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 £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

are going up and up. And of course, that one at the top is the US. And the health system in the US

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.