Canadian Family Physician in the Anthropocene

The truth is incontrovertible. Panic may resent it; ignorance may deride it; malice may distort it, but there it is.

Winston Churchill

A recent issue of the New England Journal of Medicine featured a beautiful and powerful essay by American physician Nitin Ahuja entitled “Health and high water.”¹ It is a pleasure (but also a slight disappointment) when another writer articulates so clearly what one has been struggling and at a loss to articulate for oneself.

In it he asks, “What does it mean to engage with individual distress inside a hospital while bearing witness to cataclysmic distress outside it?”¹ The “cataclysmic distress” he refers to is the unfolding climate emergency and our, to date, inadequate responses to it.

Are doctors paralyzed by what the American Psychological Association in 2017 formally recognized as a mental health condition: “ecoanxiety”?² It is not for lack of effort to overcome this condition and its variants (climate depression, environmental grief, “futilitarianism”). For more than a decade, leading general medical journals have been drawing the profession’s attention to the unfolding climate emergency and the vital role physicians must play, and trying to empower us to make change in our lives, in our practices, in our communities, and through wider advocacy.^3–5 Family medicine journals have also taken up the cause.^6,7 However, as Dr Ahuja writes:

Health care has been prone to inertia since before we all began caring so much about atmospheric carbon. This quality of stasis is distilled in Donald Hall’s poem “The Ship Pounding” (1996), a reflection on the experience of his wife, the poet Jane Kenyon, in receiving treatment for the leukemia that would later take her life …. Hall imagines the whole hospital as seaborne ... [but] stationary: “the huge / vessel that heaves water month / after month, without leaving / port, without moving a knot, / without arrival or destination.”¹

Toward the end of 2019, leading family medicine organizations such as WONCA (World Organization of Family Doctors) issued a declaration calling for family doctors of the world to act on planetary health.⁸ The declaration included a list of 9 practical things family doctors can do to improve planetary health, ranging from simply learning more about it to greater involvement and advocacy by joining Clinicians for Planetary Health.⁸

In the November 2019 editorial, my colleague Associate Editor Dr Roger Ladouceur asked readers,

Do family physicians have a specific role to play in [addressing climate change]? .... What can we as the family medicine community at large do to be more involved in the fight against climate change and to preserve our planet?⁹

The response to Dr Ladouceur’s editorial was overwhelmingly positive and included many practical suggestions for family physicians. We received more responses to this article than any we have previously published, reflecting the importance of the climate emergency to Canadian family physicians and their desire to make a difference (www.cfp.ca/content/65/11/766/tab-e-letters).

Facing up to the climate emergency and taking urgent and meaningful action to alleviate the cataclysmic distress occurring outside our clinics will help us to better alleviate individual suffering within them. But facing up to the climate emergency will require that we develop a

blueprint for an outrageous code of new biomedical ethics, by which we remain faithful to preserving all those smaller worlds without hastening the end of the larger one. Adopting these ethics would entail a profound reorganization of not only our shared professional priorities but also our standards of daily practice.¹

Canadian Family Physician is committed to supporting and empowering family physicians with ongoing practical content that aligns with and supports WONCA’s call for family doctors worldwide to act on planetary health.

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