Views of health professionals on climate change and health: a multinational survey study

Kotcher J, Maibach E, Miller J, Campbell E, Alqodmani L, Maiero M, et al. Views of health professionals on climate change and health: a multinational survey study. The Lancet Planetary Health. 2021. 10.1016/S2542-5196(21)00053-X

Relevant to:

All Dietitians-Nutritionists working to address climate change.  

Question:

This study reports on findings from a multinational survey examining 4654 health professionals’ views of climate change as a human health issue. Participants from 12 health professional organizations representing each of the six WHO regions were surveyed, including paediatricians, physicians, and nurses. The study asked about health professionals’ views and engagement with the issue, and systematically characterized both the barriers to climate change advocacy perceived by health professionals, and resources that may address those barriers.

Bottom line for nutrition practice:

This study focuses specifically on perceptions of health implications of climate change. The survey showed that participants understood that climate change is occurring and is caused by humans. Further, they see climate change as an important factor negatively impacting health in their countries, and feel a responsibility to educate the public and policymakers about it.   

The health professionals identified a range of personal, professional, and societal barriers to working on this issue, with time constraints as the most widely reported barrier. Participants proposed a diverse set of resources to address the barriers, including: continuing professional education, communication training, patient education materials, policy statements, guidance/ tools for workplace sustainability, and action alerts (e.g., about opportunities to endorse climate and health policy proposals and when and how to contact relevant policymakers, which the authors suggest can be particularly helpful for addressing time restraints). The authors state that social marketing literature underscores the importance of removing barriers in stimulating action for motivated individuals and groups.

Abstract:

Climate change arguably represents one of the greatest global health threats of our time. Health professionals can advocate for global efforts to reduce emissions and protect people from climate change; however, evidence of their willingness to do so remains scarce. In this Viewpoint, we report findings from a large, multinational survey of health professionals (n=4654) that examined their views of climate change as a human health issue. Consistent with previous research, participants in this survey largely understood that climate change is happening and is caused by humans, viewed climate change as an important and growing cause of health harm in their country, and felt a responsibility to educate the public and policymakers about the problem. Despite their high levels of commitment to engaging in education and advocacy on the issue, many survey participants indicated that a range of personal, professional, and societal barriers impede them from doing so, with time constraints being the most widely reported barrier. However, participants say various resources—continuing professional education, communication training, patient education materials, policy statements, action alerts, and guidance on how to make health-care workplaces sustainable—can help to address those barriers. We offer recommendations on how to strengthen and support health professional education and advocacy activities to address the human health challenges of climate change.

Details of results:

Participation rates were low in many nations; over 60% of survey participants were members of a single organization (the Canadian Medical Association), and 95% of all respondents were physicians. The New Zealand Nursing Organization was the only nursing organization to participate.

Details are outlined according to the questions asked by the authors.

What is their understanding of key facts and personal engagement with issue?

Consistent with findings of other studies, greater than 4/10 professionals thought that their knowledge on the topic was insufficient. Given this, the authors suggest that professional training – both within courses of study and continuing education be accelerated. They also suggest that little research has been completed on education competencies that should be developed. Most participants indicated a high degree of engagement with the issue. The authors note, however, that evidence shows that even highly motivated people often do not take related actions.\

Do professionals see climate change as a human health threat?

Approximately 2/3 of participants believe that climate change will “cause a moderate amount or a great deal of harm to them personally, 77% said the same for their patients, 81% said the same for the people in their community, 57% said the same for the people in their country, and 93% said the same for the future generations” (p.3). Most professionals stated that climate change has already negatively impacted the health of people in their country (e.g., physical and mental health, poverty and hunger, disruption to health care services).

Are professionals willing to engage with the public and with policymakers to advocate for action?

Most participants indicated that they felt that health professionals have a responsibility to advocate to the public and to nation and world leaders regarding the health effects of climate change. Participants were asked about participation in a global advocacy campaign; 26% said they were willing to participate; 37% said they might, but would need more information; 27% said they would support it, but couldn’t personally participate; 10% said they would not support it.

To what extent are professionals supportive of related policies within their professional society?

Most survey participants believe their professional societies should modify their practices. While 69% of professionals felt their society should cut ties with fossil fuel companies (including stock and bond investments), this only represented approximately 40% of the respondents as the Canadian Medical Association did not include this question in their survey. Most also indicated that their professional society should provide opportunities for members to participate virtually in the meetings and conferences they host regarding the issue.

What are barriers to engagement with the public and policymakers?

The largest barrier cited was time constraints (54%). “Less than half said other factors reduce their willingness to communicate, including their lack of knowledge (41%), their belief that engaging with the public would not make a difference (31%), little support from their peers (22%), their perception that the topic is too controversial (16%), and their perception that engaging with the public is too risky for them professionally or personally (14%)” (p.4). Another barrier noted was their belief that their peers wouldn’t support engagement (22%), and that it is too risky for them either professionally or personally (14%). The authors suggest that this reflects the need for a culture shift within health professions. They also note that evidence supports the idea that if people incorporate changes at home or in their workplace, they are more likely to feel comfortable advocating for policy change.

What resources might be helpful?

Most professionals indicated that the following resources would be moderately or very helpful: “continuing professional education on climate change and health (76%); policy statements on climate change and health by their professional associations (76%); guidance on how to make their workplace sustainable (72%); action alerts (timely information) on when and how to advocate with policy makers (69%); training to communicate effectively about climate change and health (69%); and patient education materials (65%)” (p.4).

Of additional interest:

N/A

Editor’s comment:

It is interesting to see this study focusing on climate change as related to human health. Much of the food related research to date focuses on the impact of our food systems on the environment. Focusing on the food system’s impacts on human health may be a way Dietitians-Nutritionists to more successfully advocate for the issue.

The study didn’t deeply examine how professional societies could change their practices. It might be argued that Dietitians-Nutritionists associations have the potential to be more polarized than medical associations over the issue of climate change. Dietitians-Nutritionists have a wide scope of roles, including working in food production, processing and marketing, and can have diverse views on the impact of food on climate change. Some evidence suggests that while the dominant global view of Dietitians-Nutritionists is that there is a “central role” for Dietitians-Nutritionists in contributing to sustainability in our food systems and diets, others do not agree. Dissenting views of within Dietitians-Nutritionists argued: this is not within the scope of practice; there is inadequate evidence to warrant action; and that including these issues dilutes and/or overwhelms the professional role.   

For full report, see: https://icdasustainability.org/wp-content/uploads/2020/04/Building-Common-Ground-Report-to-ICDA-Carlsson.pdf

Open access link to article:

https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(21)00053-X/fulltext?dgcid=raven_jbs_etoc_email

Conflict of interest/ Funding:

Funding from WHO supported this study.

External relevant links:

N/A

Corresponding author:

John Kotcher jkotcher@gmu.edu

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