VIEWS OF HEALTH PROFESSIONALS ON CLIMATE CHANGE AND HEALTH

Source: The Lancet Planetary Health

Text has been edited by AALEP

In 2020, nations participating in the Paris Agreement on climate change were expected to submit their revised Nationally Determined Contributions (NDCs) to reduce their greenhouse gas emissions. However, as of December, 2020, only a handful of nations had submitted their revised NDCs and only a fraction of those actually included enhanced ambition to reduce their emissions. Although two-thirds of countries mention health in their NDCs, most did not have the funding or the necessary collaboration between health and other sectors, or both, to implement the needed plans and policies.

Multiple scientific assessments have outlined the varied and substantial effects of climate change on human health and wellbeing, and a diverse body of evidence suggests that actions to reduce climate change have beneficial effects on public health.

Climate change represents the biggest global health threat and the greatest global health opportunity  of the 21st century.

Despite the tremendous opportunities and challenges, many people around the world remain unaware of the human health implications of climate change. Thankfully, a growing body of evidence suggests that providing people with information about the health harms of climate change, as well as solutions to address them, can increase public support for the actions needed to reduce emissions.

As a result, health professionals have an extraordinary opportunity to become trusted voices in support of global efforts to reduce emissions and protect people from the threat of climate change. Indeed, some health professionals have recognised this opportunity and have begun to encourage their colleagues to get involved in efforts to advocate for increased action.

For example, there are at least three major things that health professionals could do to increase the odds of meeting the goals of the Paris Agreement.

1. First, health professionals can lobby their nation's leaders directly, making the health case for climate action.
2. Second, health professionals can educate the public and other relevant stakeholders (eg, business leaders and civil society leaders) in hopes of building public will for climate policies.
3. Third, health professionals can lead by decarbonising their own practices (at work and at home) and advocate for decarbonising the hospitals and health-care systems with which they are affiliated.

Although these developments are promising, the extent to which health professionals around the world are themselves aware of the human health relevance of climate change, feel personally engaged with the issue, and are willing to advocate for increased action to address these issues, remains unclear. When people are highly engaged with an issue—i.e., they worry about the issue and feel the personal importance of it—they are more likely to support and advocate for policies to address this issue.

Most health professionals understand that climate change is happening and is affecting the health of those they care for; however, many still feel that they have insufficient knowledge about the topic.  Some evidence also suggests that physicians are supportive of the idea that they and their professional associations should be involved in advocating the health effects of climate change.

Even if health professionals are open to advocating for increased action on climate change, social science has identified a well understood gap between people's intentions and their actual behaviours.  Much of this gap is explainable by the fact that, often, various kinds of barriers can inhibit people from initiating new behaviours that are consistent with their attitudes. When barriers are reduced—i.e., when the path is cleared—performance of the behaviours becomes more.  Few studies have systematically characterised the barriers to climate change advocacy faced by health professionals and the resources that might help alleviate those barriers.

The current evidence on health professionals' perceptions of the health implications of climate change remains scarce, and most studies have been done in English-speaking countries, particularly the USA.  Moreover, many of these studies have focused on specific medical specialties (eg, thoracic specialists, allergy, and asthma specialists) and public health experts; although, a recent study has begun to examine nurses' views on climate change.

Key Questions

1. Do health professionals in Europe have a strong understanding of key facts about climate change and feel personally engaged with the issue?
2. To what extent do health professionals view climate change as a threat to human health?
3. To what extent are health professionals willing to engage with the public and policymakers about the issue, and advocate for more ambitious climate action?
4. To what extent are health professionals supportive of policies within their professional societies that would reduce their contribution to emissions?
5. What barriers reduce health professionals' willingness to communicate about climate change and health, and what resources would be helpful to them?

According to a survey conducted The Lancet, among 4000 health professionals who responded

1. Participants have a basic understanding of the fact that climate change is happening and is caused by humans: 95% of participants think climate change is happening, whereas only 2% think it is not happening, and another 2% do not know climate change is happening. 81% of participants think climate change is mostly or entirely caused by human activities, whereas 14% think it is caused equally by human activities and natural causes, and about 5% think climate change is mostly or entirely caused by natural causes or is not happening at all. Multiple studies have found that between 90% and 100% of climate scientists are convinced that climate change caused by humans is happening, with the most rigorous study estimating the consensus at 97%.
2. 66% of the survey participants think climate change will cause a moderate amount or a great deal of harm to them personally, 77% said the same for their patients, 81% said the same for the people in their community, 57% said the same for the people in their country, and 93% said the same for the future generations. In terms of specific health effects, a majority of participants reported that climate change has already adversely affected the health of people in their nation in various ways, either a moderate amount or a great deal, including 65% of participants reporting illness due to reduced outdoor air quality, 63% reporting physical or mental harm from forest fires or brush fires, 60% reporting anxiety, depression, or other mental health conditions, 56% reporting physical or mental harm from storms (including hurricanes) and floods, and 51% reporting increased poverty due to economic hardship and resulting health problems. A third to about half of participants also affirmed other current adverse health effect including loss of housing for residents displaced by extreme weather events (48%), hunger and malnutrition due to rising food prices (47%), heat-related illnesses (47%), vector-borne infectious diseases (46%), disruptions to health-care services for people with chronic conditions during extreme weather events (46%), physical or mental harm from droughts (46%), water-borne and food-borne diseases (36%), and violence, conflict, or resulting dislocation (33%). 60% or more of the survey participants said they think climate change will make all 13 health issues more frequent or severe in their country over the next 10 years.
3. A majority of participants said they felt that health professionals have a responsibility to bring the health effects of climate change to the attention of the public (86% somewhat or strongly agreed) and policy makers (90% somewhat or strongly agreed). A majority of participants felt that health professionals should actively encourage their nation's leaders (89% somewhat or strongly agreed) and all world leaders (89% somewhat or strongly agreed) to strengthen their nation's or all nations' commitments to achieving the goal of the Paris Agreement. 95% of participants said health organisations should advocate with national leaders for increased investments in health, with only 2% saying this was inappropriate, and 4% saying they were not sure. 26% of survey participants said they were personally willing to participate in a global advocacy campaign by health professionals to encourage all world leaders to strengthen their commitment to achieving the goal of the Paris Climate Agreement. 37% of survey participants said they might participate but would first need further information, and 27% said they would support such a campaign but could not personally participate. Only 10% of survey participants said they would not support such a campaign.
4. Most survey participants feel their professional societies should change their practices in several ways. 69% of survey participants felt their professional society should cut ties with fossil fuel companies including divestment from stocks and bonds. 85% of survey participants felt their professional society should provide opportunities for members to participate virtually in the meetings and conferences they host, to reduce the emission of climate pollutants.
5. 54% of survey participants said time constraints reduced their willingness (by a moderate amount or a great deal) to communicate with the public about climate change and health. Less than half said other factors reduce their willingness to communicate, including their lack of knowledge (41%), their belief that engaging with the public would not make a difference (31%), little support from their peers (22%), their perception that the topic is too controversial (16%), and their perception that it engaging with the public is too risky for them professionally or personally (14%). A majority of participants said the following resources about climate change and health would be moderately or very helpful to them: continuing professional education on climate change and health (76%); policy statements on climate change and health by their professional associations (76%); guidance on how to make their workplace sustainable (72%); action alerts (timely information) on when and how to advocate with policy makers (69%); training to communicate effectively about climate change and health (69%); and patient education materials (65%).
6. Participants in the survey had a strong understanding that climate change is happening and caused by humans, viewed it as a substantial and growing cause of health harm in their country, and felt a responsibility to educate the public and policymakers about the problem, including engaging with world leaders to encourage them to strengthen their commitments to the Paris Agreement goals.
7. Despite their high levels of commitment to engaging in education and advocacy to respond to the health threat of climate change, many survey participants indicated that a range of personal, professional, and societal barriers impede them from doing so. Time constraints was the most identified barrier.
8. Climate and health campaign organisers can address this barrier by creating opportunities for health professionals to efficiently engage in education and advocacy within their time constraints. Organisations that employ health professionals can also help address this barrier by creating programmes that specifically support their employees to engage in such actions. For example, some have proposed the creation of sabbaticals, sponsored in part by professional societies, to give physicians sufficient time to focus on policy advocacy.
9. Other efforts have focused on giving health professionals a menu of different meaningful actions they could take, arranged according to the amount of time required. Some health professional organisations have been able to alleviate time constraints by recruiting and developing more volunteers into leadership positions, which helped to diffuse responsibility across a greater number of people and reduced the demands on any single individual. Further research is needed to identify effective actions that organisations can take to reduce time constraints for policy advocacy by health professionals.
10. Despite the high rates of concern expressed by survey participants about the health threats of climate change, more than four in ten participants felt insufficient knowledge about the topic was an impediment to engaging with the public on the issue.  Given the magnitude of the problem, and the large number of health professionals who feel their lack of knowledge poses a barrier to engagement, efforts to offer such education—in medical, nursing, and other health professional curricula and through continuing education—should be accelerated, and research should be done to investigate efficient and effective ways of providing such education, especially in light of the time constraints being identified as the greatest barrier to engagement.
11. Another major impediment to public engagement by health professionals is the belief held by nearly one in three health professionals that engaging with the public would not make a difference. A large body of social science research indicates that this belief—believing a recommended corrective action would not make a difference in solving a worrisome problem—can be a highly consequential factor contributing to gaps between attitudes and behaviours.
12. On one hand, it is understandable that individual health professionals might feel their actions might not make a difference in the face of an escalating climate crisis and widespread absence of governmental leadership. On the other hand, health professionals should consider the instances in which they have acted collectively and achieved important results (eg, the Nuclear Test Ban Treaty, the global HIV epidemic, the successful smallpox elimination campaign, and the ongoing polio elimination campaign). In the past year, in a major mobilisation of the health community, organisations representing 40 million doctors, nurses, and other health professionals sent a letter to G20 leaders calling for economic recovery responses to the COVID-19 pandemic to be aligned with the necessary action to address climate change (a healthy recovery)—influencing public discourse with media coverage in over 500 articles in news outlets around the world.
13. Efforts to engage health professionals in campaigns to limit global warming and stabilise the climate should take seriously the need to help health professionals see that they have a unique and possibly necessary role to play in the global effort.
14. Another set of barriers to public engagement on climate and health—believing that one's peers will not support such an effort (reported by 22% our survey participants), and believing that public engagement is too risky for them professionally or personally (reported by 14% of participants)—speak to the need for a culture shift within the health professions. However, it is hard to imagine that health professionals would not feel supported by their peers for efforts to educate the public about the dangers of other health threats, such as tobacco use, unsafe sex, obesity, air pollution, or unsafe water. Educating members of the health community about climate change, and highlighting the priority this issue is given by leading health agencies, such as WHO, should help to create a culture shift whereby traditional public health measures, such as public education and policy advocacy,  focused on climate change will be widely accepted and supported in the health community. Tailored educational efforts might be required for clinicians, and for public health professionals, given that these two groups of health professionals have different cultures and work in different environments.
15. A final barrier to public engagement by health professionals uncovered in this research is the perception that the topic is too controversial, a barrier identified by 16% of survey participants. This barrier might partly be attributable to a misperception held by a small proportion of survey participants that there is a substantial disagreement among climate scientists about the existence of climate change caused by humans. Previous research has found that correcting misperceptions about the scientific consensus around climate change and providing normative information about the extent of other people's concern about the topic can lead to more support for societal action and willingness to speak up about the issue.
16. Fortunately, most participants in the survey felt that a range of resources, which can easily be produced by their professional societies and others, can help them engage in education and advocacy. Continuing professional education on climate change and health is clearly needed because so many health professionals report their insufficient knowledge about climate and health presents a barrier to them engaging on the issue. In turn, most survey participants said such education would be helpful to them. A small but growing number of educational institutions and medical and nursing societies are beginning to offer continuing education courses on climate and health, but surprisingly little research has been done on the competencies that should be developed in such education.
17. A majority of survey participants also said that training to communicate effectively about climate change and health, and patient education materials, would be helpful. Providing continuing education courses and communication training, and producing patient education materials, are core competencies of most health professional associations; those competencies must be mobilised in service of addressing climate change as a health issue.
18. Policy statements are a standard mechanism by which health professional societies make their views and recommendations known about a range of important health issues. Health professional societies should develop, or update, their policy statement on climate and health, and should explicitly encourage climate and health advocacy consistent with the goals of the Paris Agreement. A majority of survey participants said such a policy statement would be helpful to them.
19. The use of action alerts—ie, timely information about when and how to effectively engage in advocacy—is also a standard mechanism by which health professional societies mobilise their members to advance the society's advocacy goals. Receiving action alerts about opportunities to endorse climate and health policy proposals, and when and how to contact relevant policymakers, might help interested members overcome the most common barrier to their climate and health advocacy—their time constraints.
20. The notion that change begins at home—or at work—is supported by a large body of social science. For example, health professionals are more comfortable with and effective at helping their patients take preventive measures when they themselves have taken those measures;  and therefore would be more likely to be comfortable advocating for policy change when they have themselves taken all reasonable measures within their purview to deal with the problem. A majority of survey participants said that guidance on how to make their workplace sustainable would be helpful to them.
21. All of these resources—continuing professional education, communication training, patient education materials, policy statements, action alerts, and guidance on how to make health-care workplaces more sustainable—can be produced or acquired by most health professional associations. Collaboration among health professional societies to produce or acquire these resources for their members might reduce the costs per person served.
22. Behavioural scientists (and health professionals) have long understood that even highly motivated people often do not engage in the actions that are consistent with their motivations. An important insight from the social marketing literature is that moving members of a motivated audience to take action is often effectively accomplished by removing or reducing the barriers that make the recommended action difficult for them to do. Making these resources,widely available is a promising strategy for reducing the barriers that impede motivated health professionals from taking climate and health advocacy actions.