A duty of care

Doctors must recognise the impacts of their work and the health sector on climate change, write DEA members Dr Richard Le and Dr Vienna Tran.

It is no secret that climate change is a serious global issue. However, its impact on human health has not received the attention that it deserves. As clinicians, we are responsible for understanding the issues that affect our patients and communities. Dubbed by The Lancet as ‘the biggest global health threat of the 21st century’, climate change is no exception to this rule. Doctors for the Environment Australia (DEA) is one of many organisations that advocates for a cleaner, greener healthcare system by engaging with the public and meeting with members of parliament, including South Australia’s Health Minister Chris Picton.

Effects of climate change on health

An increasing average global temperature is having grave downstream effects on our health. Global heating is resulting in higher incidences of heatstroke and exacerbations of pre-existing health conditions, such as cardiovascular, respiratory and renal disease. Rates of hospital admissions increase during heatwaves, placing immense pressure on hospital emergency services.

A warmer planet increases the incidence of extreme weather events, such as storms, droughts, bushfires and floods. Australia is not immune. These events damage vital infrastructure and displace communities, impacting mental health.

Our duty as doctors is to be adequately informed about these well-documented effects of climate change on human health. Currently, students and experienced clinicians are co-designing a planetary health-organ system map for integration within Australia’s medical curricula. The Australian Medical Council is considering it as an additional accreditation step for medical schools. Its success may be the first step in improving how climate health is taught to medical practitioners, shaping how our workforce manages inevitable climate-related health burdens.

As we all know, the patient-doctor relationship is based on personal connection and trust. We can leverage this relationship to educate our patients on climate health, rather than relying on mass media. For example, we can engage in conversations about climate-related health and behaviour during consults and display climate-minded posters in GP practices.

Effects of healthcare

One of the fundamental precepts of medical practice is to ‘do no harm’. We follow this by providing evidence–based, high-value care for our patients. However, some of this care may involve environmentally wasteful, low-value practices that do not benefit our patients. With 7% of Australia’s total CO2 emissions coming from the healthcare industry, we have much room for improvement. These emissions mostly stem from procurement of hospital goods, fossil fuel-based energy supply and pharmaceuticals. Other contributors include the masses of anaesthetic gases vented to the atmosphere daily. Unnecessary diagnostic imaging and pathology collection add to emissions: performing one CT scan and 100 Full Blood Counts together emits the CO2 equivalent of driving a petrol car for 37 km and 77 km respectively.

Many individuals and groups champion sustainable healthcare practice in their local area, but isolated silos of advocacy are not optimal. A coordinated response across local, state and national jurisdictions is required.

The 2022-2023 Federal budget committed $3.4 million in funding to the establishment and operation of a national Sustainable Healthcare Unit (SHU), a promising first step. Such a unit will provide leadership on implementation of evidence-based strategies, such as shifting to a preventative model of care, facilitating Australian hospitals’ switch to renewable electricity, and locally procuring medical supplies. South Australia has yet to establish its own SHU, but there still is time for us to lead change.

We have a duty of care to our patients. Amid the climate crisis, advocacy and environmentally informed practice are now critical components of this duty. Though it may seem overwhelming, we can all become involved individually, institutionally or on a macro-policy level. Using both bottom-up and the top-down approaches, we can collectively generate change. The will is there – we just need to act now.

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