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Doctors should be eco-warriors too

Doctors should be eco-warriors too

Tim Smith, Consultant Anaesthetist (locum), at Perth Royal Infirmary, NHS Tayside told us about his sideline studying an MSc in Environmental Management. Read his story for more insights about why doctors should be eco-warriors too...

Studying for a Masters in Environmental Management

If there's one thing I've learned from studying for a Masters in Environmental Management, it's that humans do not exist in isolation from the rest of the biosphere; we are utterly dependent on it for our survival, health and happiness.

My initial motivation for doing another degree was simply to get a better insight into environmental issues. It was refreshing to study an area completely unrelated to medicine; quite a different experience to studying for undergraduate and postgraduate medical exams, no doubt because my career wasn't riding on the results! 

The only downside was that, once you start delving more deeply into environmental problems, rather than looking the other way as we usually do, the world never appears the same again.  

"One of the penalties of an ecological education is that one lives alone in a world of wounds" Aldo Leopold, American ecologist

The Scottish Highlands (which I love) went from seeming like one of the last unspoilt wilderness areas of Europe, to a mostly barren landscape of heather moorland, stripped of its ancient Caledonian Forest by centuries of deforestation and overgrazing, its keystone species long since extirpated. 

I saw the Great Barrier Reef for what it has become, rather than the way it is portrayed: its coral bleached by climate change related ocean warming; the water polluted by farm run-off and industrial activity along the coastline, to the extent that the reef is now in danger of losing its UNESCO World Heritage Status.

It was depressing to learn just how deeply the issue of climate change has been manipulated by the fossil fuel industry in order to prevent attempts at mitigation. It has obfuscated, sown doubt and manufactured the appearance of a debate among the scientific community about the existence, cause, and catastrophic consequences of climate change. 

There is no debate; we are decades beyond that point. And as serious as the threat of climate change is, it is by no means the only environmental crisis we face. 

Air and water pollution, biodiversity loss, deforestation, industrial fishing, plastic waste and intensive farming are all life-threatening problems that urgently need to be addressed. 

The healthcare industry and the environment 

Closer to home, it became clear that the healthcare industry is no longer making a wholly positive contribution to human health. We are unwittingly contributing to environmental degradation via carbon dioxide emissions, waste and pollution generated by our hospitals.

If all this sounds rather bleak or melodramatic, don't worry, environmentalism often has this effect on people, paralysing them into inaction with negative, extinction-based messages, or provoking a psychological backlash. 

But I also learnt that the existential threats we face provide an opportunity for humanity to take a giant leap forward into the next phase of our development, as long as we don't procrastinate much longer.

We can decide to adopt progressive solutions such as: 

  • Steady state economics
  • Agro-ecology
  • Renewable technologies
  • Urban redesign with green spaces
  • Rapid mass transport and walking/cycling networks
  • An ecosystem approach to decision making

Alternatively, we can continue with business as usual, caught in our progress trap, hoping that the market and technological fixes will bail us out. However, given that these are the mechanisms that created our problems in the first place, this is unlikely to be a successful strategy.

If we do decide to embrace these new ideas, it will be a difficult transition, since underpinning them is the need to dispense with the established economic model of limitless growth, rampant consumerism, and the philosophy of exploitation and dominion over nature. 

We only have one planet

Instead, we must start to think and act in ways that reflect the fact that we have only one planet, with finite resources, and that our health depends on protecting and restoring its ecosystems. 

When we view environmental problems in this way (i.e. as a public health emergency), it becomes apparent that doctors have a pivotal role to play in helping to address them. Indeed this 'health frame' has been shown to be an effective tool for communicating climate change to the general public. 

We are one of the few remaining professions that is still largely trusted by society. This means we're uniquely placed to educate patients, students and the public about the inextricable links between the environment and human health. We can promote sustainable, low carbon behaviour, and convince policy makers that robust environmental legislation is urgently required, as is health promoting infrastructure, such as active travel networks and access to urban green spaces.

If we're going to start engaging in environmental advocacy, we'll have to adopt an evidence-based approach where possible. However, in the face of life-threatening problems, it is inappropriate to postpone preventive measures while we wait for full scientific certainty. This is known as the precautionary principle, and it is a key component of environmental decision making. 

We may not recognise it by this name, but it is something we practice every day when treating our patients. It's well established that our survival and physical health depends on intact ecosystems and biodiversity. They provide life-supporting services such as food, clean air and water, healthy soil, medicines and disease regulation. However, there is also an emerging evidence base that our mental health and wellbeing is dependent on interaction with nature. 

A growing number of studies suggest that contact with nature reduces mortality from all causes, alleviates stress, improves mood and self esteem, increases levels of physical activity, improves healing, increases concentration and reduces symptoms in mental health patients and children with ADHD. 

Urban green space (i.e. any vegetated land such as parks, gardens, woods and wetland within an urban area) has also been shown to increase social interaction, reduce health inequality, reduce crime rates, and improve air and noise quality. Interestingly, the psychological benefits of contact with urban green space increase with the species richness (biodiversity) of the area. 

Conversely, environmental degradation is very bad for human health. Air pollution, for example, causes cardiovascular disease, asthma and lung cancer. Climate change is the biggest global health threat of the 21st century, causing food and water insecurity, morbidity and mortality from heat waves, droughts and floods, and mental health problems arising from such extreme events. 

Biodiversity loss is a less well-publicised, yet incredibly important health crisis. Biodiversity, or the variety of life on earth, underpins ecosystem function and thus facilitates the lifesupport services mentioned above. However, it also represents a huge, mostly untapped source of potential pharmaceuticals and medical research.

Over half of all drugs developed during the past 25 years are either derived directly from, or modelled after, natural compounds. Some examples of widely used medications that have been developed from plants include: 

  • Morphine
  • Aspirin
  • Warfarin
  • Vancomycin
  • Cyclosporine
  • Sirolimus
  • Paclitaxel

Microbial derived medicines include: 

  • Penicillin
  • Aminoglycosides
  • Tetracyclines 
  • Anti-fungals

The polymerase chain reaction was developed from a thermostable DNA polymerase, isolated from the bacterium Thermus aquaticus, which was found in a hot spring in Yellowstone National Park. Cone snails, from which the potent analgesic agent ziconotide was derived, are the source of an estimated 70,000 biologically active compounds, only a fraction of which have been studied so far. They are thought to be one of the greatest potential sources of medicines in nature, yet they are in danger of being lost forever, as ocean warming and acidification are destroying their coral reef habitats. 

Indeed, the sheer scale of global biodiversity loss is massive and unprecedented, mainly due to extensive habitat destruction both on land and in the oceans (e.g. by deforestation, bottom trawling, damning and dredging of rivers, draining of wetlands).

Pollution, invasive species and climate change are also major drivers. We've barely begun to scratch the surface of what nature has to offer mankind, but who knows how many potentially lifesaving discoveries we've already wiped from existence. Of course, if we're going to take a leadership role in advocating environmental protection and promoting sustainable, healthy, low carbon behaviour, then we need to get our own house in order. 

The NHS is a major emitter of CO2, and is responsible for approximately 25% of total public sector emissions. It also generates huge amounts of waste, the vast majority of which ends up in landfill.

The healthcare industry has the opportunity to set an example to the rest of the population. We could build energy efficient hospitals powered by renewable sources, incorporating green space for patients, staff and the local community to use for exercise, rest and relaxation. We can significantly reduce our waste through more appropriate procurement, waste segregation and recycling. 

Hospitals could source healthy, seasonal, local food, promote active travel and public transport for staff and patients, and provide incentives for staff to reduce their ecological footprint.

Tim Smith Consultant Anaesthetist (locum), Perth Royal Infirmary, NHS Tayside

This article first appeared in Anaesthesia News, May 2018.

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