Planetary health in practice

Purpose and context

The climate crisis threatens health at population and individual level. The Lancet has recognised this (Watts, et al., 2018) along with the fact that “tackling climate change could be the greatest global health opportunity of the 21st century”. This is because many of the actions needed to tackle the climate crisis, such as reducing emissions and increasing biodiverse green space, also have immediate health co-benefits – for example, through reduced air pollution, access to nature, healthy sustainable diets and increased active travel (Lacobucci, 2016). It is vital that tomorrow’s GPs are equipped with the knowledge of how human health is fundamentally predicated on planetary life support systems and the tools to apply sustainable healthcare principles to individual and population health.

The NHS is the largest public sector contributor to carbon emissions in England. In October 2020, in response to the profound and growing threat to health posed by climate change, the NHS became the world’s first health service to commit to reaching carbon net zero. Following COP26 in the UK in 2021, HEE committed to educate every future NHS clinician about sustainability and the net zero initiative through the programmes we commission and deliver.

The report Delivering a Net Zero Health Service (NHS, 2020) sets out a clear ambition and two evidence-based targets:

• The NHS Carbon Footprint: for the emissions we control directly, net zero by 2040.
• The NHS Carbon Footprint Plus: for the emissions we can influence, net zero by 2045.

Clinicians have a direct influence on the ability of the NHS to meet these targets. This is particularly the case in primary care, where the majority of the carbon footprint comes from clinical activity. Sustainable healthcare is fundamentally aligned to person-centred, evidence based and cost-effective healthcare, as it is achieved through the application of the following four principles: prevention, patient empowerment and self-care, lean systems and low-carbon alternatives (Mortimer, et al., 2018). These principles can be applied to quality improvement in all clinical areas.

Medicines account for about 25 per cent of emissions within the NHS in England and two thirds of the primary care carbon footprint. They also contribute to the pollution of aquatic ecosystems. Metered dose inhalers are a particular prescribing carbon hotspot in primary care, accounting for 13 per cent (Greener Practice, 2023) of its carbon footprint. Quality improvement in this area boosts respiratory health for patients while reducing the carbon footprint.

Transport accounts for around 14 per cent of NHS emissions, so changes in the way healthcare is delivered – such as via remote consulting and local delivery – along with changes in the way training is delivered, can all work towards meeting the targets.  

The COVID-19 pandemic had a huge impact on the way we practice, but also highlighted the inequality both in our healthcare system and in population health in general. It is vital that tomorrow’s GPs understand the impact of the climate crisis on exacerbating health inequalities (Institute of Health Equity, 2020) and how to ensure sustainable healthcare addresses this issue.

Each individual primary care encounter can be viewed through the lens of community and planetary health by asking two questions: how does planetary health impact on clinical formulation? And how does clinical management impact on planetary health by using the principles of sustainable healthcare?

The role of the future GP includes:

• protecting and improving the health of populations,
• understanding the wider determinants of health to address inequalities and inequities,
• maximising the effectiveness of resources and services while minimising harm to people and planet through the use of sustainable healthcare principles,
• monitoring and assessing the needs of local population groups,
• communicating risks to individuals and local populations,
• advocating for measures to improve the health of populations and the planet.

We heard...

GP DiTs are deeply engaged in planetary health and in many instances are ahead of their educators. They understand that a rapidly changing climate and biodiversity crisis has a profound impact on our health and the way that we practice medicine, and that training needs to reflect these changing demands.

Sustainable healthcare training is popular and GP DiTs are leading on GP practice and PCNbased quality improvement projects that aim to reduce emissions and improve patient care.

Priorities and action

Teaching on planetary health and sustainability should be embedded in the curriculum.

These themes will be priorities for the virtual learning academy and pilot blended learning placements. All GP DiTs should be given regular opportunities through their training programmes to be involved in projects that support the NHS zero carbon commitment, including sustainable quality improvement and leadership activity.

Training programmes and deaneries adapted quickly to remote learning and the remote management of GP training. Educational teams will embed best practice from the COVID-19 pandemic to maintain quality education while minimising carbon emissions. Considerations on environmental impact should be routinely factored into decisions on the delivery of GP training.