I was not sure what to expect as I stepped up to the podium to present at FIS 2021. I was the penultimate speaker of the session, sandwiched between an insightful presentation on COVID-19 infections post-vaccination and an engaging case study of a Serratia marcescens outbreak. My topic was no less relevant to infectious diseases, yet I was unsure whether the audience of clinicians and scientists would see it that way.

Expect the unexpected

My presentation explored the carbon footprint of antibiotics – how we can calculate it, and how the results might inform clinical practice. The response (more questions than the programme allowed for, and a stream of follow up conversations in breaks, on twitter and in other fora and the subsequent formation of a BIA working group on sustainability) far exceeded my expectations. But perhaps I shouldn’t have been surprised.

Momentum and engagement around environmental issues has been gathering over the past two decades. While FIS delegates met in Manchester to discuss infection topics, government representatives from around the world were negotiating climate change targets in Glasgow. COP26 has spurred research, reflection and action across the UK and the world. Among this activity has been a proliferation of surveys to assess views about environmental change and health.

What do the public think?

Perhaps most well-reported among these has been a Health Foundation survey of 1,848 adults in the UK published just before COP26. It found that people in the UK do think of climate change as a threat to their health, but only a quarter recognised that the NHS itself is contributing to climate change. When given information, the vast majority of respondents said that they support the plan for the NHS to work towards net zero carbon emissions. However, reducing the NHS’s impact on the environment was rated low relative to other priorities such as reducing waiting times and hiring more staff. When it came to changes that would directly affect them, most respondents were willing to make behaviour changes (e.g. returning unused medication) and most said that they support ‘consideration of the environmental impact of treatments when offering them to patients’.

Also published at the end of 2021, was the ONS's Opinions and Lifestyle Survey, which invited responses from those aged over 15 years and living in Great Britain. Over 80% of those who completed the survey said that they have made lifestyle changes to help to tackle climate change. Of those who had not made changes, the most common reason for this was thinking that such changes would not have an impact – which highlights the importance of agency and collective action. Three quarters of respondents said that they were anxious or very anxious about the impact of climate change. A greater proportion of women were anxious compared to men.

Climate change and infectious diseases: health professionals’ views

A survey of 4,654 health professionals from Australasia, Canada, Chile, Colombia, India, Jamaica, Kuwait, New Zealand, South Africa, Uruguay and the UK found that 91% are worried about climate change. Nurses made up 2% of the respondents, while 95% self-identified as physicians.

Most respondents had already observed multiple health issues, including infections, being exacerbated by climate change. Almost half (46%) of respondents had already seen exacerbation of vector-borne infectious diseases due to climate change; 69% of all respondents expected this to become more of a problem in their setting in the next decade. Waterborne and foodborne diseases exacerbated by climate change were already observed by 36% of respondents, with 63% expecting this to get worse in the decade.

Most respondents felt that health professionals have a responsibility to inform the public about the health effects of climate change. Barriers to taking up this responsibility included time constraints (54%), lack of knowledge (41%) and lack of support from peers (22%).

A 2018 literature review of public and health professional views similarly found that knowledge is lacking and further education required. A 2014 survey of African American physicians found that 88% of respondents thought the US should invest more in protecting people from the health effects of climate change.

In a 2017 NHS staff survey, 98% of respondents supported changes to improve sustainability in the health system, such as measures to reduce waste production and carbon emissions and improving resource efficiency.

A legacy for future generations

Ultimately, the risks of our changing climate are more significant for your children (and your neighbour’s children) than they are for you. Children have a particular interest in whether we, health professionals, effectively voice the health case for climate action and model sustainability in the health service. Two projects collecting the views of children are worthy of report.

A survey of 10,000 16- to 25-year-olds found that, similar to UK adults, 84% were moderately or extremely worried about climate change. At least half said they felt each of the following: sad, angry, powerless and helpless. Nearly half (45%) said negative feelings about climate change affected their daily life and function. 

UNICEF’s ‘Changing Childhood' Project collected views from young people in 21 countries. In this study, only 80% of respondents overall had heard of climate change, and only 23% of respondents in low- and middle-income countries, highlighting a need for education about global and local environmental challenges and how we can respond.

Infection specialists knew before COVID-19 the critical importance of mitigating and adapting to infectious disease outbreaks. We might impart similar insights about climate change. Not only do we know the threat facing us, we also know about the health benefits that moving to more sustainable health systems and societies can bring. 

The UNICEF survey asked young people whether they think that the world is becoming a better place. Just over half (57%) of young people said that it is. Healthcare professionals, not least infection specialists, have a key role to play in taking this hope and making it a reality.

Want to find out more about the impact of the healthcare sector in climate change? Join the BIA’s Sustainability Webinar on 23 March 2022.