AN EVOLVING PUBLIC HEALTH THREAT AND A SHARED RESPONSIBILITY
Climate change is an existential threat to humanity but also an evolving threat to public health, requiring urgent action. Institutions and individuals alike have a responsibility towards helping to reduce their carbon footprint. Around 90% of NHS patient contacts are via primary care.1 As a first-contact personal healthcare service and gate-keeper, general practice provides over 300 million patient consultations each year compared to 23 million A&E visits.2 On average, GPs are in touch with 41 patients a day — via face-to-face appointments during the surgery, home visits, and via telephone and email.3 This highlights the perfect opportunity that GPs have in engaging with our community and raising awareness of the benefits and threats of climate change on our health.
In essence, the primary care team should view clinical care through a sustainability lens to benefit the health and wellbeing of current and future generations. If we are proactive, we can support our patient population to tackle the climate crisis.
So why has there been a slow movement in ‘greener’ education in primary care? Although GPs may well be aware that the ‘climate emergency’ is also a ‘health emergency’, many of us do not make the connection with clinical practice when it comes to taking action. We often fail to realise that the majority of a general practice’s carbon footprint (approximately 60%) results from clinical work.4
HOW CAN GPs SUPPORT GREENER PRACTICE?
The World Health Organization believes that in the 21st century, primary health care should adopt a whole-of-society approach, addressing not only individual and family health needs but also the broader issues of public health and the needs of defined populations — with health promotion, disease prevention, treatment, rehabilitation, and palliative care as priorities.5 This vision is the basis to combat climate change. Every opportunity must be taken to link health problems with climate change during our consultations. Humanity, public health, and nature are not separate, and it is crucial to see them as one to help fix the climate crisis. For instance, increased physical activity, improvement in air quality, better access to nature, and ‘green prescribing’ would not only improve the physical and mental health of an individual and a community but would also contribute to mitigating the climate crisis. Identifying ‘teachable moments’ in primary care is crucial — being able to identify and explore patient concerns and recognise opportunities to link them with unhealthy behaviours increases their willingness and commitment to change behaviour.6 Regular conversations promoting a cleaner more sustainable life might motivate our society to take charge and focus on creating such a world.
TAILOR INFORMATION TO PATIENTS’ NEEDS
There is a wealth of information about the climate crisis in the media that can be overwhelming and disempowering. In primary care, we are trained to give evidence-based, person-centred advice, and have the capacity to connect and build meaningful constructive relationships with our patient population over a period of time. Also, as the most trusted healthcare professionals in the UK7 we can provide essential health information and guidance about health and climate change in a way that is acceptable to most of our patient population. Everyone has a role to play in climate change. By considering what matters to each patient and tailoring the information to their needs and wishes during consultations we can empower and encourage behavioural changes, however small they may seem. This is much more sustainable in the long term.
BREAKING THE DOWNWARD SPIRAL OF SILENCE
Humans tend to be social beings and want to blend in with society. We tend to monitor our social environment and modify our behaviour accordingly. Mostly, we want to feel accepted and respected by everyone, sometimes pressing us to agree superficially. Fear of isolation strongly affects our willingness to express our personal opinions, which can set the ‘spiral of silence’ in motion.8 As respected role models, GPs could influence people in developing high self-esteem and an environmentally conscious society that is willing to speak up, breaking the spiral of silence and helping to fight climate change.
SELF-CARE AND SELF-MANAGEMENT
We need to promote the importance of self-care and self-help measures as a part of daily living — lifestyle medicine (regular physical activity, healthy sustainable eating, adequate sleep, stress management, avoidance of risky substances, forming and maintaining relationships, and reducing loneliness); self-limiting minor ailments with over-the-counter medications. Support for patient self-management interventions for long-term physical health conditions and mental health problems is a positive strategy for reducing unnecessary visits to the surgery, the environmental costs of overprescribing, and costly medical interventions.
HAVE A LIST OF PRACTICAL TIPS TO HAND
In primary care, it is unpredictable who comes through the door and how busy the day could be. Hence, it is helpful to have a list of practical tips that can be referred to and shared with patients. Given the time pressures associated with patient consultations, we only need to focus on one piece of practical advice at a time that is tailored to the patient’s needs that requires a behavioural change to make a difference. Such small steps not only improve an individual’s health and wellbeing but could also have a ripple effect on their loved ones, ultimately leading to positive societal influence in fighting climate change.
The following are a list of practical tips to consider that can be shared, discussed, and updated regularly. Some are easy, some are hard, and not all of them work all of the time — for example, if making your packed lunch involves using more energy than buying a meal!
LIFESTYLE INTERVENTION: FOOD
Enjoy a plant-based/vegetarian diet;
eat seasonal vegetables (healthier, cheaper, fresher, and tastier);
have a meat-free day during the week;
bring a packed lunch from home to work;
use herbs grown in your own garden; and
consume local and seasonal products.
ACTIVE TRAVEL/EXERCISE
Walk, cycle, or use public transport;
make use of carpooling;
use an electric vehicle;
enjoy local parks; and
stop smoking.
WOMEN AND INTIMATE HEALTH
Long-acting reversible contraception reduces monthly bleeds;
consider using bamboo-based rather than cotton-based sanitary products (more sustainable); and
consider using reusable pads/menstrual cups where safe and appropriate.
HOLIDAY/TRAVEL
Enjoy the green spaces in your local environment;
make use of public transport;
avoid flying or fly less; and
carry reusable bags and bottles when travelling.
ENERGY
Switch off lights when not in use;
change light bulbs to LED lights;
switch off electronic appliances when not in use;
only boil the water that you need;
cover the pot while cooking (saves energy/cooks faster);
only use the washing machine and dishwasher when fully loaded;
install solar panels;
draught proof your home (saves money and energy); and
encourage digital communication whenever possible and appropriate, but also consider when an email or text is unnecessary (perhaps add a message to this effect to your e-signature).
WASTE
Use reusable water bottles, cups, and bags;
avoid using single-use plastics;
recycle items (such as clothes, shoes, newspapers, and books);
reduce food waste;
compost your waste;
think before you print;
print on both sides of the paper; and
use non-confidential printouts as rough paper.
MEDICINES
Inhalers (seek advice about optimal usage and disposal);
return used/unwanted/expired medications to the pharmacist; and
do not flush medicines down the toilet.
CAREER/ACTIVITIES
Think how you could reduce carbon footprint in your chosen career;
plant trees (for example, the Plant-for-the-Planet initiative [https://www1.plant-for-the-planet.org] allows people to sponsor tree-planting around the world);
form local enviromental groups or join existing initiatives;
support small projects in the community, such as a local school’s educational intiative;
take part in communal area gardening; and
contribute to a local newsletter sharing ideas and achievements.
As trusted primary care leaders, GPs have ample opportunities to communicate, empower, and engage with our community to help reverse climate change. Simple, repeatable messages are most effective. Understanding our unique patient population and having positive conversations while offering pragmatic practical advice tailored to the person’s needs is the way forward.
Footnotes
This article was first posted on BJGP Life on 1 Jul 2022; https://bjgplife.com/eco
- © British Journal of General Practice 2022