When the patient is the planet

This is the claim a multidisciplinary group of researchers from the University of Sydney and Harvard University make in a new perspective piece in the New England Journal of Medicine, the world's leading medical journal.

The researchers – including historians, medical doctors and public health experts – explain that although bringing environmental ethics into the domain of medical practice may seem like a radical rupture, it actually has powerful antecedents.

In the paper, the researchers point out that the links between the environment and human disease date as far back as the texts of ancient Greek physician Hippocrates, while interest in the impact of climate change on human health has emerged gradually over the past 50 years.

“Doctors have always taken interest in the physical environment, but the scale and complexity of the current crisis demands that they address not only environmental threats to humans, but threats to the environment itself – to the natural systems of the planet,” said the paper’s lead author, historian of medicine and University of Sydney research fellow Dr James Dunk.

Commitment to improving public health has driven physicians to support radical political and ethical programs throughout history, the researchers explain.

“There is a strong history of physician advocacy – including the very effective campaigns of physicians against nuclear war, which they saw as the greatest threat to human health,” Dr Dunk said.

“But though we can celebrate past successes, the stakes have never been higher, or the scale greater, than those of today’s multiple ecological crises – climate change, pollution, air and water quality, ocean acidification, biodiversity loss.

In the paper, the researchers use historical analysis to explain what has worked in health activism (antinuclear advocacy, global efforts against AIDS) and what has not, or at least not yet (carbon dioxide levels continue to rise).

They argue that rigorous historical scrutiny of the political effectiveness and ethical dimensions of past interventions can provide a guide for social medicine and public health in this climate emergency.

“We live in an age that praises scientific and medical research, but history suggests that more evidence alone will not compel action.

“As policy debates seem ever less rational, and the climate crisis grows, protecting human health will require physicians to mobilise politically, and again become fierce advocates for major social and economic change,” Dr Dunk said.

‘Human Health on an Ailing Planet — Historical Perspectives on Our Future’ was published in the New England Journal of Medicine on August 22, 2019.

The paper is authored by Dr Dunk, with Professor Warwick Anderson, the Janet Dora Hine Professor of Politics, Governance and Ethics in the University of Sydney’s Department of History and leader of the Politics, Governance and Ethics Theme with the Charles Perkins Centre; Professor Anthony Capon, Professor of Planetary Health at the University of Sydney; and Professor David S. Jones, the A. Bernard Ackerman Professor of the Culture of Medicine at Harvard University.

Dr Dunk’s postdoctoral research is partially funded through the University of Sydney Planetary Health Platform.