U.S. medical organizations and climate change advocacy: a review of public facing websites | BMC Public Health

We evaluated the involvement of the U.S. medical community in climate change through the lens of medical society websites, official society journal publications, and national meetings. We found wide variation in climate change advocacy. The climate emergency must be addressed vigorously and expeditiously at all levels of society in order to lessen its impact. The U.S. health care sector has a unique role: as an industry it produces a substantial amount of carbon emissions [8], while its professional workers have an ethical and moral responsibility to protect patients from the adverse impacts of climate change and to educate patients on how they can proactively fight climate change [34]. The U.S. lacks a strong centralized health care authority, such as the United Kingdom’s National Health Service, that can drive the health sector’s actions towards mitigation and adaptation [35]. A recent review of U.S. public health department websites revealed that fewer than half (40%) of state health department websites, and only 1.6% and 3.9% of county and city websites, respectively, contained any information for the public about climate change [18]. The U.S. federal government can influence the behavior of the health care sector to some degree [9, 36], but we will need additional robust strategies, including a unified medical community, to enable the generational change required to address the climate crisis.

Our national medical societies need to take a leading role in directing the health sector to mitigate its carbon emissions and guide our patients in adapting to climate change. Medical providers depend on these organizations to provide direction in health care policies and to promote best practices for our medical facilities [37]. Our medical societies are adept in the development and dissemination of physician and patient education materials. The COVID pandemic has underscored the importance of medical society websites, which have provided a forum for rapid dissemination of updated guidelines and recommendations for patient care [17]. Further, physicians remain highly trusted by patients and are well-positioned to discuss issues related to climate change with patients [15]. An international survey of health professionals highlighted the need for continuing professional education and policy statements on climate change and health by their professional associations [16].

Our review demonstrates that about twenty national medical societies are already actively addressing climate change. Mobilization of the remainder of the organizations will require astute leadership and/or a groundswell of support from concerned members. One author (TB) has been involved in an effort to persuade their specialty organization to adopt a more vigorous approach to climate change [38]. Although this review was not set up to evaluate the effectiveness of various measures that organizations can undertake to address the climate crisis, it would be reasonable to presume that a solid foundation would require the crafting of strong position or policy statements and the formation of devoted committees or task forces. The top scoring organizations in our survey all posted position statements and policies that recognized the significant health risks of climate change, and committed to various actions to mitigate and adapt to the crisis.

A relatively small number of organizations posted patient educational materials regarding climate change, while a larger number provided some green practice references or resources. We have highlighted two organizations, the Medical Society Consortium on Climate and Health and My Green Doctor, since they are well positioned to work with medical societies and individual providers to quickly and efficiently address the climate emergency with a wealth of information and resources [24, 25]. Other organizations are doing excellent work in this field and could be consulted – including Climate and Health Alliance, Health Care without Harm, Practice Greenhealth and Planetary Health Alliance [20,21,22,23].

Many of the top scoring medical societies represent providers that care for large patient populations, including family practitioners (American Association of Family Practitioners), pediatricians (American Academy of Pediatrics), and internists (American College of Physicians and the American Medical Association). Given the increased risks of vector-borne and other infectious diseases that accompany climate change, it is not surprising that the Infectious Disease Society also scored highly in our survey. These organizations generally exhibited a balanced approach to both educate and protect their vulnerable patients as well as to reduce their carbon footprints.

Procedure and technology rich specialties may have little or no ongoing direct patient care responsibilities, but they are likely to have a large carbon footprint. Examples include greenhouse gas emissions of volatile anesthetics (e.g., halogenated fluorocarbons), and use of energy intensive equipment for medical imaging (e.g., scanners, reading stations). Accordingly, the organizations with higher scores reflecting an emphasis on the reduction of their carbon footprints included specialties such as anesthesia and radiology.

We believe that medical societies should aim to address both (a) the health impacts of climate change and (b) mitigation of their carbon footprint. The scoring system we employed highlighted these goals in the “patient education” and “practice recommendation” metrics but did not specifically capture the weighting of these goals in either the “position statement and policy” metric or the “committee and task force” metric. In future surveys, it would be helpful to differentiate the relative contributions to these domains in order to better acknowledge current progress as well as to identify areas for improvement.

The publications and blogs promoted by national medical associations tended to address climate change issues much more readily than the organizations themselves. The bar for a robust literature on climate change has been set by the Lancet Countdown [39] and the NEJM Group Series [40], with more research urgently needed to comprehend the impact of the climate crisis by all disciplines.

Medical societies adapted to the constraints of the COVID-19 pandemic by leveraging technology to provide for virtual attendance at most annual meetings in 2021. As the pandemic wanes in 2022, most organizations are planning to retain a hybrid virtual option, though many are returning to an in-person format [41]. Employing a virtual option for attendance can reduce the carbon footprint of meetings which average emissions of at least 1.5 metric tons of CO₂per attendee [42, 43]. The leaders of our medical organizations should leverage this technology as a means to reduce their carbon emissions [44]. The use of a hybrid format provides a mechanism to reduce carbon footprints but still offer in-person attendance when deemed necessary by program planners.

A primary limitation of our study was the lack of available metrics or scoring systems to evaluate publicly facing medical society websites for evidence of involvement in climate change issues. The authors created de novo search parameters and a novel scoring system that we felt best represented the key domains needed for an effective climate change response. A similar approach has been utilized to evaluate health department websites for the inclusion of climate change content [18] and to determine the quality of information presented on websites regarding methotrexate [45]. Another potential limitation is that the cross-sectional snapshot of the visible content of websites may not have fully reflected the current level of organizational engagement in addressing climate change issues. Such organizations should consider adding content to their social media platforms using the model for dissemination of information developed for COVID-19 [17]. Some data may have been inaccessible due to password protected sections of websites as noted in Table 1 and Additional File 1. As review of website content may be subject to errors of omission or interpretation, we mitigated this possibility by creating a structured template for our website searches.