BMJ Supports Sustainable Healthcare: Rachel Stancliffe and Mahmood Bhutta: Should doctors lead on sustainability?

Welcome to a new series of blogs on sustainable healthcare that will look at health, sustainability and the interplay between the two. The blog will share ideas from experts across the healthcare field, some of whom are speaking at a major European conference looking at Pathways to Sustainable Healthcare in September 2013.  More about the conference can be seen at www.cleanmedeurope.org.

The British Medical Journal (BMJ) is running a new series of blogs on sustainable healthcare that will look at health, sustainability and the interplay between the two. It will share ideas from experts across the healthcare field, some of whom are speaking at the CleanMed Europe conference looking at Pathways to Sustainable Healthcare in September 2013. The first blog,, written by Rachel Stancliffe, founder and director of the Centre for Sustainable Healthcare, and Mahmood Bhutta, a founding member of the BMA Medical Fair and Ethical Trade Group, was published by the BMJ on 1st July 2013.

The GMC’s Good Medical Practice states that: “Good doctors make the care of their patients their first concern.” This is of course a laudable principle, and good doctors strive to ensure that patients are seen in a timely manner, that they are treated by appropriately trained staff, and that systems of clinical governance are in place to enable improvement. Yet we all know that we work within constraints, with these most commonly relating to financial or logistical constraints on service provision. However the evidence now makes it clear that those constraints should also include consideration of the wider impact of healthcare provision on the global need to care for the environment and to protect labour rights. 

The natural reaction to such a suggestion for many doctors is to say that this is someone else’s concern, or that they don’t have time for this: “Doctors should concentrate on saving lives and not saving the planet.” However climate change is already affecting human health and a growing number of doctors realise that we need to address this in our clinical practice and make it a normal part of the way that we provide good care. As Dr Donal O’Donoghue, former National Clinical Director for Kidney Care put it: “Sustainability is the seventh dimension of quality.”

Moreover, the NHS as an organisation sees this as a major issue. Five years ago it set up the Sustainable Development Unit to look at ways to reduce NHS carbon emissions by 80% by 2050, which complies with the requirements of the Climate Act 2008 that the UK Government has signed up to. Meanwhile, the BMA Medical Fair and Ethical Trade Group has been looking at ethical issues within the supply chain to try and ensure that no harm is done to those who make the products that we use in our everyday work life.

So how does this affect doctors? There is often such a disconnect between our day-to-day working and the global view of healthcare provision. What difference can we as individuals make? Quite a bit, we would argue, not least because we are seen as ambassadors for change. Over the coming weeks, clinicians and experts on sustainable healthcare will discuss what that might mean in practice, and how we as doctors and other healthcare professionals can engage.

We are motivated by the understanding that there is a really crucial interplay between health, the environment, and labour conditions. If we understand this interplay, and act on our knowledge in a scientific way, we can use this to help us solve some of the greatest problems of our time: climate change, social inequality, and a healthcare system which is near breaking point for many reasons.

We hope these blogs will inform, provoke and ultimately inspire you to understand the urgency required and benefits accrued to a system of healthcare that engages fully with its environmental and ethical aspects.