BMJ  2006;333:983-984 (11 November), doi:10.1136/bmj.39028.427164.BE

Editorials

What should we do about climate change?

Health professionals need to act now, collectively and individually

Action on climate change has been likened to teenage sex. Everyone claims to be in on the action, but only a few are, and those not very effectively. Given the scientific consensus that global warming—the underlying cause of climate change—is mainly caused by human beings^{1 2} and its effects are likely to be seriously damaging to global health,^{3 4} citizens and governments must take much more effective action. This sense of urgency has been confirmed by the Stern report, commissioned by the UK chancellor, Gordon Brown, and published last week.⁵ It concludes that the cost of doing something to combat climate change is likely to be 1% of global gross domestic product, but the cost of doing nothing will be up to 20% of global gross domestic product. It also concludes that the cost to the environment of each ton of carbon dioxide emitted is £50 (75; $95), a figure that gives us a financial yardstick of the damage we are doing by our continued reliance on fossil fuels.

Health professionals have a track record of identifying and helping resolve serious public health issues. We are well placed to play a leadership role. Indeed it is a role that we cannot shirk. So what should we do? The BMJ has set up a carbon council with the objective of harnessing the intelligence and imagination of health professionals to expedite the transition to a low carbon world (see bmj.com for list of council members).

The council's strategy is fourfold. Firstly, to recruit as many health professional as possible to act and act now. Although the global effects of climate change and benefits of resolving these are well known,^{6 7} many doctors and other health professionals have not articulated for themselves and others the public health priority of climate change compared, for example, with smoking and inequalities in health. This is alarming, given that climate change related rises in sea level and changing food growing patterns will lead to massive social disruption, with the increased likelihood of resource wars, the spread of many "tropical" diseases, and a greatly increased burden of ill health. The BMJ's contribution will be to present the evidence for the health damaging impacts of climate change, both in the developed and developing world, and the health benefits of moving towards low carbon living.

Secondly, we want to identify the most effective low carbon policies that when implemented will reduce greenhouse gas emissions. The BMJ's climate change issue in June of this year offered examples of such policies,⁸ which must ensure welfare development for the global poor at the same time as controlling carbon emissions. Of several possible approaches, contraction and convergence is our favoured option.^{9 10} Adoption of this policy would create a global carbon budget, with a phased reduction over the next 30 years (to tackle global warming), and an equal per capita allocation of carbon entitlements. Frugal emitters, essentially the world's poor, could sell their unused entitlements to excessive emitters, the rich, thereby enhancing the welfare of the poor as well as creating incentives for the excessive emitters to reduce emissions. Another professionally concerned group, the Royal Institute of British Architects, has recently adopted contraction and convergence as its favoured framework.¹¹ We welcome readers' views on the workability of this policy option compared with other options you may be aware of.

Thirdly, we aim to establish a coalition of health professionals to act as policy advocates nationally and internationally. Advocacy will be directed at the organisations within which we work—particularly the health service—at governments, and at business, all of which have good reason to tackle climate change. The BMJ is already exploring how best to become carbon neutral and will encourage all other health facilities to do likewise. We will invite other medical journals, the UK royal colleges and health related professional associations, academics, and policy makers to work together to create what will be a powerful force for change.

Finally, the council will encourage individual lifestyle change among health professionals around the world. This is part of the strategy—not because we have any illusions about the contribution of individual behavioural change to the overall problem of global climate change—but because it is vital that health professionals lead by example. As a start, we invite you to estimate the carbon emissions for which you are personally responsible by registering on www.rsacarbonlimited.org and signing up to CarbonDAQ, and then to commit to reducing your emissions each year. To make this commitment stick, and to ensure that it brings appropriate benefit, we are establishing a scheme in conjunction with the Royal Society of Arts. This scheme asks you to reduce your individual emissions by 5% a year and to pay £25 for each ton of carbon dioxide you emit in excess of the average UK personal emission of five tons into a development fund. The money raised will support low carbon projects in the yet to be industrialised world. We will contact those of you who complete the Royal Society of Arts profile and ask you to join this part of the scheme.

By personal and collective action health professionals can contribute to the health of our own and future generations. By contributing your ideas, deploying your advocacy skills, and making your personal commitment you will join us to create a new breed of climate concerned health professionals. We can then justly say to our descendants that we played our part in preserving the integrity of our beautiful but fragile world.

¹ Medact, London N19 4DJ, ² BMJ, London WC1H 9JR

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Competing interest: None declared.

References

1. Houghton J. Global warming. Rep Prog Phys 2005;68:1343-403.[CrossRef]
2. Pearce F. The last generation. Chester: Eden Books, 2006.
3. McMichael AJ, Woodruff RE, Hales S. Climate change and human health—present and future risks. Lancet 2006;367:859-69.[CrossRef][Web of Science][Medline]
4. World Health Organization. Climate change and human health—risks and responses, Summary. Geneva: WHO, 2006. www.who.int/globalchange/climate/summary/en/.
5. HM Treasury. Stern review final report. London: HM Treasury, 2006. www.hm-treasury.gov.uk/independent_reviews/stern_review_economics_climate_change/stern_review_report.cfm.
6. Coote A. What the health services could do about climate change. BMJ 2006;332:1343-4.[Free Full Text]
7. Stott R. Implications for health in a low carbon (contract and converge) world. J Epidemiol Community Health 2006;60:828.[Free Full Text]
8. Stott R. Healthy response to climate change. BMJ 2006;332:1385-7.[Free Full Text]
9. Global Commons Institute. Contraction and convergence A global solution to a global problem.
10. Global Commons Institute. Contraction and convergence. London: GCI, 2006. www.gci.org.uk/images/C%26C_Bubbles.pdf.
11. Royal Institute of British Architects. RIBA confirms basis for its climate change policy. London: RIBA, 2006. www.riba.org/go/RIBA/news/press_5779.html.

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