Dr Richard Smith - Transcript
Straight on to Dr. Richard Smith. He's one of his many hats as chair of the U.K. Health Alliance
on Climate Change, and will be well known to many of the medics in the audience as well. Thank you.
Good. Well, I must say, it's always a pleasure to be back in Edinburgh. The city of my youth, which has now
almost disappeared completely. And my my wife. I'm very romantic about Scotland.
I think this is where everybody should live. But my Scottish wife thinks I'm bonkers.
Right. And also, I say it's a great pleasure. I mean, Alex Salmond described Scotland as the Saudi
Arabia of wind power. And they've made a reference to this is a great place from that point
of view, too. So I wanted to start with this slide, which in some ways I think
tells the story. It shows how many earths we would need
if everybody in the planet getting on for 9 billion were to live
as people live in North America, then we would need five Earths. As you probably notice,
we don't have five Earths. If everybody lived as we live here in Scotland
and Britain, we would need roughly three earths. And the reason we can get by
is because of all those people in Asia Pacific and Africa who live
much lower carbon lives. And yet those people. This is what this arrow indicates.
They they're saying where we want what you've got. You know, we wouldn't want to be left
in poverty. We want to have cars and be able to fly around the world. And if that's gonna happen,
then we're going to have to reduce very dramatically. Each of us as individuals.
How much carbon we consume. And I thought it was important
to put this, I've you've probably seen these world mapper maps which should reshape the world
in relation to how many doctors or whatever. And this shows who it is that is
producing the greenhouse gases. And you notice the big places
are America, Europe, the top. And who is suffering the damage?
Well, this is the mortality and Francesca. People are dying now
from climate change. And lo and behold, it's mostly Africa. They're not contributing to the
carbon. It's mostly India. This is a huge issue of social justice.
I think that's one of the things we have to keep at the front of our mind as we talk about this. Now as I
thought, how would I get started on this? I thought back to when I was a junior doctor
here in Edinburgh in the East and then in Dunfermline. And somehow we wouldn't quite tell
people just how terrible their health was. We've sort of gloss over it a bit, but I thought I
would do differently tonight. So I went to this debate a couple of weeks
ago. And I must say it was an extraordinary debate. It had a waiting list. It was Â£30
quid to get in. They had a waiting list of 1200 people who wanted to attend the debate, which
shows, just as Dave was saying, you know, there is real passion and interest around
all of this. Now, you probably recognize George Monbiot. Oh, on the right there, one of the
leading campaigners for a very long time. And he was arguing to stop
climate collapse. We must end capitalism. He was arguing climate
change is an inevitable response of capitalism. Adair Turner on the left
was arguing the opposite. He was the first chair of the Climate Change Committee
and he was a director of the CBI. And I'll tell you, the result of the debate, if you
want to ask me afterwards why I put it up now, is because in the discussion afterwards, a woman
said to Adair Turner, I've got three children under 10. Can
you give me something to be optimistic about? And he said, Well,
to tell you the truth, I think we've got only a 30 percent chance of avoiding
climate collapse. But I work every single day to try and make
it 31 percent, 32 percent. And he is working with the Indian government, the Chinese
government, because, you know, that's where the action needs. It's what they do.
As David Attenborough said, it's what happens in China that will really decide whether Dave
can ever open his champagne. Well, whether he opens it to cheer himself up or to drown. And
then I thought I would add this. I was at a meeting where I heard this man speak. He's an earth scientist,
just like Dave. I imagined Dave probably noticed him. He's one of the co-directors of the Grantham
Institute, which is the big institute at Imperial College, concerned with climate change.
And he's a. And he gave these sort of rather staggering figures.
So until 1850, for the previous 10,000 years, the CO2 level
in the atmosphere was about 280 parts per million. I mean, Dave put it up and showed you
it's now 400, but now it is 400. And this last happened
five million years ago. Which was Pliocene period at which I'm sure you will know.
And at that time, temperatures were 4 degrees warmer than they are now. And the
sea levels were 20 meters higher. So Dave made the point that this you know, all that ice, it
takes a while to melt. But the way we're going at the moment, because although we're supposed
to be reducing carbon emissions, we're actually putting 7 percent more in each year
as a global organization, as a as a globe where we're headed by
the end of the century for a thousand parts per million. I mean, Dave's graph was very narrow.
I think it just went from 2015 to 2020. And that last, we
reached that level last. Fifty five million years ago, when the temperatures
were eight degrees higher than we are now. And there was no ice on the planet
and the sea level was 60 metres higher. So that would be lapping around
this building. It wouldn't just be Leith that disappeared. And the crucial fact to emphasize
was, we're going to do this if we don't stop in 100 years, which as
he said, is a geological instant. The pace of climate change that we are responsible
for has no analogy in the geological record. Climate has changed naturally in the
past at the levels we are experiencing, but not at the present rate of change.
You can read more about that. He wrote a blog for the BMJ in which he extended on that.
So how best to encourage action? There's a lot of debate about, you know, how do we message
this? Well, one way, which is in a sense, what I've just done is we're headed for
disaster, human extinction. And the evidence is that that doesn't get
ordinary people up out of their seats to make a difference. Although the evidence is it does work
for people like Extinction Rebellion. And as you probably know, there's Doctors for Extinction Rebellion,
friends of mine who've been arrested and worried. And now before the GMC,
a second message is, well, a little bit of change. Plus, technology.
Dave, who knows a lot about technology much more than I do that don't trust technology
will fix the problem. And that's often the message you get from politicians.
And Martin interestedly cause those people to lukewalmers. I mean, we don't hear a lot from the
climate denial people now. They've largely disappeared from Britain. The BBC doesn't need
to wheel out Nigel Lawson and say it's all a fantasy.
And then another way is, well, the change and this is sort of in a way well, the Lancet has put across the changes
necessary can lead to the biggest improvements in public health ever.
Because if we were all to stop living low carbon lives, we would be a lot healthier.
We wouldn't be so fat, we wouldn't be so diabetic. We'd have all kinds of advantages. But
I think the problem there is potentially that it it doesn't quite emphasize
just how much we have to change. And it's unclear on the extent of change necessary.
So the message that does seem to work best and I think it's really the message that Dave was delivering
is that it will be hard to solve this problem. This is not easy. It's very hard. But together
we can do it. And if we do do it, not only will we save the planet, but we will be living
better, healthier lives. And I think I wanted
to emphasize very strongly not only to take long over this, that, you know, this is not something in the future.
Climate change is damaging health right now. So this is a graph
from the Lancet countdown. I hope you know, the Lancet countdown. There's been six of them. They gathered
data which is produced just before each COP, and they'll be producing one before the Glasgow
COP. Well, these are the data on heatwaves. They're just going up and up and up and up and
up around the world. And as we know, and as Francesca said at the beginning,
heatwaves kill people. You can see that dramatic spike there in the middle in response
to this heat wave that occurred in Cook County in the US and,
of course, extreme weather events. Well, I hardly need to emphasize that with all the pictures on the news
of floods all over the place. So floods, snow and ice heatwaves
are happening more and more and more and more often, exactly as has been predicted by
climate scientists. I mean, what happened in Australia with that burning of the forest was predicted
four or five years ago. Somehow these things were predicted, but it was almost as if they were never going to happen.
And it effects hospitals. I mean, hospitals can be flooded and then they're unable
to function. And air pollution, as Francesca said. Right. Of being I mean, that's killing people.
Seven million around the world, but it's killing people right here in Edinburgh. It's increasing hospital admissions
here in Edinburgh and all across the country. It's right here, right now. And it has exactly
the same roots of the problem as as climate change does. And
Francesca talked about necessity to walk the talk. Well,
this is the carbon emissions of health systems around
the world. And you can see they're all going up. And there's something clearly
crazy about that. That is, we are trying to help people and do things. Our carbon emissions
is 12 percent of all the emissions of the US, an enormous
emission. And my friend David Pencheon, who used to headed the Sustainable Development
Unit in England, said, well, this seems to be a kind of moral offsetting that
happens. He calls it so we're doctors, we're saving lives. We're doing good
all day long. We can't save the planet in our evenings and weekends.
And I think that has been a factor. But I think, again, it's changing. We're in a period
of very dramatic change in how people are thinking about all of this. But here's I I just
gave you the one about the US 12 percent. And the NHS accounts for 5
percent of UK carbon emissions, which is what you'd expect because it's roughly 10 percent of the economy.
One in 20 vehicles on the road in the UK is related to the NHS,
which actually again when you think about it's not so surprising because it's 10 percent of the economy people are traveling
to and from work and there they're going to and from outpatient appointments
cetera. So how do we respond? Well, I think we have to recognize
we need response at every level. There has to be a global response that in the end that will determine
whether we live or die. There's got to be a national response within Scotland, within England. City
responses. I'm not sure I'd like to hear how much Edinburgh is doing. I know that
the London mayor is very active particular on air pollution. The health system has to change.
And that's what I'm going to move on to in a minute. And organisations have to change. That includes
Royal Colleges and individuals have to change. That has to be changed every single level.
It won't work if there isn't change at all those levels. So
health systems responding. Well, here's a good news thing from
the Lancet countdown. It's how it shows data on how much
people are talking about health in relation to climate change, because if you went to many of the
initial costs, then health wasn't mentioned. It's about energy and agriculture
and trade. But increasingly, health has been one of the things
that features in the COPs. And there is an ambition. I'm interested. Francesca didn't say it because
the W.H.O. have articulated it. They would like to make the Glasgow COP a
health COP because actually, in a way, ordinary people can relate more to that. There's something I
can do. I can change the way I live. I can change the way I travel. And I will
do myself good and I will do the planet good. So this graph shows that
health is featuring much more in those conversations. And who are the
most trusted professions? Well, it's nurses. It's not doctors, as everybody knows.
And we are a trusted profession. We have to speak up. I mean, why would we not speak up
when this is, as The Lancet says, the major threat to health in the world today, we
have to speak up and we will be listened to. And here is examples
of things that doctors have played a very prominent role. I'm not honestly sure how much
they were involved in slavery abolition, but certainly cholera smoking in tobacco. IPPNW
International Physicians for the Prevention of Nuclear War, which won the
Nobel Peace Prize, is an interesting model, I think, of how physicians
around the world, because I'm sure the College here will have lots of links with Chinese, Indian
physicians that we can we can operate at a global level and really encourage
action. We're still battling on alcohol. We've made a lot of problem on obesity. We're doing not badly with
HIV. And this this is the big problem. Now we've got to show we can respond.
So the the the NHS in England has had a sustainable development unit
for 10 years and a friend of mine, David Pencheon, ran it. And quite a lot of these slides come
from him and really he had a lonely task. He tramped around the trusts
saying this is really important. We're part of the problem as well as part of the solution. We need to do
something. And people said, yes, you're right, we ought to do something. But people didn't do
very much, as you can see, with those rising levels. There have been improvements in England. I'll show you.
And as far as I know, the health systems in Britain are the only health systems in the world
that are legally committed to reducing their carbon consumption. Others
just don't seem to think about it in many sets of circumstances. And this
is the carbon footprint of the NHS, the public health
and social care sector that comes from 2012. And you can
see there that the biggest chunk is procurement, all that equipment,
all those drugs, all those buildings, all that stuff. Travel is a big part
of it. I said that. And building energy is obviously an actually the building
energy is in some ways one of the easiest bits to fix.
And you can see that drugs are a huge part of it. And as Mike Griffin was emphasizing,
surgery is a monstrous part of all of this. So when you look at
the hotspots in the footprint where there is primary care, because that's where
most pharmaceuticals are prescribed. And actually the College of GPs
does have a very active programme of how individual practices can get to net zero,
acute medical instruments and equipment, acute building energy. But there
are many, many things where carbon is being produced
as a part of healthcare, and this is what the
NHS in England has achieved. So going back to 1990,
that kind of blip is when Tony Blair and people put a lot more money into
the NHS and consequently carbon emissions went up, but they've begun to come
down, but they've got a long, long way to go. And this is something that gets harder and harder.
You've got some easy wins at the beginning, but it gets steadily more difficult
and actually is I think Francesca quoted these figures. So there has been an increase
in activity, but overall there has been a reduction in the carbon footprint.
And to go along with it, there have been some substantial financial
savings which can be fed back into health care. But now there's
been an important development, I think. So this is Simon Stephens
just a few weeks ago, has committed. Well,
he's he's set up a net zero advisory committee. And the first exam
question is, how quickly can the NHS in England get to carbon
zero? At the moment is committed to 2045. But he says, I
think the answer lies between somewhere between 2025 and 2035.
And then the next exam question, as he puts
it, how do we do that? You know, because it's other easy to say we will be carbon net zero
by X, but now I actually have a foggy clue you're ever going to do it, whereas
he's very keen that it's quite clear how it's going to be done. And then he points out
that the NHS is the biggest employer in the country and most towns in Britain, it's the
biggest employer. So it has very considerable power in terms of the energy
it buys, the food it buys, and how it operates. And then, of course, the individuals
within it as they change and can provide a sort of leadership role. So the idea
is that they will update the carbon footprint by April
2020. There's a call for evidence, and I would urge all of you to submit
evidence on programmes, as people often say, the future is already here. It's just not evenly distributed.
There are all sorts of interesting things going on all over the place, which it scaled up could have considerable
impact. And then the idea is that there'll be an interim report by June and
then the final report before COP in Glasgow feeding into the idea
of COP 26 being a health COP. And I think of it a bit like you remember the London
Olympics. There was the whole display of the of the NHS wheeling all
those beds about. Well, I think the idea is something similar here. This is an area where Britain
can has shown leadership and can show further leadership.
And in terms of measuring the NHS footprint, there's a debate about what do
you include and what do you not include? And the travel of staff and patients
and visitors wasn't included in the old footprint, but it is included in
this one. And very importantly, this is the carbon that the NHS
uses because. George Monbiot in his debate said, well,
Britain hasn't really done as well as it looks as if it's done, because actually what it's done is exported
a lot of its manufacturing. So things are being made in filthy
factories in low and middle income countries and then brought to Britain. And the carbon footprint
is being counted in the low and middle income countries, not in
in Britain. So importantly, it's everything that the NHS actually
uses. And how? Well, this
is a tough question. Obviously, some of the things they're
you know, they depend really on national changes and other things the NHS
can control. But when it comes to procurement, how much can the NHS negotiate
with these international manufacturers saying we need you to reduce the carbon in
the drugs you're making, the equipment you're producing. So it's this is a tough
ask. It's not going to be easy. And it's being chaired by Nick Watts who
also chairs the Lancet countdown. And there are a lot of climate scientists
involved. But here's some more figures. So the NHS and I think this is the NHS
just in England uses two billion plastic gloves a year
and it could almost certainly be one billion, which somehow got out of control with using plastic
gloves. And the biggest component of business services, which is part of the footprint,
is scientific research and development services. It's 5 percent of the
NHS footprint. And I asked them whether it included academics flying
all around the world to which they didn't have an answer. So I'm not sure it absolutely does. So if you
were to include that as well, maybe the contribution of universities and people
would be even higher. Now offsetting, I've heard the word offsetting
mention a lot today. And as Dave said, in order to reach
net zero, the NHS will have to offset which you know can be real
in the sense of planting trees and sequestering carbon in enriched soil,
the things that Dave talked about. But a lot of offsetting is really paying poorer people
to make simple changes, which does reduce the overall carbon emissions by changing light bulbs
or whatever. And George Monbiot says carbon offsets are like the ancient Catholic churches,
practice of selling indulgences, absolution from sins and reduced time in purgatory
in return. And he has an even better quote. So this is cheap, neutral.
So it suggests you can do the same for adultery. So "When you cheat on your partner, you add to the heartbreak,
pain and jealousy in the atmosphere. Cheat neutral offsets your cheating by funding
someone else to be faithful and not cheat. This neutralizes the pain and unhappy emotion
and leaves you with a clear conscience." So I think there's. I mean, as people say that an and
interestingly, Adair Turner talked about in order to avoid climate collapse, he said we need
to get an absolute zero. And I think you have to be very wary of a lot of offsetting. And I think
you are really buying indulgences a lot of the time when you're offsetting.
So I was I wanted to know what was happening in Scotland.
And I hope you know this. There was a sustainability conference in September last year.
And there are a whole lot of commitments there. So at the moment, NHS Scotland will be net zero by
2045. But I think that's going to be explored more. I won't read through all
of these, but I think there, you know, the problem is being taken seriously here. And
I wanted to thank Rebecca Campbell for giving me this information and this
certainly in terms of the estate admissions of global health, greenhouse
gases. It's coming down impressively in
Scotland. And Scotland is leading the way on all of this. But I'm
not sure how fair this comparison is because I'm not sure these footprints are
calculate in exactly the same way. But I did find some data from 2004
and remembering that the Scottish population is effectively 10 percent of the English
population, which suggests really that the carbon emissions, which are there
2.47 MtCO2, whereas it's 18.61 MtCO2 for England.
I mean, if that was true and I'm not sure it is. I think we're not necessarily comparing like with like. It does suggest
that. I mean, really it that Scotland is is worse.
It's not doing as well as England. But I don't know. That's true and probably shouldn't have said it at all.
And here are data that these are studies of what does the public think? Do
they support the NHS being more sustainable?
And you can see that in the numbers are increasing. Again, as Dave said, there's real energy
around all of this now, although when it really comes
to the crunch, again, as Dave said, when the politics get really difficult and it's really hurting people
in a way, then maybe people will begin to think differently. Although I think unfortunate, they're going to
see the effects more or more, just like we've seen the effects of floods. And so
maybe they will be motivated. At the moment
the UK parliament is running a citizens assembly, which is meeting
over four weekends in Birmingham, where people would be ordinary people reflecting
the population in terms of age and sex ending and how they think about climate change, whether they
see it as a serious problem or not. And they are being presented with lots of data and they are going to come up
with their responses to the problem. And I think that will be useful for politicians because it is very difficult
for politicians if they get too far ahead of the public anyway. Just
a word, a few words about the UK Health Alliance, which I chair. We have 17
Royal Colleges and membership, also the BMA, The Lancet and the BMJ.
And you'll notice there that the colleges that are based in Scotland, I've learnt not to call
them Scottish colleges are conspicuous by their absence. And I've been met with
all three of the Presidents today, and I'm hoping to persuade them to join up because altogether
we represent some 600,000 health professionals,
not just doctors, the College of Nursing. And I'm also trying to encourage the College of Midwives, the Royal Pharmaceutical
Society, because I showed you how important drugs are. And what do we do?
Well, we unite health professionals with the voice of health professionals. We empower our
member organisations. We help them to reduce their own climate
impacts. And our focus has been and still is
what is good for the planet is also good for the health of people. So clean air, active lives,
healthy diets. And here's my list of what I think. Royal Colleges
should do. Well, I think the first thing is to declare that there is a climate emergency
as a health emergency, and quite a few of the colleges have done that. We have a menu
of actions that we want colleges to take, some of which are easy to talk
and write about it. And some of which are harder to disinvest from - fossil fuels.
Contribute to developing a national network of health professionals who are
willing to speak up on all aspects of climate change with local communities
on in local media, encourage their own members to reduce the environmental
impact of their lifestyles. I remember back when
when Richard Doll and Bradford Hill first identified that
smoking was the cause of lung cancer back in the 60s, and at that time 70 percent of doctors
smoke. And over a very few number of years, it fell to something like 20 percent. And so they were
able to set up the British Doctors' Study, which showed that if you stop smoking, you quite
quickly got back to having something like the the same risk as people
who smoked. And I wonder if we couldn't do something similar here. I would. I think this because
this is a global problem, encouraging colleges in other countries to act, encourage
other organisations of health professionals to join us. And very importantly, contribute
to COP 26 and make it a health COP. And we've been having conversations about that today.
But what can you do now? Well, you can move better. You can fly less, ideally
Not at all. You can drive less. You can walk and cycle more. And you will benefit from
it. You can eat better. You can move from a high carbon diet to a low carbon
diet. So more plants, small vegetables, fewer/less meat.
But I don't think you have to stop meat altogether. I don't say that only because my son
is head of beef. And you can use your money better. You
can make sure that you're not investing in fossil fuels. You can invest in sustainable goods and services
and you can talk better. You can talk about this issue. A friend of mine has been concerned
about it for 30 years, tries to find have one extra conversation every day.
Doctors from Extinction Rebellion, get on the tube in London and deliver a little lecture on it. You can all
do that, too. And I've got a much longer list. This is a blog
on the BMJ. If you want to and I've ranked them all easy, less easy.
Y'know, easiest less-easy or can't remember. But there's there's a huge list there and you could go
down it and see how many you're doing. And here's three books for you to read. I
particularly recommend this The Uninhabitable Earth. I think if you read that, you will not
think are just going to let this pass me by. And my take home message
is this is the most important problem facing humanity, we face a lot of other
problems and poverty and social injustice. It's caught up with it in many way. Time
is running out, but public concern has increased dramatically in the past year, as Dave
said. And yes, you you can make a difference. And here's the evidence.
This is what happened with flights from Stockholm Airport. And you'll notice
that they show how they were increasing months compared with the previous year, and they were
all increasing alone. Something happened and they dramatically reduced
and that something was Greta Thunberg. You can be a Greta Thunberg, thank you.