Engaging with our responsibility to protect health from climate change.

Abstract

From 6 November to 18 November 2022 nurses, midwives, doctors and other health professionals represented the health community at the 27th Conference of Parties (COP) in Sharm el-Sheikh, Egypt. COP is the apex decision-making body of the United Nations Climate Change Framework Convention (UNFCCC), assembled in 1994 to protect the planet from the impacts of climate change (United Nations, n.d.). Climate change is the biggest threat and opportunity to global health. Staying under 1.5° of warming—the goal of the 2015 Paris Agreement (United Nations Climate Change, n.d.)—is essential for the health and well-being of all people, especially the world's most at-risk populations, least responsible for, yet most harshly affected by climate change. The ongoing climate-related shifts in temperature, weather patterns, land surface and ice sheets because of human-induced generation of greenhouse gases, are increasingly evident through intense and more frequent catastrophic fires, heatwaves, storms, floods, droughts, famine, social disruptions, ecosystem loss, sea-level rise and species extinctions with brutal health and socioeconomic costs (World Health Organization (WHO), 2021). Collective action is needed to coordinate climate mitigation, adaptation, and health resilience. Throughout the history of nursing, we have demonstrated our value in providing care, patient advocacy, prevention of injury, health promotion, education, research and policymaking (Thorne, 2021; Wei & Horton-Deutsch, 2022). In the process, we have earned the community's trust -trust that is now needed to help communities adapt to climate change and to prepare climate-resilient healthcare systems. This editorial summarizes interventions for nurses to lead a meaningful change at the individual, local, national and global levels. Addressing climate change is a complex, wicked problem as it intertwines health, environmental, social justice and ethical issues, disproportionately affecting historically marginalized and underserved communities encompassing different social, economic and public health impacts (United Nations, n.d.; World Health Organization, 2021). Tackling climate change requires addressing responsibility for climate change as well as social and ecological determinants of health (World Health Organization, 2021). Nurses' worldwide call-to-action stems from being the most trusted profession globally, representing the largest group of health professionals, with significant community outreach including to the most marginalized communities often most affected by climate change-related events (Atwoli et al., 2021; Thorne, 2021). Since climate change is the biggest threat to human health, reversing global warming also presents one of the most significant opportunities to improve global public health (Watts et al., 2018). For nursing, this also means being present at COP27 and advocating for change. The challenge for the nursing profession is to increase nurses' capacity to deliver climate-related interventions (Atwoli et al., 2021). On an individual level, knowing something needs to be done but not knowing where to start or what critical skill set is needed to engage may feel overwhelming and paralysing. However, we must remember that any effort at an individual level is precisely the crucial element to a successful collective fight against climate change's impact on our planet's health (Atwoli et al., 2021; Thorne, 2021). Undeniably, different individuals will feel comfortable with different levels of engagement, and everyone will forge a different path in responding to climate change. To help increase nurses' capacity to deliver climate-related interventions, we have compiled a list of interventions to help you engage with our responsibility to protect health from the impacts of climate change. This means learning about the impacts of climate change on health and then using this information as a skill to educate others to help protect health. To develop knowledge, start with the International Council of Nurses (ICN) position statement on nurses, climate change, and health first adopted in 2008 (ICN, 2018) identifying roles nurses can undertake to tackle the impacts of climate change. Connect with others with an interest in climate change through the WHO's Nursing and Midwifery Global Community of Practice (World Health Organization, 2022a). The international organization Health Care Without Harm hosts the Nurses Climate Challenge to mobilize and educate nurses about the health impacts of climate change (Health Care Without Harm, 2022). Nurses are uniquely positioned to steward a paradigm shift in health—given that our philosophy is oriented toward the socio-environmental model, prevention, and a holistic view of health (Wei & Horton-Deutsch, 2022). Our willingness and ability to advocate for climate action, which has direct and indirect impacts on the health of individuals and communities, can be supported by undertaking training programs in policy development to ensure that nurses' expertise and experiences are reflected throughout the healthcare systems (ICN, 2018). Find a seat at health governance tables and influence policy, professional standards, ethical codes, curricula programs and processes. Advocate for environmentally sustainable supply chains, influence the purchasing cycle towards a more circular economy model and advocate for better waste management practices. First Nation Peoples protect 80% of the global diversity (World Wild Life, 2022). Seek to learn and consult First Nations Peoples so that Indigenous people participate in the national conversation on addressing climate change and co-lead on nature-based solutions integrating indigenous and local knowledge (HEAL Network & CRE-STRIDE, 2021). Leverage our longstanding history of centring the socio-environmental model of health, community health approaches through a preventative and health-promoting orientation (Wei & Horton-Deutsch, 2022). Step up our focus on the impact of climate change threats to health by accentuating and augmenting existing content to ensure climate health literacy is a critical skill set (Shaw et al., 2021). The solution is to ‘take a climate lens’ to existing education—not consider it as an ‘add on’. Thus, when teaching about sustainable development goals, social determinants of health, and impacts of environmental factors on health (i.e., airborne, and waterborne diseases), consider how these evolve with changing climate. Use your knowledge of climate change impacts on health to initiate patient-centric conversations to tackle climate change and its health consequences, promoting actions that deliver immediate health benefits, and reduce costs to health systems and communities. Examples and guidance on effectively communicating climate change impacts on health and health in an evidence-based way include the ‘Real, Urgent and Now’ guide (Climate and Health Alliance, 2020). The WHO's operational framework for building climate-resilient health systems can guide these interventions toward health systems that can anticipate, mitigate, respond to, and recover from climate-related impacts (World Health Organization, 2022b). Locally, initiate and share innovative ways to reduce clinical waste and influence purchasing decisions, including digital health technologies, to make more environmentally friendly choices. Engage in developing equitable, gender-sensitive low carbon digital health care models supportive of value-based care. Nurses, as the lynchpin of health systems, are equipped to build and walk multidisciplinary bridges, given that we routinely coordinate with different groups in the health system to deliver patient care (Thorne, 2021; Wei & Horton-Deutsch, 2022). Expanding nurse-led research to encompass the growing field of climate change and health research inclusive of at-risk communities to capture authentic stories is essential to build evidence to support the development of resilient communities. Becoming members of interdisciplinary research teams enriches those teams as nurses and midwives bring a unique lens to real-world problems which contributes to better patient and community outcomes (Wei & Horton-Deutsch, 2022). This requires a significant mind shift and short term-discomfort as we move away from the heavy dominance of the medical system towards collaborations with urban planners, engineers, information technology experts and community experts. Purposefully attend multi-disciplinary climate change conferences and submit proposals to add themes on climate change impacts on health to present nurse-led research. Whilst systemic action is required, personal action and leadership are essential to change social norms favouring low-carbon and environmentally responsible lifestyles. Moving to low-carbon and active transport reduces personal health risks and helps reduce air pollution; reducing meat consumption lowers our risk of bowel cancer and lowers methane emissions; spending time in nature to improve mental health and build a sense of connection and responsibility for the environment in which we live is valuable (WHO, 2021). Other options include reducing our contribution to the problem through composting, responsible consumerism and insisting on climate-friendly choices for our superannuation. Nurses came to the climate debate early, uniquely positioned to steward and accelerate climate action (Butterfield et al., 2021; ICN, 2018). We have had some success, but we also have a long way to go. As action-oriented, practical, and evidence-based problem solvers, we can lead when it comes to complex problems involving multiple stakeholders, requiring a system thinking, planet-centred approach. Thinking strategically how to use our knowledge, interests, and diverse skill sets to minimize harm and maximize the benefits of climate action is a meaningful, hopeful way forward.