The climate change challenge for general practice in
Rochelle Phipps, Rebecca Randerson, Grant Blashki
Climate change is one of the greatest public health
challenges of our time. Despite some inherent uncertainties in making
predictions about climate change, there is wide scientific consensus that global
warming is occurring; that it is largely due to manmade greenhouse gas
emissions; and that it will have substantial health implications for the future.
The predicted health impacts of climate change are now
clearer for New Zealand, and general practitioners can take action to mitigate
these impacts and adapt to the future environment.
Actions required involve a combination of
‘top-down’ and ‘ground-up’ approaches; effective
leadership and policy from our health institutions and, importantly, individual
practice initiatives that transform these goals into practical outcomes.
Climate change—the science
There is wide consensus amongst leading scientific bodies
around the world that climate change is occurring and that it is very likely the
result of human activity contributing to an enhanced greenhouse
Anthropogenic (manmade) influences on the natural carbon
cycle include increased greenhouse gas emissions, release of sequestered fossil
carbon, and deforestation. The evidence has been well described in leading
scientific and medical journals
internationally,5–8 and the conclusions
of the Intergovernmental Panel on Climate Change
(IPCC)9 remain robust despite a small number of
errors that have now been acknowledged to exist in the 2007 report (for example
the melting rate of Himalayan glaciers).10
There is now more carbon dioxide
(CO2) in the atmosphere than at any time during
human civilisation11 and we know that this
increased CO2 has been unlocked from fossil
fuels12 as a result of human industry since the
19th Century. We know that the planet’s average global temperature is
climbing,13 that sea levels are
rising,14 and that overall, glaciers are
Given the high likelihood that climate change is going to
cause major global health problems for the future, it is prudent for the medical
profession to comprehensively engage with this issue. General practitioners
(GPs) are well placed to promote both mitigation and adaptation strategies and
incorporate environmentally friendly practice into New Zealand primary health
Environmental and health impacts
Consistent with global climate trends, temperature data from
around New Zealand shows a warming of 0.7–1.0°C over the
Century,17 and this trend has continued over
the decade 2000–2010.18 Other changes
include more rain in the southwest, less rain in the
northeast,19 and an annual sea level rise of
1.6 mm.20 There has been reduced frost
frequency, retreat of Southland/Fiordland glaciers and a reduction in alpine
Relative to 1990, projected temperature increases for New
Zealand range between 0.2–2.0°C by 2040, and 0.7–5.1°C by
2090 with best estimates 0.9°C and 2.1°C
respectively.21 These projections have been
derived from an aggregate of global climate models and the best estimates have
been assigned a moderate degree of confidence by scientists at the National
Institute of Water and Atmospheric Research
NIWA scientists are very confident that New Zealand will
continue to experience rising sea levels (0.18–0.59m by
2090),22 increasing the risk of coastal erosion
and saltwater intrusion.23 More frequent
extreme weather events such as droughts, storms and floods are
anticipated,5 and hotter summers are likely to
bring increased risk of heat stress, fires and infectious
The most vulnerable areas for New Zealand are natural
ecosystems, water security and coastal communities. By 2050, agriculture,
horticulture and forestry are likely to be reduced over eastern New Zealand due
to increased droughts and fire risk.14 Any
initial benefits of a warmer climate to New Zealand are expected to be lost by
2030 with the most vulnerable areas likely to be Northland to Bay of Plenty (sea
level rise and storms), eastern lowland regions (water security and droughts),
and alpine zones (flooding, erosion and
Table 1 provides a summary of
the likely health impacts climate change will bring to New Zealand.
Despite some uncertainty about the precise rate and extent
of climate change, the potential health risks are very severe (see Table 1) and
the precautionary principle dictates that we should act now to mitigate those
International collective action to limit climate change
through reduced greenhouse gas emissions is not yet a reality and although it is
required to achieve real global benefits, action at a local level is also
Local measures are essential in gaining momentum for
national (and international) changes in policy. In addition, many of the
strategies designed to reduce greenhouse gas emissions have considerable health
co-benefits, and these benefits alone should be enough to gain support within
general practice for a groundswell of action. For example, the shift from car
use to more active forms of transport and public transport leads to increased
physical activity (reducing obesity, cardiovascular disease, cancer and
depression), safer roads and reduced air
pollution.29 Affordable, accessible and
environmentally cleaner forms of public transport will be necessary for this to
and injury from extreme weather events—flash floods (drowning),
landslides, fires and potentially more severe storms.
in heat-related deaths and morbidity (hyperthermia, dehydration, respiratory
illnesses, increased cardiac deaths etc) particularly in the elderly, although
winter-related deaths may decline due to better home insulation and warmer
of infectious diseases such as gastroenteritis will rise due to both warmer
temperatures (campylobacter, salmonella) and threats to water security
(cryptosporidium) such as failure of drainage/sewerage systems from frequent
flooding, erosion etc.
of skin cancer are expected to continue to rise with warmer temperatures
promoting increased outdoor sun exposure and climate change may contribute to a
delayed recovery of the ozone hole.25
rates of depression26 related to loss of
livelihood (e.g. farmers with drought, lost crops, flood damage, enforced
reattribution of land usage).
stress disorder seen in victims of environmental disasters (loss of homes,
communities, loved ones).
impacts on young people who may suffer anxieties about potential catastrophic
climate change not unlike those experienced by children growing up amidst the
fear of nuclear war.27
water intrusion in low lying coastal areas from rising sea levels and storm
droughts and shortages.
of drinking water from storms and flash flooding.
temperatures are likely to bring an increased range and incidence of pests and
diseases to both animal stock and crops.
food security in New Zealand is not considered to be at high risk due to our
large capacity for production and comparatively low
population.14 However New Zealand food prices
tend to rise in tandem with global prices, and this could impact on those from
lower socioeconomic groups leading to poorer nutrition and associated health
of the North Island are likely to become environmentally suitable for the major
dengue vector in the latter part of this
century.28 Australian mosquito-borne
arboviruses, such as Ross River Fever, also pose a potential threat. Adaptation
measures to prevent the accidental introduction and proliferation of new
mosquito vectors will be vital to ensure that these diseases do not become
established in New Zealand.
atolls such as Tuvalu and Kiribati are at greatest initial risk, but all Pacific
Islands have high vulnerability and low adaptation capacity to rising sea
levels, more frequent severe storm surges and other impacts of climate change on
their health and economy.
is likely that environmental refugees from the Pacific will migrate to New
Zealand, but there may also be high numbers of refugees from other regions.
Migrant primary health care will require increasing resources.
elderly and the poor will have increased vulnerability to both the direct and
indirect effects of climate change on health. With an ageing population this
will become even more pronounced.
and Pacific Island New Zealanders are particularly vulnerable to early impacts
of climate change due to their lower average socioeconomic status, and poorer
health outcomes. Māori also have high economic investment in areas that are
particularly susceptible to climate change including fisheries, agriculture,
forestry and tourism.
Insulated homes are not only more energy efficient and
warmer, but in addition occupants of insulated households have been shown to
suffer from less respiratory illness.30
Insulation therefore provides improved health equity for lower socioeconomic
Reduced population intake of red meat can reduce the
greenhouse gas emissions from intensive farming and at the same time lead to
improved rates of cardiovascular disease and bowel
Measures to reduce carbon emissions can also lead to better
business outcomes with improved supply chain efficiency, energy management, and
waste minimisation all leading to reduced expenses and improved business profit.
Greening your practice
Individual general practices can make low-carbon sustainable
changes in the day-to-day running of their business that are cost-saving or
cost-neutral from a financial viewpoint and have the potential to provide
enormous environmental returns.33
Triple-bottom-line reporting is now commonplace in business: accounting for the
social, ecological as well as financial performance of an organisation.
General practice has traditionally focussed on social and
financial outcomes. We now need to introduce environmental sustainability as an
integral component of our business planning.
Some suggestions for reducing the carbon footprint of your
medical centre are included in Table 2. Please note that these sustainable
business practices are not unique to general practice and can be implemented
across the wider healthcare industry.34
an electricity supplier that has sustainable generation sources
low-energy lighting and switch off when not required
off computers, photocopiers and other appliances at the end of the day
efficient appliances (e.g. fridges)
efficient practice heating and air conditioning
Supply chain sustainability
supplies from local suppliers, minimise packaging and use recycled materials
orders to reduce frequency of deliveries
suppliers to use a packaging exchange system (e.g. polystyrene
medication wastage by prudent prescribing, especially when initiating a new
your notes, use electronic referrals, print double-sided where possible
unnecessary incoming mail e.g. paper duplication of results, unwanted junk mail,
staff to minimise wastage of single-use items such as swabs, dressings etc and
return to sterilising/cleaning reusable equipment where possible
aerators to taps, fix leaks, use dual-flush toilets
Recycle and reuse
up by council service/local recycler
recycled office supplies, printing paper, toilet paper, hand towels
Promote green and healthy lifestyles to staff and
eligible patients to gain subsidised home insulation
food scraps (e.g. Bokashi bench-top composter)
the carbon emissions you cannot avoid (e.g. plant more shrubs/trees around your
ethical business investments (investments that consider both the profit
potential and the impact on society and the environment)
Adaptation is about identifying and reducing vulnerabilities
to climate change. Due to the backlog of existing emissions, even if the world
eliminated all greenhouse gas emissions today, it is estimated that there would
still be an increase in global average temperatures of 0.6°C by
2100.24 It is therefore imperative that we look
towards adaptation strategies for primary health care in order to best be
prepared for the predicted health impacts of climate change.
GPs have a role in health promotion, primary disease
prevention, disaster preparedness, and building resilience at a community level
(see Figure 1).
Source: Adapted from Blashki et
If temperature rises of 3–4°C do occur (the upper
range predicted by 2080)14 adaptation measures
will not be sufficient to deal with the effects of climate change on our
It is therefore vital that climate change issues continue to
be mainstreamed into health policy, planning and strategic development.
It is a combination of approaches—both
‘top-down’ policy leadership and ‘grassroots-up’
individual practice initiatives—that will protect New Zealand from
devastating health consequences in the future.
Greening Your Practice Toolkit has been developed for New Zealand GPs (and other
medics) and is available in .pdf/CD format (contact: firstname.lastname@example.org)
your demand on consumables and lower your personal and business carbon
with other health professionals concerned about climate change (e.g. OraTaiao:
NZ Climate & Health)
public education (posters in waiting rooms)
programmes (e.g. educate on food hygiene, nutrition, improve your immunisation
alert to mental health impacts
preparedness (develop service continuity plans)
the support of professional organisations such as Independent Practice
Associations (IPA), Primary Health Organisations (PHO) and District Health
Boards (DHB) in policy development.
Competing interests: None.
Author information: Rochelle Phipps,
General Practitioner, Christchurch; Rebecca Randerson, General Practitioner,
Wellington; Grant Blashki, Associate Professor, Nossal Institute for Global
Health, Melbourne Sustainable Society Institute, University of Melbourne,
Dr Rochelle Phipps,
Gloucester Sports Clinic, 211 Gloucester Street, Christchurch 8011, New Zealand.
Fax: +64 0)3 3666874; email: email@example.com
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