Young Irish doctors are working together to raise awareness on how the environment impacts our health, says Helen O’Callaghan
Last autumn, a handful of junior doctors got together and founded Irish Doctors for the Environment (IDE). The fledgeling organisation has really grown since then. “Every time we send out a newsletter or put up a Facebook post, we’re astounded by the pick-up,” says Dr Sandra Green, a non-consultant house doctor at the Mater Hospital.
IDE now has a core group of about 20 on their committee, all junior doctors, and a mailing list of about 400. They’re mostly in their 20s and 30s, though some are older, and they span many specialities.
They hold meetings once or twice a month, including Skype meetings for non-Dublin-based doctors. They’ve got a strong contingent in Galway and they’ve recently started a consultant advisory board with the hope consultants across specialities — with an interest in the environmental impact on health — will come on board to advise.
IDE is driven by three key realisations: First, the biggest global health issue we’re facing is climate change. Second, we have a window of opportunity to change things. And third: tackling climate change could be the greatest global health opportunity of the 21st century.
From Athlone, IDE member Dr Sadhbh Lee is a junior doctor in the area of obstetrics and gynaecology at University Maternity Hospital, Limerick. She got interested in grassroots campaigning and advocacy around environmental issues before ever coming at it from a health perspective.
Lee sees healthcare providers as having a role and responsibility in at least three areas — they can influence policy on environmental health impacts, they can address the health system’s impact on the environment and they can improve patients’ resilience to the negative environmental changes we’re seeing.
Currently, for example, IDE has a research group looking at A&E attendance and hospital admissions during heat-waves. “Last year, we had a great summer but there’s kickback,” says Lee.
“A&E sees an increase in severe sunburn, as well as constipation and collapse in older patients secondary to dehydration.”
At a policy level, IDE brought three motions to the Irish Medical Organisation’s recent AGM — calling for sustainable energy (Government should penalise unsustainable energy, they said), increased investment in cycling and walking and that Government buildings prioritise access to sustainable, culture-appropriate food.
“These motions were very well received by regular attendees. They were unanimously passed. A lot of people were pleased to see climate change issues on the agenda,” says Green. On foot of this, IDE is now hoping to meet with Health Minister Simon Harris.
IDE also signed the April 2019 international letter by the Planetary Health Alliance, ‘A Call for Clinicians to Act on Planetary Health’.
Last month, they joined with other major Irish health bodies to call for ‘active travel’ to be an integral part of the forthcoming All of Government Climate Action Plan. “Active travel (walking, cycling, public transport) provides a great opportunity to tackle Ireland’s public health issue of non-communicable diseases (NCDs) and obesity — a growing area of concern as 11% of premature deaths [here] result from four main NCDs: stroke, ischaemic heart disease, chronic obstructive lung disease and diabetes.”
IDE wants increased investment in cycling and walking to 20% of the transport budget, in line with achieving sustainable development goals on air quality benefits and climate change mitigation.
Each month, IDE picks an aspect of planetary health as its monthly theme. “This month it’s ocean health. We’ve had air pollution, bio-diversity and conscious consumerism,” says Lee.
While IDE members are exercised about all environmental impacts on health, they’re naturally particularly passionate about areas that link with their own specialties. By July, Green will be a respiratory registrar and she’s especially concerned about air pollution, which — as Niall Roche, environmental specialist with Irish Forum for Global Health (IFGH), points out — is the biggest single environmental determinant of health, estimated to kill over seven million people per year.
“We all share the same air — it doesn’t stay within boundaries. What one country does far away can affect another,” says Green, citing the WHO 2018 statistic — 91% of air pollution-related premature deaths in 2016 were in low and middle-income countries.
And while Ireland has a relatively low level of air pollution compared to other European countries, we’re not exempt from what’s happening across the board, warns Green — 400,000 premature deaths in Europe annually are related to air pollution and over 1,000 of these happen in Ireland, according to a European Environment Agency 2018 report.
The Department of Communications, Climate Action and Environment has said the economic impact of air pollution health effects in Ireland costs €2bn per year — including the annual loss of 382,000 workdays.
With 29% of lung cancers linked to air pollution, people often don’t think about its other impacts on the body, says Green, pointing to maternal consequences like preterm delivery, low birth weight and adverse birth outcomes. It’s also linked to increased risk of cardiovascular disease and stroke — outdoor air pollution’s associated with 25% of heart attacks (WHO, 2018).
Lee says IDE members are acting in their own hospitals to improve sustainability. “Some members are doing audits on waste management. I’ve just joined the sustainability committee [in University Maternity, Limerick) to discuss plastic waste and recycling in the hospital.”
Lee enjoys diving, is a big sea-lover and is passionate about issues of ocean pollution and the amount of plastic ending up in the sea.
Citing an Environmental Agency Austria 2018 study which found microplastics in human stools for the first time, she says: “We know we’re getting it from fish, from water in plastic bottles and food in plastic containers. The health implications for humans aren’t determined yet, but its impact on marine life is affecting us indirectly in terms of food and nutrition.”
Loving the sea as she does, she knows its feelgood effects — backed up, she says, by a study on ‘coastal blue space and depression in older adults’ that used data from The Irish Longitudinal Study on Ageing (TILDA). It found TILDA respondents with the highest share of sea view visibility have lower depression scores.
Last weekend, IDE teamed up with the SOPHIE 2020 EU Ocean Human Health project for a beach clean along Sligo’s coastline, a surf lesson and a series of workshops/talks about ocean and human health.
Lee points to a just-published landmark report from the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES), the most comprehensive ever completed and the first intergovernmental report of its kind, and which grabbed headlines around the world.
It warns that nature is declining rapidly at rates unprecedented in human history — and the rate of species extinctions is accelerating, with grave impacts now likely on people worldwide.
“It was shared a lot on social media. It shows that one million species are at threat of extinction.
IDE has been busy building networks with other planetary health organisations. In April, they joined IFGH. They’re also a member of Stop Climate Chaos, a coalition of civil society organisations campaigning to ensure Ireland does its share to tackle causes/consequences of climate change. They’ve affiliated with Planetary Health Alliance as well as with WONCA World Family Doctors, Caring for People.
“Connecting with wider groups allows us to grow and learn, thereby enhancing our work. We hope we can collaborate on projects going forward,” says Lee.
Lee sees a change in attitudes to environmental issues since she was at college in 2014-’15. “You were seen as the tree hugger, the hippie who cared about nature. People would laugh and say ‘that’s your thing’. One friend said ‘it’s not what I’m interested in’. Now, it’s a blanket interest.
“It’s no longer the domain of environmentalists alone — it’s a societal interest and it has to be. Everybody has to take action.”
Green sees “a tide of change”.
She points to increased coverage of health and climate change issues in scientific journals (by 182%) between 2007 and 2018.
“It’s a grave situation. If we don’t recognise that, we’re either misinformed or scared off by the hugeness of it all. We don’t have [the luxury] of giving airtime to people who aren’t part of the solution — all our efforts need to be put into positive change,” she says, adding that IDE is “getting emails everyday” from colleagues from all backgrounds who realise this is an urgent issue and doctors need to advocate for patients on it.
In a paper on Air Pollution and Asthma, published in the Irish Medical Times in April 2019, IDE member Rachel MacCann points to dramatic positive health effects following the coal ban, which took effect in Dublin in 1990 and later in other regions: smoke pollution dropped by 70% and there were 17% fewer deaths from respiratory-related conditions. “It’s proof direct environmental actions show clear health improvements,” says Lee.
The issues are huge but we tackle them one new step, one positive change, at a time — across individual, societal and governmental levels. Meanwhile, for IDE members, Green says there’s a sense of being part of something exciting and solution-focused. And she wants us all to share the same big vision.
“We’re facing a climate emergency. A recent report by Médecins Sans Frontières in The Lancet says that by 2050 we could be looking at 200m people displaced because of climate chaos. It’s hard to imagine how as a planet we would address that.
With WHO estimating 4.3m premature deaths annually from illnesses linked to household air pollution caused by the inefficient use of solid fuels, the second International Pathways to Clean Cooking conference is currently running in Wexford – it’s examining recent advances in cleaner cooking technologies/practices and their potential to improve global health and the environment.
Small actions can make a big difference to the environment – and to health.
IDE’s Dr Sandra Green says: