Three cheers for health workers who care for patients, communities and the planet
Dec 3, 2020During the Covid crisis doctors and heath care workers have been a ‘light on the hill’ for service and dedication to humanity. By September 2020 over 7000 around the world had died from Covid contracted at work.
In Australia the public health leaders in each state have provided exemplary leadership and it is becoming clear that Australia and a handful of other countries have escaped a massive death toll by acting promptly on medical and scientific advice.
Even when their advice has been rejected by governments, many doctors have been recognised for their responsible and dedicated leadership, none more so than Anthony Fauci who has stood firm before a President responsible for thousands of deaths in his quest for re-election.
Many in the health professions now recognise that zoonotic diseases are increasing in frequency and are linked to humanity’s progressive exploitation of the natural environment. Our planetary life support systems, the quality of the air we breathe, the water we drink, the climate we can tolerate, and the biodiversity and food producing soils are being irrevocably damaged.
Planetary health
The concept of planetary health in which human and planetary health are irrevocably linked is defined in the report of The Rockefeller Foundation–Lancet Commission on planetary health 2015 “Safeguarding human health in the Anthropocene epoch” which stated;-
“As a Commission, we conclude that the continuing degradation of natural systems threatens to reverse the health gains seen over the last century. In short, we have mortgaged the health of future generations to realise economic and development gains in the present”
The degradation of natural systems results from at least six interrelated biophysical changes;- disruption of the global climate system; widespread pollution of air, water and soils; rapid biodiversity loss and consequent disruption of ecological systems; reconfiguration of biogeochemical cycles of carbon, nitrogen and phosphorus; (5) comprehensive changes in land use and land cover; and resource scarcity, including that of fresh water and arable land.
In relation to one of these threats, climate warming, according to Break Through the situation is now so dire that we face 1.5C degrees of warming by 2030, 2C degrees by 2050 and 3C degrees this century under the current emission scenario. Clearly the strategy for net zero emissions by 2050 is a sinecure; it must be replaced by 2030.
As David Ritter has pointed out, the failure of the federal government to act decisively on climate mitigation has resulted in unexpected resolve from state governments of both political persuasions to increase renewable energy development and in the resolve of many major corporations to reduce their emissions. Indeed every section of the Australian community and particularly professional organisations must set themselves tasks to reduce their carbon foot print.
As with Covid-19, the medical profession has the standing and trust to offer leadership. A study for the Australian Council of Professions gives doctors a trust rating of 69 per cent and government ministers 12 per cent. Similar findings occur in other countries. For example in the UK (Ipsos MORI poll) nurses and doctors rate at 95 and 93 per cent whereas government ministers and advertising executives rate 17 per cent.
The Medical profession acts on emissions
Recently the Australian Medical Association and Doctors for the Environment Australia made a clear commitment to work together to address the health impacts of climate change.
They call on the government to establish an “Australian Sustainable Development Unit to support environmentally sustainable practice in healthcare and reduce the sector’s own significant emissions” which are 7% of the national total. This would provide a national structural framework to health service emissions reductions already in progress.
The Australian Nursing & Midwifery Federation, Climate and Health Alliance and many other health organisations also work to encourage government to address these vital sustainability issues.
All professions be they lawyers, architects, teachers, engineers need to signify how they are changing their practice to serve these aims. Like health workers, community groups and the Unions can take pride in widening their resolve beyond the service to their members “to the protection of natural systems on which human health depends”.
An expanded Hippocratic Oath
Graduation of the medical student is signified by an acceptance of responsibility for the lives and health of others. It is a personal and professional lifelong commitment. Similar values are adopted by nurses.
The public will know this commitment as the Hippocratic Oath created by
Hippocrates (c.460BC), known as the Father of Medicine. Currently graduating student make an updated pledge which accounts for the norms of today’s society.
However doctors and health care workers increasingly recognise that our personal care commitment to patients and communities is not enough. We now live in a world changed by us, the Anthropocene, and this demands an additional dimension of care.
In September an article in the eminent medical journal The Lancet
proposed “A planetary health pledge for health professionals in the Anthropocene” This expands the interpretation of primum non nocere (first do no harm) to the integrity and health of the planet.
The first two sentences are:-
“I solemnly pledge to dedicate my life to the service of humanity and to the protection of natural systems on which human health depends”.
“The health of people, their communities, and the planet will be my first consideration and I will maintain the utmost respect for human life, as well as reverence for the diversity of life on Earth” and it concludes;-
“By taking this pledge, I am committing to a vision of personal, community, and planetary health that will enable the diversity of life on our planet to thrive now and in the future.”
Few politicians have yet to recognise that their prime commitment must be to stabilise our life support systems. They are not trusted to deliver the necessary reforms. Until the Government and Opposition are resurrected from their ideological coffins we must fill the void.
“The dread and darkness of the mind cannot be dispelled by the sunbeams, the shining shafts of the day, but only by an understanding of the outward form and inner workings of nature”—Lucretius, ca.60 B.C.
Meanwhile let all doctors take Dr Fauci’s career achievements as symbolic of our collective lifetime commitments to medicine and science. His discoveries in HIV, other viral infections and immunological diseases are legendary. Now that he has escaped beheading at the age of 79, there is every indication he will continue to serve humanity.
David Shearman is Emeritus Professor of Medicine at Adelaide University and previously held senior academic positions at Edinburgh University, where he qualified in Medicine and Biological Science, and at Yale University. He is author of many books on climate change and related issues. He has served on the IPCC, has been President of the Conservation Council of South Australia. With the late Professor Tony McMichael he founded Doctors for the Environment Australia in 2001. He is author and co-author of several hundred scientific and medical papers.
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