Climate change and the pivotal role of health professionals

Imagine if countries worldwide were robustly dialling back their greenhouse gas consumption to slow the acceleration of climate change and that this had started to bend the curve on the alarming trends of rising air pollution, ambient temperatures, and extreme weather events. The good news is that recent events have made this vision possible. And, perhaps surprisingly, health professionals play a crucial role in making this happen. This commentary explores the recent shift in the global response to climate change, explains why health care professionals are pivotal in supporting this shift, and identifies actions. To better understand this recent upturn in events, it is useful to revisit Kingdon's 'three streams' model that explains why some policy issues rise to become priorities and others do not.1 Kingdon identified that 'three streams' must be present for an issue to capture the attention of decision-makers: (1) a compelling problem, (2) a viable solution, and (3) a conducive political environment. Climate change is a compelling problem. It is indisputable that ambient temperatures are rising. In Europe, 2023 set a record for the hottest year on record, where average temperatures were at least 1°C warmer every day, and nearly half of the days were more than 1.5°C warmer than preindustrial levels.2 It is also known that each 1°C rise in temperature is associated with increases in both extreme weather events and rising sea levels.3 We have viable solutions to address climate change. We need to transition away from fossil fuels to renewable clean energy sources, adopt sustainable food habits, build climate smart infrastructures,4 and address broader planetary issues, such as environmental degradation and polluted water.5 What has been missing is a conducive political environment. The lack of public and political consensus about climate change has been present for over 50 years. For example, less than half of American adults believe climate change is caused by human activity (46%); 26% attribute it to natural causes; 14% see no solid evidence of climate change; and 14% remain incertain.6 And even among those who agree climate change may be happening, some believe other priorities are more pressing.7 In light of this long-standing stalemate, what has changed? The answer is: increasingly compelling research on the health effects of climate change and incremental progress at the last COP28 meeting. Research has forged a growing consensus that climate change has deleterious effects on human health. Fossil fuels are the primary driver. Air pollution now kills about 7 million people prematurely each year.8 Virtually everyone in the world (99%) is breathing air that exceeds global air quality guidelines.9 Air pollution triggers difficult-to-control asthma and exacerbates other respiratory diseases.10 Rising temperatures contribute to increased waterborne and tickborne infectious diseases11 and heat-related deaths in the elderly and other vulnerable populations.12 As Meibach wryly stated: "This isn't about polar bears and penguins anymore."4 This is about our loved ones. The Conference of the Parties (COP) to the United Nations Framework Convention on Climate Change (UNFCCC) is the mechanism for operationalizing the 2016 Paris Agreement. Before the 28th COP meeting in December 2023 there was a concerted effort to highlight the growing concern about climate change's health effects. This was exemplified by over 200 health journals issuing a joint statement identifying climate change and environmental degradation as a global health emergency.13 There were two landmark events at COP28. First, the inaugural Health Day highlighted that with our current trajectory towards 3°C of warming, no health system would be able to keep people well.14 This was followed by a health interministerial meeting and the launch of the COP28 United Arab Emirates Declaration on Climate and Health to signal that climate change is a health crisis. It has now been endorsed by 148 countries.14 Second, in the consensus agreement signed at the end of the meeting, countries agreed on the need to 'transition away from fossil fuels'. This was the first time that the words 'fossil fuels' appeared in a COP agreement. Previously, the focus had been on 'decreasing emissions' without specifying the source. So, although there was nothing binding, the agreements—that climate change is a health crisis and there is a need to transition away from fossil fuels—signalled a pivotal shift in the 'third stream' towards a more conducive political environment. What is needed now is to strengthen this consensus with growing public support. The incontrovertible evidence that climate change is having a profound effect on human health means climate change is now clearly in the purview of health care professionals. Health care professionals are well-placed to address climate change with the people they care for to garner public support to transition away from fossil fuels. We have three characteristics that make us ideal for this task: understanding science, explaining health effects, and being trusted professionals. While some may doubt they have an impact,15 evidence shows that when people hear from a reliable source there is scientific consensus that global warming has been caused by humans, they are more likely to believe it.16 Framing climate change as a health issue, and that something can be done about it, is effective in motivating change.17 It is especially effective when linking local environmental events to health impacts.18 There are three important ways to boost public support to address climate change. First, health care professionals are well-positioned to address misinformation. As a trusted professional, people will listen, regardless of their political persuasion.19 Research has found that simple, frequent, and consistent messages from a trusted source is an effective way to combat misinformation.20 It is important to acknowledge that climate change is real, it is affecting our health, and actions can make a difference. See Table 1 for more details. Five key facts It's real It's us It's bad for our health We need to care about this The majority of people are concerned And there's hope Actions we take now will make a difference. Four groups will need help the most Babies, children, pregnant women Seniors, people with chronic illness People in low income and communities of colour Outdoor workers Eight ways climate change harms your health Air pollution Extreme heat Extreme weather Vector-borne illness (from ticks and mosquitoes) Waterborne illness Foodborne illness Hunger and malnutrition Harm to mental health Five solution pathways Use clean, renewable energy and reduce waste Favour climate smart foods Support clean and active transportation options Work towards climate smart buildings and homes Create climate smart community environments Second, when health professionals address climate change personally, it sends an important message: We all have a role to play. The most effective activities are those that tend to resonate with others, creating tipping points, that lead to widespread adoption.21 Examples include estimating your carbon footprint and then starting to reduce your carbon consumption. You may use your bike more, buy an electric vehicle, and reduce food waste. Discussing these changes with others may inspire them to change, thereby turning individual actions into a collective trend. In light of the fact that health care accounts for almost 5% of all greenhouse gases, taking steps to decrease carbon pollution in the office setting is a good place to start.22 See Table 2 for a summary of things that can be done. Get inspired Read what others have done Discuss with colleagues; suggest an initiative Start with simple goals Celebrate successes Reduce Carbon but tipping point activities that scale up can change norms. As the awareness grows about the health effects of climate change and the need to taper off fossil fuels, peoples' perspectives, practices, and expectations will change. And as the social norms shift, this will increase the public support needed for politicians in countries around the world to make the tough decisions needed to address climate change. Progress in adaptation planning and implementation has been observed across all sectors and regions, generating multiple benefits (very high confidence). Growing public and political awareness of climate impacts and risks has resulted in at least 170 countries and many cities including adaptation in their climate policies and planning processes (high confidence) …. However, policy coverage is uneven across sectors and although aspirations might be there, there is a high "implementation gap".3 Widespread public support is needed to bridge this implementation gap. Health care professionals are pivotal in helping to build this public support. One drop of water on its own will soon dry up, but when that drop is part of an ocean, it becomes a formidable force. Now we have a compelling problem, a viable solution and a more conducive political environment. With increasing public support, all three streams could converge so that we can turn the possible into the probable. Many thanks to Dr. Maddie Venables for her perspicacious and helpful suggestions on earlier drafts of this manuscript. The authors declare no conflict of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.