Planetary Health refers to “the health of human civilization and the state of the natural systems on which it depends“. As family doctors are on the front lines of protecting health, it is important that we are aware and act upon the interplay between the climate crisis and emerging health impacts. With only 10 years to achieve Ireland’s legally binding commitment to reduce carbon emissions by 40%, it is worth considering the consequences globally and at home if these are not met. The UN Secretary General estimated that such cuts in emissions on such a time scale would require a wartime governmental effort. To quote Naomi Kline, this changes everything.
Regardless of whether you are informed about planetary health via Sunday evenings with David Attenborough, long nights in the pub or even longer nights on PubMed, you soon become humbled by how much we do not understand about the natural world. However, there exists a commonality; when we live in asymmetry to the natural systems upon which we depend then disease, disability and death soon flourishes.
If global healthcare were a country, it is estimated that it would be one of the top 5 in the world with respect to emissions. With respect to healthcare’s contribution to our environmental problems and solutions, anything less than a complete revision about how we practice and think about healthcare in Ireland would be an insufficient response to the accumulated evidence. Whilst the climate crisis has been dubbed the greatest threat to healthcare in the 21st century, it is simultaneously a generational golden opportunity to address not only ill health but also social injustice and inequality.
The recent 2019 WONCA declaration has called on family doctors across the world to act and lead on planetary health and has been seconded by the Lancet which as called for all healthcare professionals to lead on this issue. This declaration has been formally recognised by the ICGP after a motion calling for planetary health to become policy was adopted at the 2019 ICGP AGM.
The reason why GPs have been called upon to lead on planetary health is our central role and trusted role in the community, our frequent patient contacts and our unique capacity to engage with our patients longitudinally and to therefore modify behaviours. We well understand the growing burden of non-communicable diseases, however as the system is already under critical stress planetary health offers a unique opportunity to reassess and change the current paradigm from a disease-care model to a healthcare model. Once we darken the door of a hospital there is an inevitable carbon, plastic, water and waste footprint that is incredibly difficult to mitigate never mind eradicate. That is to say the largest gains in planetary health are to be found upstream from tertiary care. However we must ask are GPs adequately funded, adequately trained and adequately supported in the community to engage in the degree of change that is required?
Whilst climate scenarios such as heat stroke, UV radiation, air pollution and other weather related events will represent an ever increasing challenge for the health sector in Ireland, indirect climate effects are more likely to impact our health systems and communities first. The number of climate refugees from regions with greater exposure to climate extremes is likely to increase exponentially, presenting future resource and political pressures that will adversely affect marginalised communities disproportionately. Precipitation issues should have particular consideration, not least as healthcare facilities are heavily reliant and in recent years we have seen severe shortages and recurrent contamination of regional water sources.
An ever growing issue is that of antimicrobial resistance (AMR) which is on course to alter the way healthcare is delivered irrevocably, perhaps outpacing the climate crisis. The issue is not just confined to antimicrobial stewardship in the human population but also to how inefficiently antimicrobials are used in animal agriculture. This aside a concurrent paucity of new antimicrobials being brought to market.
At a clinical care level, lifestyle and particularly diet must be brought into consultations, with a supportive framework of referral pathways for those that require direction or resources. Whilst there are any number of efforts that could be made to mitigate the climate crisis, the low hanging fruit for healthcare are active transport and plant based diets. They are what have been termed “triple wins” i.e. firstly there are less carbon emissions, secondly they are cheaper on the pocket and thirdly they confer improved and better health. In practical terms an example of a useful tool for GPs is the RCGP Green Toolkit which can lead individual practices to not only reduce their carbon footprint, but also to become community leaders, influencers and advocates for sustainability.
The Dutch theologian Desiderius Erasmus is famed for his quote “prevention is better than cure”. A macroscopic view of the Irish healthcare status quo would suggest a distinct lack of Erasmus-like thinking, with emphasis and resources heavily weighted towards cure, or rather the expensive management of inevitable complications.
Planetary Health is the antitheses of our current failing model and it is ours to embrace.
Written by: Dr Sean Owens