At a training day on Environmental Sustainability in 2017, run by a fellow Public Health Registrar, I remember the feelings of utter fear and panic rising in me as I saw slide after slide about the planetary and human health impacts of climate change. The first response to learning of the impacts of climate change is often panic – it can feel too big, too much and too overwhelming to do anything effective or meaningful. The Lancet identified it in 2009 as the biggest global health threat of the 21st century, so why has public health been so slow to react? 

What’s the problem?

The changes in global temperatures are being driven by human activities: with industrialisation, fossil-fuel driven economies, changes in land use such as deforestation and expanding populations. 

The general pattern predicted for Scotland is hotter, drier summers and milder, wetter autumns and winters, and a knock-on effect of climate change is increasing extreme weather events which are harder to predict. Globally we have seen an increase in heat waves, droughts, flooding, cyclones and wild fires. Within Scotland we have seen increasing storms, increasingly heavy downpours with subsequent flooding and extreme cold snaps. Over the last couple of years, these effects are getting more frequent and severe, with more and more people directly affected. 

Flooding, extreme heat and extreme cold all have impacts on the functioning of healthcare and other vital services, so they are likely to affect those who are more vulnerable, such as the very young, the very elderly and those with existing health conditions, increasing the risk of illness, injury and death. As a result, climate change will increase demands on health services. Extreme weather will also have an impact on food production and on the food supply chains we have established with other parts of the world, impacting on the availability and cost of food. 

These impacts of climate change will widen inequalities within our society, globally and locally: those who have contributed the least to emissions will be most likely to suffer the worst consequences and be less resilient to the impacts. For example, those on lower incomes are less likely to have a car, more likely to live in flood prone areas and less likely to have adequate house insurance.  

What’s the answer? 

The Intergovernmental Panel on Climate Change warned that we have 12 years to make the rapid reductions in emissions required to avert worst case scenarios. We now need transformational change across every part of society. 

The NHS is a major contributor of Greenhouse Gas Emissions through our vehicles, buildings, procurement and waste. We have the opportunity as an anchor organisation, as an employer of 160,000 people and provider of services to millions, to influence many and act as an exemplar. 

The health of humans is dependent on the health of the natural environment and its ecosystems. Focusing primarily on the downstream determinants of health, such as encouraging a healthy diet, while neglecting environmental sustainability, will limit and undermine efforts to improve health and reduce inequality. The new Public Health Priorities will not be achieved without also working to improve environmental sustainability. In public health, environmental sustainability cuts across everything we are trying to do. 

The public health voice in the response to the climate emergency is a vital one. In the NHS we are used to dealing with emergencies: the response needs to be rapid, effective and requires many people with different skills all playing their part. We need to speak up, we need to act fast, we need to scale up our response and we need everyone to understand their role and play their part in tackling the climate emergency.  

And the first step we need to take is taking it on as OUR fight.