Talking about Climate Change and Environmental Degradation with Patients in Primary Care: A Cross-Sectional Survey on Knowledge, Potential Domains of Action and Points of View of General Practitioners

Climate-sensitive health counselling in Germany: a cross-sectional study about previous participation and preferences in the general public

BACKGROUND

In response to climate change (CC), medicine needs to consider new aspects in health counselling of patients. Such climate-sensitive health counselling (CSHC) may include counselling patients on preventing and coping with climate-sensitive diseases or on leading healthy and climate-friendly lifestyles. This study aimed to identify previous participation in and preferences for CSHC as well as associated sociodemographic and attitudinal factors among the general public in Germany.

METHODS

We conducted a cross-sectional study in a population-based online panel in five German federal states (04-06/2022). We performed descriptive statistics and multivariable regression analysis to assess prior participation in CSHC and content preferences regarding CSHC, as well as associations between sociodemographic variables and general preference for CSHC.

RESULTS

Among 1491 participants (response rate 47.1%), 8.7% explicitly reported having participated in CSHC, while 39.9% had discussed at least one CSHC-related topic with physicians. In the studied sample, 46.7% of participants would like CSHC to be part of the consultation with their physician, while 33.9% rejected this idea. Participants aged 21 to 40 years (versus 51 to 60), individuals alarmed about CC (versus concerned/cautious/disengaged/doubtful/dismissive), and those politically oriented to the left (vs. centre or right) showed greater preference for CSHC in the multivariable regression model. Most participants wanted to talk about links to their personal health (65.1%) as opposed to links to the health of all people (33.2%).

CONCLUSIONS

Almost half of the participants in this sample would like to receive CSHC, especially those who are younger, more alarmed about CC and more politically oriented to the left. More research and training on patient-centred implementation of CSHC is needed.

Establishing and Defining an Approach to Climate Conscious Clinical Medical Ethics

An anthropocentric scope for clinical medical ethics (CME) has largely separated this area of bioethics from environmental concerns. In this article, we first identify and reconcile the ethical issues imposed on CME by climate change including the dispersion of related causes and effects, the transdisciplinary and transhuman nature of climate change, and the historic divorce of CME from the environment. We then establish how several moral theories undergirding modern CME, such as virtue ethics, feminist ethics, and several theories of justice, promote both a flourishing of human medical practice and the environment. We conclude by defining an expanded the scope of CME as inclusive of not only patients, families, physicians, and other health professionals but other humans, non-humans, and their shared environment. We then apply this scope and theory to a widely used framework for applying CME, the Four Topics model, to construct a climate conscious approach to CME.

Patient-planetary health co-benefit prescribing in a circumpolar health region: a qualitative study of physician voices from the Northwest Territories, Canada

BACKGROUND

Despite climate change being described as a code red for humanity, health systems have been particularly slow in both climate mitigation and adaptation responses. The effects of climate change on health and health systems will not be felt equally, with underserved and marginalised communities disproportionately impacted. The circumpolar region is warming at 3-4 times the global rate, amplifying already existing socioeconomic barriers and health inequities, with particular amplified effects for the substantial Indigenous population in the area.

OBJECTIVES AND SETTING

We therefore sought to explore perspectives of physicians around patient-planetary health (P-PH) co-benefit prescribing in a circumpolar region in the Northwest Territories (NWT), Canada, known to be one of the ground zero levels for climate change.

METHODS

Thirteen semi-structured physician interviews were carried out in the NWT region between May 2022 and March 2023 using purposive sampling. Interviews were transcribed verbatim and reflexive thematic analysis was carried out to identify key themes.

RESULTS

There were three main themes identified including (1) current healthcare system does not support planetary health, (2) supporting patient-planetary health is currently difficult for clinicians and (3) considering change in the NWT to support patient-planetary health. Participants noted key opportunities to move planetary health forward, with the NWT having the potential to be an innovative model for planetary health-informed change for other health systems.

CONCLUSION

The NWT health system has unique features due to its rural and remote nature and smaller population base. Despite this, our study identified some key opportunities for advancing P-PH co-benefit efforts. The identified opportunities may be considered in future intervention, organisational change and policy-making efforts with potential relevance in other settings.

Patients' perceptions of climate-sensitive health counselling in primary care: Qualitative results from Germany

BACKGROUND

Climate change is the greatest threat to global health in the twenty first century, yet combating it entails substantial health co-benefits. Physicians and other health professionals have not yet fully embraced their responsibilities in the climate crisis, especially about their communication with patients. While medical associations are calling on physicians to integrate climate change into health counselling, there is little empirical evidence about corresponding perceptions of patients.

OBJECTIVES

This study aimed to explore primary care patients' perceptions of climate-sensitive health counselling.

METHODS

From July to December 2021, 27 qualitative interviews with patients were conducted and analysed using thematic analysis. A purposive sampling technique was applied to identify patients who had already experienced climate-sensitive health counselling in Germany.

RESULTS

Patients' perceptions of climate-sensitive health counselling were characterised by a high level of acceptance, which was enhanced by stressing the link between climate change and health, being credible concerning physician's own climate-friendly lifestyle, building upon good therapeutic relationships, creating a sense of solidarity, and working in a patient centred manner. Challenges and risks for acceptance were patients' disinterest or surprise, time constraints, feared politicisation of consultations, and evoking feelings of guilt and shame.

CONCLUSION

These findings suggest that primary care patients can accept climate-sensitive health counselling, if it follows certain principles of communication, including patient-centredness. Our findings can be useful for developing communication guidelines, respective policies as well as well-designed intervention studies, which are needed to test the health and environmental effects of climate-sensitive health counselling.

Climate-sensitive health counselling: a scoping review and conceptual framework

Health professional societies and researchers call for the integration of climate change into health counselling. However, the scientific evidence and conceptual grounding of such climate-sensitive health counselling (CSHC) remains unclear. We conducted a scoping review identifying scientific articles on the integration of climate change into communication between health professionals and patients in health-care settings. Scientific databases (Web of Science, PubMed, and Google Scholar) were searched from inception until Nov 30, 2022. 97 articles were included, of which 33 represented empirical research, and only two evaluated the effects of CSHC. More than half of the articles originated from the USA and addressed physicians. We introduce a conceptual framework for CSHC, which elaborates on aims, content areas, and communication strategies, and establishes the guiding principle of integrating CSHC into routine activities of health care. This framework supports health professionals in implementing CSHC and enables researchers to conceptualise intervention studies investigating how CSHC can contribute to the health of patients and the planet.

Physicians' views of patient-planetary health co-benefit prescribing: a mixed methods systematic review

Health professionals are increasingly called to become partners in planetary health. Using patient-planetary health (P-PH) co-benefit prescribing framing, we did a mixed methods systematic review to identify barriers and facilitators to adopting P-PH co-benefit prescribing by physicians and mapped these onto the Capability, Opportunity, Motivation, and Behaviour (COM-B) model and Theoretical Domains Framework (TDF). We searched electronic databases from inception until October, 2022, and did a content analysis of the included articles (n=12). Relevant categories were matched to items in the COM-B model and TDF. Nine barriers and eight facilitators were identified. Barriers included an absence of, or little, knowledge of how to change practice and time to implement change; facilitators included having policy statements and guidelines from respected associations. More diverse study designs that include health professionals, patients, and health-care system stakeholders are needed to ensure a more holistic understanding of the individual, system, and policy levers involved in implementing clinical work informed by planetary health.

An international planetary health for primary care massive open online course

In this Viewpoint we argue that primary care practitioners should receive professional education in how to directly respond to planetary health challenges. We reflect on the provision of a massive open online course (MOOC) on planetary health for primary care practitioners in the context of existing training programmes. We describe the construction, delivery, and certification of a Global South-originated MOOC and explain aspects of its rhizomatic learning theory. We share baseline information and preliminary findings collected on the initial cohort of participants, including their profiles and previous knowledge about planetary health. We suggest that this MOOC is an appropriate response to planetary health challenges, and argue that cost-free, accredited planetary health education for primary care practitioners should be provided as a public good that also fulfils individual professionals' entitlement to quality education and continuing professional development.

Sustainable development in general practice

BACKGROUND

As health care accounts for 4-5% of global carbon emissions, many health organisations have called for implementing sustainable development actions in health care. However, sustainable development measures in general practice are rarely implemented by physicians. The aim of this study was to explore the practices of general practitioners (GPs) in terms of sustainable development to identify which actions are appropriate and achievable.

METHODS

A qualitative study was conducted in 12 French GPs using face-to-face or telephone interviews, transcribed verbatim and analysed through a global inductive analysis with constant comparison. Semi-structured interviews were focussed on waste management, relationships between health professionals, sustainable development, and GPs' activity.

RESULTS

The mean age of the GPs was 42.8 years and they mainly worked in an urban environment. The interviews highlighted 4 themes. It appeared that a balance needs to be found between the environmental impact and the constraints related to medical care. To be able to think about integrating sustainable development into health care, GPs should make a personal commitment to change their routine. In practice, consumption should be reassessed, prescriptions and prevention reconsidered. These actions could be applied to the GPs' environment as role models for their patients, business leaders, and members of the healthcare system.

CONCLUSION

GPs felt concerned by sustainable development and were already involved in its implementation in their practice. Tools are available to help GPs to continue to implement their actions described in this article, but their impact remains to be investigated.

Public Perceptions of Climate Change and Health-A Cross-Sectional Survey Study

Climate change is inseparably linked to human health. Although there is growing awareness of the threats to human health caused by climate change, it remains unclear how the German population perceives the relevance of climate change and its health consequences. Between May and September 2022, German residents were invited to participate in a cross-sectional online survey that explored three content areas: (1) the relevance of climate change, (2) health risks in connection with climate change and (3) collective and individual options for action against climate change. A total of 697 full data sets were collected for analysis (72% female, 51% ≥55 years old). The majority of participants agreed that human-induced climate change exists (85%), and that it has an impact on human health (83%). They also perceived the global population to be more strongly impacted by climate change than themselves (89% versus 68%). Most participants (76%) claimed to personally contribute to climate protection and 23% felt that their city or council contributed to climate protection. Although the majority of participants saw climate change as a threat to human health, they perceived other population groups to be most strongly affected. Cognitive dissonance might explain this lack of individual concern and one approach to addressing such distorted perceptions might be the dissemination of appropriate risk communication with health professionals involved in the communication.