Policy on Climate Emergency

Policy on Climate Emergency

Executive summary 

• European Junior Doctors (EJD) aligns with other medical organisations in addressing the climate emergency, committing to efforts in reducing the effects of human-induced climate change.
• Climate change has severe public health repercussions and increases population disease burden and mortality. 
• Collective action by governments, healthcare systems and professionals, and citizens is crucial to avert the most severe consequences of climate change.
• Healthcare systems significantly contribute to carbon emissions, necessitating the mitigation of emissions throughout the entirety of the healthcare sector's operations.
• EJD advocates for the following strategic actions:
  o    Advancing the European Green Deal¹ and integrating a One Health²  approach across all policies to ensure cohesive action on health and climate.
  o    Incorporating global health and climate change content into medical education at all levels.
  o    Preparation of the health workforce for the pressure climate change will exert on healthcare systems by increased and improved funding, planning, and capacity enhancement.
  o    Allocating resources towards implementing measures that enhance the sustainability and efficiency of healthcare systems.

0. Introduction
The latest findings from the Intergovernmental Panel on Climate Change (IPCC) call for urgent and resolute action^[1]. The IPCC's report demonstrates the undeniable effects of human activity on global warming, with a notable rise of 1.1°C in global surface temperatures, a direct consequence of greenhouse gas emissions stemming from industrial activity, energy consumption and the use of earth’s resources. Compelling evidence^[2][3] underscores the severe repercussions of climate change on public health, highlighting an alarming escalation in disease and mortality rates alongside the deepening gap of health inequalities.

We stand at a critical juncture where we must address immediate dangers while simultaneously preventing the worst possible outcomes of climate change. The international community’s urgent call to action underlines our brief opportunity to sidestep the gravest predictions. While the impacts of climate change are set to become more evident in our daily lives, there's still a chance to avoid the severest effects through determined and united action. 

In these critical times, junior doctors and the broader medical profession must adopt a resolute stance. Positioned at the frontline of healthcare delivery, junior doctors are witness to the tangible consequences of climate change on human wellbeing. Our experience and insights make us powerful advocates for healthier climate policies and the fortification of healthcare systems against climate adversities. As affirmed by the World Medical Association (WMA)^[4] the Standing Committee of European Doctors (CPME)^[5] and the European Union of Medical Specialists (UEMS)^[6] the era of mere observation has concluded; it is incumbent upon the medical sector and the health workforce to step forward as promoters of change.

1. Health Implications of climate change
Climate change is a magnifier of existing health inequalities, disproportionately affecting the most vulnerable populations. The increasing prevalence and intensity of extreme weather events like heat waves, hurricanes, and floods will create a wide range of health challenges.^[7] These events not only precipitate direct health impacts like heat-related illnesses, cardiovascular stress, and physical injuries but also induce a wide array of mental health problems, including anxiety and depression underscoring the diverse and complex nature of health impacts yet to unfold.

Furthermore, the shifting climate patterns extend the reach and lifespan of disease-carrying vectors such as mosquitoes, escalating the threat of vector-borne diseases like malaria, dengue, and Zika virus to Europe. Additionally, climate change contributes to and exacerbates existing air pollution, which threatens human health by aggravating respiratory conditions, including asthma and chronic obstructive pulmonary disease. These examples merely scratch the surface of the myriad health challenges poised to emerge in the context of the climate emergency.

1.1 Impact on Healthcare Systems
The resilience of healthcare systems is severely tested by the challenges posed by climate change. Extreme weather events not only precipitate a surge in healthcare demand but also disrupt healthcare delivery by damaging infrastructure and impeding access to facilities. For instance, floods and hurricanes can incapacitate hospitals and clinics, disrupt supply chains, and hinder the mobility of both patients and healthcare professionals.

Healthcare facilities must adapt to the increased burden of climate-related diseases by expanding capacities, incorporating climate considerations into public health surveillance, and developing emergency preparedness plans that account for the likelihood of more frequent and severe climate events. A stronger focus on  primary prevention should be seen as an opportunity to reduce greenhouse gas emissions as well as a way of avoiding unnecessary medical interventions.  

If not addressed quickly, climate change would exacerbate existing inequalities in access to healthcare services and health outcomes. The lack of training for healthcare professionals in managing climate-related health conditions could result in suboptimal care delivery and inadequate responses to emerging health threats. Overall, ignoring these issues could deepen disparities, compromise patient safety, and undermine the overall effectiveness of healthcare systems in addressing emerging health challenges.

1.2 Impact on Societies and Geopolitics
The ripple effects of climate change, manifesting as rampant desertification, disrupted food supplies, and forced migration, pose profound challenges to global stability. Desertification diminishes fertile soil, severely hampering food production and security, which, in turn, can trigger mass migrations as communities seek food and shelter elsewhere. Such movements strain resources, heighten geopolitical tensions, and challenge the fabric of societies, altering our way of life and governance structures. The political landscape is thus compelled to adapt, confronting the urgent need for cooperative, sustainable solutions to mitigate these cascading crises.

1.3 Challenges for the Health Workforce
EJD has long been vocal about the challenges faced by the medical workforce following important demographic changes and the consequences of the 2008 economic crisis and the SARS-CoV-2 pandemic. In this already strained context, the advancing climate crisis introduces additional layers of complexity and demand. The health workforce confronts escalating pressures from the climate emergency, which is set to intensify healthcare demand significantly.

Healthcare professionals are grappling with an expanding array of climate-related health issues, necessitating not only enhanced clinical skills but also a deeper awareness of the intricate relationship between climate change and health. The aftermath of extreme weather events further tests their resilience, as they often have to provide care under compromised conditions with scarce resources. The emotional and psychological burden in such scenarios underscores the urgent need for supportive policies and practices that safeguard healthcare workers' satisfaction and well-being.

Amid these challenges, the importance of incorporating  climate education into medical training becomes even more pronounced. Equipping healthcare professionals with the knowledge and skills to effectively tackle climate-related health risks is crucial. This encompasses a comprehensive understanding of climate change's indirect effects on health, driven by social, economic, and environmental factors, ensuring a well-prepared workforce ready to face the increasing demands of the climate emergency.

2. Climate Change Implications of Healthcare
Acknowledging the significant role healthcare systems play in the exacerbation of the global climate crisis is essential. The emissions stemming from healthcare operations, including energy consumption, transportation, waste management, and supply chains, constitute a substantial portion of overall carbon emissions - healthcare’s climate footprint is equivalent to 4.4% of global net emissions. If the health sector were a country, it would be the fifth-largest emitter on the planet.^[8][9] Recognising this impact prompts a call to action for healthcare organisations to address their climate footprint comprehensively.

The urgent need to mitigate healthcare-related pollution highlights the dual impact of healthcare systems on climate change and public health. Emissions from medical procedures and technology significantly contribute to the sector's carbon footprint, underscoring the importance of sustainable practices among healthcare professionals to both uphold patient care standards and reduce environmental harm^[10][11].

The ethical imperative of healthcare professionals to "do no harm" extends beyond individual patient care to include broader considerations of environmental sustainability and climate change mitigation. By integrating principles of sustainability into healthcare practice, professionals can contribute to reducing the sector's environmental impact while promoting public health and well-being.^[12]
 
3. Tackling the Climate Emergency

At the Governance Level:

• Promotion of green and sustainable development: Advocate for policies that encourage green and sustainable development across the EU, aligning with the goals of the European Green Deal to achieve climate neutrality by 2050.
• Integration of One Health approach: Ensure that a One Health approach, which considers the interconnected health of humans, animals, and ecosystems, is embedded in all policies to address the multifaceted impacts of climate change comprehensively.
• Focus on prevention: Governments should prioritize and allocate increased funding to disease prevention and the implementation of policies that promote a healthy environment.
• Sustainable Food Systems: Aligning with the United Nations' Sustainable Development Goals, we call on governments to adopt policies that promote sustainable food production and dietary practices. This includes resilient agricultural methods, minimizing soil and water degradation, strengthening local food networks, increasing reliance on plant-based products, promoting biodiversity, thus reducing malnutrition and decreasing epidemiological risk factors.

Within Healthcare Systems:

• Carbon footprint assessment of healthcare systems, provide valuable insights into the specific areas where emissions occur within the sector. Utilizing this data, healthcare organisations can develop targeted strategies to reduce carbon emissions, ranging from energy efficiency measures to sustainable procurement practices.[14]
• Carbon footprint reduction: Implement strategies to significantly reduce the carbon footprint of healthcare facilities, including energy efficiency improvements, sustainable procurement practices, investment in renewable energy sources, optimizing transportation logistics, minimizing waste generation. Renovations of existing health facilities and construction of new health facilities must aim to minimize the building’s carbon footprint while promoting patient and staff wellbeing. Strategies to improve the sustainability of healthcare should not come at the cost of patient safety.^[13]
• Redesign clinical pathways: Create sustainable models of care. A stronger focus on primary prevention should be seen as an opportunity to reduce greenhouse gas emissions as well as a way of avoiding unnecessary medical interventions. 
• Investing in the development or financing of energy-efficient initiatives for healthcare institutions and healthcare related organisations can yield favourable returns on investment, thereby contributing to addressing the climate crisis.
• Workforce planning and forecast: Enhance workforce planning and forecasting to address the expected increase in healthcare demands due to the climate emergency. 
• Preparation for the challenges arising from the climate emergency: Develop and refine preparedness plans to ensure healthcare systems can respond effectively to the increased healthcare demands resulting from climate-related events.
   

In Training and Education:

• Enhancement of Training and Competencies: Revise and enhance training programs to include comprehensive education on climate change and planetary health, ensuring healthcare professionals are well-versed in these critical areas. Invest in capacity building initiatives to equip the health workforce with the necessary skills and resources.
• Training continuum: Promote the integration of climate change and health topics throughout the educational continuum, from higher education to postgraduate training (PGT) and continuing medical education/professional development (CME/CPD) activities.
• Foster research on the interplay between healthcare and climate change: More research is required to comprehend the dynamics between healthcare and climate change. It is important to examine future trends in healthcare emissions, thoroughly analyze supply chain impacts, and evaluate the economic and health implications of transitioning to climate-resilient healthcare.

Role of Junior Doctors and the Medical community:

• Awareness and advocacy: As trusted professionals,  doctors can play a crucial role in  raising awareness about the health impacts of climate change among patients and the broader community.[9] Junior doctors should act as advocates towards a more sustainable healthcare system.
• Engagement with policymakers: Encourage junior doctors and the medical community to actively engage with policymakers, advocating for the implementation of climate-informed health policies and practices and advocate to reduce carbon emission in as many ways as possible.
• Community leadership: Empower junior doctors to take on leadership roles within their communities and professional circles, promoting sustainable healthcare practices and leading by example in the fight against climate change.
• Lead by example: Junior doctors and the medical community can set a precedent in the upcoming transition by advocating for an accelerated shift toward sustainable food practices and reducing airplane travel to international meetings.

Implementing these measures requires a coordinated effort across all levels of governance, healthcare systems, and the medical community. Recognising the vital connection between human health and planetary well-being emphasizes the importance of promoting healthcare delivery models that prioritize environmental sustainability, social equity, and economic viability. By taking decisive action, we can mitigate the impacts of climate change on health and work towards a sustainable future.

 
References
1.    IPCC, 2023: Sections. In: Climate Change 2023: Synthesis Report. Contribution of Working Groups I, II and III to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change [Core Writing Team, H. Lee and J. Romero (eds.)]. IPCC, Geneva, Switzerland, pp. 35-115, doi: 10.59327/IPCC/AR6-9789291691647 
2.    WHO, 2021. Health and climate change global survey report. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO. 
3.    Van Daalen KR, Romanello M, Rocklöv J, et al. The 2022 Europe report of the Lancet Countdown on health and climate change: towards a climate resilient future. The Lancet Public Health 2022;7(11):e942- e65. doi: 10.1016/S2468-2667(22)00197-9 
4.    WMA, 2019. WMA resolution on Climate Emergency. Adopted by the 70th WMA General Assembly, Tbilisi, Georgia, October 2019. World Medical Association. 
5.    CPME, 2023. Policy on Climate Change. Standing Committee of European Doctors. Marc 2023.
6.    UEMS, 2023. Thematic Federation on Green and sustainable practice’s policy on Planetary Health.
7.    Ballester, J., et al., 2023, Heat-related mortality in Europe during the summer of 2022, Nature Medicine 29(7), 1857-1866. https://doi.org/10.1038/s41591-023-02419-z
8.    Sampath, B., et al., 2022, Reducing Healthcare Carbon Emissions: A Primer on Measures and Actions for Healthcare Organizations to Mitigate Climate Change. AHRQ Publication No. 22-M011. https://www.ahrq.gov/healthsystemsresearch/decarbonization/index.html&n…;
9.    Health Care Without Harm, Climate-smart health care series, Green Paper Number One, Produced in collaboration with Arup, September 2019. https://noharm-global.org/documents/health-care-climate-footprint-report
10.    Matthew J. Eckelman, et al., 2020, Health Care Pollution And PublicHealth Damage In The UnitedStates: An Update. Health affairs 39,No.12:2071–2079. https://doi.org/10.1377/hlthaff.2020.01247
11.    Andersen, M. P. S., Nielsen, O. J., & Sherman, J. D. (2023). Assessing the potential climate impact of anaesthetic gases. The Lancet Planetary Health, 7, e622–e629. https://doi.org/10.1016/S2542-5196(23)00084-0 
12.    Economist Impact, 2022. Do no harm: healthcare professionals address sustainability and climate change. https://impact.economist.com/sustainability/resilience-and-adaptation/h…
13.    (WHO). 2023 Operational framework for building climate resilient and low carbon health systems. https://www.who.int/publications/i/item/9789240081888 
14.    Tennison, I., et al., 2021, Health care’s response to climate change: a carbon footprint assessment of the NHS in England. The Lancet. Planetary Health, 5, e84–e92. https://doi.org/10.1016/S2542-5196(20)30271-0
15.    Communicating on climate change and health: toolkit for health professionals. Geneva: World Health Organization; 2024. Licence: CC BY-NC-SA 3.0 IGO