William Beharrell

“The pandemic is a reminder of the intimate and delicate relationship between people and planet. Any efforts to make our world safer are doomed to fail unless they address the critical interface between people and pathogens, and the existential threat of climate change, that is making our Earth less habitable.”

WHO Director-General Dr Tedros Adhanom Ghebreyesus. Address to the 73rd World Health Assembly.  May 18th 2020.


Dr Tom Downs is coming to the end of his eight year in medical training. He studied as an undergraduate in Cardiff for six years and has worked as a junior doctor in north Wales for the last two years. It is worth pausing for a moment to consider just how much knowledge Tom has had to absorb in that time, and the personal qualities required to undertake this kind of training.  Pause again, and all kinds of interesting questions arise when one considers the challenges facing 21st century healthcare.  Would it have been possible to acquire this knowledge in a different way? Does the training need to take that long? Are there aspects of healthcare which weren’t covered in the training?

A point on which I suspect most of us would agree, is the importance of personal development to the practise of good medicine.  Yes, any of us might be able to Google our symptoms to reach a differential diagnosis but developing the personal virtues and the practical judgement to become an effective clinician isn’t something that can be taught in the absence of experience.  Take, for example, the skill of ‘getting stuff done’.  Any individual who possesses the vision, courage, charm, and wit to take the initiative and make things happen, is often rightly praised for their leadership skills. We don’t teach this so where does it come from?

Tom is clearly someone who can ‘get things moving’.  Take, for example, the title of Tom’s project with the Bevan Commission: “Making connections to improve sustainability in our hospital Ysbyty Gwynedd”.  The personal qualities mentioned above are essential to the act of making connections and to the process of improvement. As for the topic of sustainable healthcare, Tom arrived at medical school with an affection for the natural world and an interest in climate change. It wasn’t until he came across the Lancet Countdown on health and climate change in his final year, that he made the link between his future career in medicine and his personal interest in climate change. Whilst Tom’s medical career looks set to be shaped by his contribution to sustainable healthcare – which is acknowledged by Welsh Government to be of central importance to the future of the NHS – it is worth asking how much his medical training contributed to his interest in this area, and to what extent it equipped him with the skills required to develop it.

Tom’s interest in the natural world developed during a childhood growing up in the Somerset countryside. With both parents job-sharing as GPs, his exposure to the medical world no doubt started early and one imagines in part through the daily dinner-time badinage that helps so many couples wind down at the end of the day.  Tom credits his love for the outdoors as a key factor in moving to North Wales and his parents as key influencers on his career choice.  But it is harder to account for his single-minded commitment to sustainable healthcare. As any medic knows, a junior doctor’s rota makes it hard enough to maintain a social life, let alone pursue a passion as relentlessly as Tom has.

If the Lancet Countdown on health and climate change was his first-step on this particular journey, then his decision to not fly during his medical elective, and to instead participate in the Devon local nature partnership called Active Devon, was the second. A third step came with reading of the Healthcare Without Harm report which described the NHS as if it were a country, as the fifth largest global emitter of greenhouse gases. The Lancet report fulfils the role of monitoring the evolving health profile of climate change, and providing an independent assessment of the delivery of commitments made by governments worldwide under the Paris Agreement. Health Care Without Harm (HCWH) is a non-profit network of European healthcare providers, whose members are part of the Global Green and Healthy Hospitals network. This is the largest sustainable healthcare network in the world, transforming the European healthcare sector so that it reduces its environmental footprint, becomes a community anchor for sustainability, and a leader in the global movement for environmental health and justice.

It is clear that Tom drew inspiration from this network to establish the Green Group at Ysbyty Gwynedd.  When Tom started asking about the hospital’s response to climate change, he began to encounter all sorts of pockets of activity. His natural impulse was to coordinate these different individuals and thus the Green Group was formed. Together with Yasmina, who I interviewed for the previous blog, and other colleagues, they began to draw up a list of projects on topics such as food, energy, transport, waste, and biodiversity, and categorised them into three workstreams: Connect (communications); Learn (education); Transform (improvement).  The group was multidisciplinary in its formation and national in its scope.

Tom took his project with the Bevan Commission to the Spread and scale Academy and was given an opportunity to reflect on its purpose, its ambition, the team, and what actions might be required to extend the network.  This sounds like the first opportunity Tom has had, as an NHS employee, to benefit from the kind of skills and development training that helps people ‘get things done’.  When it comes to scaling this work across Wales, Tom has the advantage of being able to align the principles of sustainable healthcare with the principles of prudent healthcare. When taken together with the three pillars of the healthcare climate challenge, i.e. mitigation, resilience, leadership, this can serve as a conceptual framework to guide future action.  (see below for Tom’s schematic illustration)

The action being called for, includes the WHO Manifesto for a Green Recovery from Covid-19 which presents some clear objectives around which we are being asked to mobilise. For example, it is imperative that we protect and preserve the source of our human health: Nature; invest in essential services, from water and sanitation to clean energy in healthcare facilities; ensure a quick healthy energy transition; promote healthy, sustainable food systems; build healthy, liveable cities; and stop using taxpayers money to fund pollution.

Opinion polls from around the world show that people want to protect the environment and preserve the positive that have come about through the response to Covid-19.  A new Ipsos poll conducted online among more than 28,000 adults in 14 countries found that 71% of adults agreed that, in the long term, climate change is as serious a crisis as Covid-19. The survey showed widespread support for government actions to prioritise climate change in the economic recovery after Covid-19 with 65% agreeing that this is important. However, another Ipsos survey, carried out online among more than 20,000 adults across 29 countries found that while climate change remains the most important environmental issue for citizens globally, citizens are no more likely to say they plan to make changes to their own environmental behaviours than they were six years ago.

These polls offer three fundamental insights. Firstly, at a cognitive level, there is a popular mandate for bold action but that at an affective level, people require forms of leadership that are currently lacking.  This is likely to be crucial when considering policies that do not seek only to maximize GDP, but to protect and enhance wellbeing. Secondly, if climate change is seen as no less a threat to our health than Covid-19, then the seriousness with which we responded to the pandemic offers a precedent for prioritising planetary health in terms of government spending, legislation and multi-lateral action. Thirdly, if as a health service our first duty is to no harm, then healthcare policy should be revised to include multidisciplinary programmes that protect the health of natural systems and prevent further harm from environmental degradation, pollution and greenhouse gas emissions.

Perhaps the most salient point to emerge from these polls is that a majority of the public (68%) agreed that if their governments do not act now to combat climate change, they will be failing their citizens. If, above all, we are called to public service, then we have a responsibility not just to lead, but also to listen and learn from the experiences and anxieties that are now being expressed in public opinion.  Tom’s work offers us an example of how it is so often voices from beyond our traditional hierarchies that show us the way forward.  In this case, Tom’s awareness of the work being done through global coalitions such as Healthcare Without Harm has helped him to galvanise us into action. The Green Health Wales network conference, which has been organised by many of those featured in this blog series, offers us all a chance to respond.

Most fundamentally, protecting lives, livelihoods and the environment depends on the support of the people. There is widespread public support for policies that do not seek only to maximize GDP, but to protect and enhance wellbeing, and for governments to combat climate change and environmental destruction with the same seriousness with which they are now fighting COVID-19. It is also shown by the millions of young people who have mobilized to demand action not only on climate and biodiversity – but also for the right to breathe clean air, and for their future on a liveable planet.