How colleges should lead on climate

If colleges aspire to be leaders in health, they must show leadership on climate

Climate change is an immediate threat to population health, health equity and the health sector.1 Already, the impacts of climate change are observed throughout Australasia, with the most immediate challenges noted in general and rural practice, mental health, and respiratory medicine.2 In coming years, climate change will affect every medical specialty, and the practice of every doctor will need to adapt.

The role of doctors in addressing climate change

Doctors are influential leaders in their communities, and they have a major stake in reducing societal harm from climate change and environmental degradation. Leaders in science and medicine are already calling for emergency action from doctors to advocate for emissions reductions.3 Duhaime and colleagues4 developed a useful framework for how doctors can and should contribute towards a sustainable future: as climate collaborators (because decarbonisation is a multidisciplinary problem), leaders (in our institutions, professions and communities), educators (for trainees, other professions and the public), advocates (for bold, broad ranging climate‐friendly policy), and researchers (on the impact of climate change and solutions in health care). This framework does not differentiate between the work of climate adaptation and mitigation, both of which are required.

The role of colleges generally

The role of a medical college is outlined in legislation and regulation: to train, examine, and accredit specialist qualifications, including continuing professional development (CPD). Dental associations are less involved in training and more oriented to education and advocacy. Colleges set professional standards, guide practice patterns, and advocate for changes inside and outside the health system, based on their specialist expertise. Compared with pan‐professional medical associations and advocacy groups such as Doctors for the Environment Australia (DEA), colleges have greater connection to members’ clinical practice and more influence over practice and clinical activity. Although there is not unanimity among specialists on most issues, this should not prevent colleges from having a broad voice on matters of science, health and justice.5,6

Medical colleges have already had significant impacts on important public health issues. For example, after the Christchurch mosque shootings in 2019, the Royal Australasian College of Surgeons was one of only a few organisations invited to submit to the select committee hearings on the proposed changes to New Zealand gun control legislation in response to the shootings. The College’s submission was specifically mentioned during the second reading by the Minister leading the bill through parliament, the Honourable Stuart Nash: “There is one more submission I wish to single out … The Royal Australasian College of Surgeons”.7

Colleges’ action on climate change

Broadly speaking, the role of colleges is to support and enable their members to act on the Duhaime framework and to enact these behaviours in their own organisation.4 The specific actions of colleges could include education of, and engagement with, members and trainees, corporate responsibility, and advocacy.8 In 2022, we surveyed medical colleges and dental associations to benchmark their actions in these domains (Box).

Education and engagement with members and trainees

There is a strong appetite from doctors for practical guidance on sustainability, and colleges are the best placed organisations to lead this grassroots transition. Sustainability concepts should be incorporated into the training curriculum and into CPD. Colleges are also well placed to provide auditing tools for measuring the carbon footprint of practice.10 Some excellent examples include Greening general practice: a toolkit for sustainable practice from the Royal New Zealand College of General Practitioners,11 and the Environmental Sustainability Network and its Audit Tool from the Australian and New Zealand College of Anaesthetists. The Royal Australian and New Zealand College of Ophthalmologists and the Australian Dental Association have sustainable practice guidelines with practical steps to reduce waste and emissions from clinical care.

Despite some examples of good practice, this was the area where colleges had the most potential for improvement in the 2022 survey. Only a minority of colleges included sustainability in the training curriculum or CPD resources for Fellows.

This work on educating and engaging with members is important due to the diversity of views on climate change within medical specialists,12,13 and misconceptions among health professionals that health care decarbonisation will result in lower quality care.14 These educational activities are important, first, as sources of evidence‐based information and, second, as an illustration of college leadership and commitment in this area.

Corporate responsibility

Corporate responsibility refers to the minimisation of emissions from college activities. This was an area where nearly all participating colleges and both dental associations had committees and working groups and policy positions on sustainability. Most colleges had divested from polluting industries, which is an important and public ethical stance.

Three participating colleges had measured corporate carbon footprints and had plans to reduce them, and another five had a less precise emission reduction plan. Only the Royal Australian and New Zealand College of Obstetricians and Gynaecologists had a concrete and immediate plan to offset all measured corporate emissions in the short term. The Royal Australian College of General Practitioners (RACGP) has a longer term target of net zero emissions by 2040. The RACGP has also embedded sustainability into governance processes by designating their chief operating officer also a sustainability officer and requiring consideration of sustainability across their organisation. These actions signal to members the importance of sustainability, even if the footprints of college offices are far smaller than their members’ clinical work.

Advocacy

Some colleges decline to speak on topics they see as being outside of their professional expertise, and others perceive they have a broad mandate to speak for improving health on behalf of their members. Several colleges have endorsed statements from DEA and OraTaiao (the New Zealand Climate and Health Council), joined the Climate and Health Alliance, and shared calls for sustainable energy infrastructure. The Healthy Climate Future campaign, supported by ten colleges in advance of the 2022 Australian general election was an example of multicollege public advocacy.15 The Council of Presidents of Medical Colleges and the similar Council of Medical Colleges (CMC) in New Zealand have not made statements on climate, although the CMC endorsed a call to action from OraTaiao in 2022.

Advocacy goes beyond external communications; it can also involve leading and encouraging change within organisations.16 Examples that are especially salient to colleges include promoting sustainable practice guidelines to broader health services,17 lobbying purchasers and licensing agencies to consider the carbon footprints of medications and devices, responding to public consultations or inquiries, or negotiating with industry to improve sustainability of clinical products.

Conclusions

Colleges have an important leadership role in the practical clinical aspects of decarbonising the health sector. Even though we found innovation and creativity in some colleges, all of the participating organisations had opportunities to expand their sustainability activities. Colleges in this survey wanted a strong mandate and collaboration with other colleges, which is supported by several recent and innovative pieces on this topic.10,18,19,20 Colleges may need to create a shared understanding of the importance of climate and health among their members, and research on climate impacts, adaptation and decarbonisation is a good way to quantify and explain these issues to an evidence‐driven specialist audience. Sustainable medicine to date has largely focused on decarbonisation of health care to mitigate climate change, but increasingly, doctors and health systems will need to innovate to adapt to climate change impacts.

Colleges both represent and lead their membership. By empowering members to be interdisciplinary collaborators, leaders, educators, advocates and researchers, colleges can represent and lead their specialists towards a climate‐resilient, decarbonised and sustainable future.4