past 3 decades has seen an exponential increase in the depth of understanding of the complex set of natural systems that define our environment. However there now exists a depressing paradox i.e., the more we study the relationship between our planet and our health and are humbled by our lack of knowledge, the less we demonstrate any level of care for the very relationship that sustains our existence. Whilst the climate crisis has become a media zeitgeist, spearheaded by a 16 year old Swedish girl on school strike, it is evident that as a society and as a medical profession we may be hearing, but we are still not listening.

A GP colleague of mine recently remarked that while attending a medical dinner function the main course for circa 100 guests was a rack of lamb, with no sustainable alternatives without specifically asking. Whilst guests no doubt ranged from thoroughly enjoying the meal to perhaps picking here and there, how many do you suppose were mindful? Mindful of the egregious antibiotic, carbon, water, waste and biodiversity footprint that 100 covers for rack of lamb represented? Mindful that after energy consumption the food system is the next largest contributor to carbon emissions and the leading cause of biodiversity loss? Mindful that the medical profession in particular has been called upon to lead in planetary health at a personal, practice and policy level? Of course banning lamb from the menu is unlikely to be productive and only serve to irk ardent meat lovers. Guilt is an alternative condiment to mint, however it is a less palatable pairing and risks souring other environmental efforts. Perhaps with urgent education about the true environmental cost of the Western lifestyle, particularly that of our diet, there is hope that a mindful approach to planetary health would offer the optimal buy-in from the medical community.

It was by design and not accident that the evolving concept of planetary health was launched at the 2019 ICGP AGM in a programme that followed on from a mindfulness session; an exploration from the inner self to the outer world. David Foster Wallace’s speech is worth reading afresh in the context of planetary health. In 2005 it was a call for postgraduates to utilize their education to choose what to think, to label their thoughts and keep their mind exercised and furthermore not to succumb to the daily despair of modern consumerism. In 2019 it could be reread as a call for Irish GP’s to utilize their longstanding and trusted relationships with their patients and communities to be great effectors of change in the existential battle to avoid a climate catastrophe simply by choosing to think this way.

The Rockefeller Foundation–Lancet Commission on planetary health has stated “we have mortgaged the health of future generations to realise economic and development gains in the present”.  If Planetary Health represents another “thing to do” in Irish General Practice, or worse, another manifestation of Irish guilt, it will be an abject failure. What it should represent is a rethinking of how we practice medicine, a golden opportunity to move from a disease-care to a healthcare model and an unrelenting demand for the truth. Wallace ends his speech discussing Truth as follows “It is about the real value of a real education, which has almost nothing to do with knowledge, and everything to do with simple awareness; awareness of what is so real and essential, so hidden in plain sight all around us, all the time, that we have to keep reminding ourselves over and over: This is water. This is water”.