Planetary health in primary care

I want you to act as you would in a crisis. I want you to act as if our house is on fire. Because it is.

                                                                                                   Greta Thunberg

Ella Roberta Adoo Kissi Debrah died in London, England, in 2013, at the young age of 9. Despite asthma exacerbation being the immediate cause of death, the coroner’s report distinctly noted that one of the causes was air pollution—the first of its kind to do so. The report’s conclusion was that Ella “died of asthma contributed to by exposure to excessive air pollution.”¹

As Ella’s mother recounted in an interview with The Guardian,² one of Ella’s dying wishes was for her siblings and friends to remember her. On February 9, 2024, almost 11 years after Ella’s death, the mayor of London apologized to Ella’s mother for the illegal levels of toxic air near her home.³ A clean air bill, known as Ella’s law, is currently being deliberated in the United Kingdom Parliament.³

It is now evident that human health is inextricably linked to that of the planet. In their landmark commission on planetary health, the Lancet provided a simple definition of planetary health as “the health of human civilisation and the state of the natural systems on which it depends.”⁴ The same report also clearly points out why planetary health will be worse for those living in equity-denied communities and nations.

The responsibility of family doctors in addressing planetary health and advocating in the realm of climate change is gaining traction. The World Organization of Family Doctors Europe recently released their 2023 definition of general practice and family medicine.⁵ The revised definition includes a renewed focus on planetary health, specifying that family physicians have a responsibility to “their community and environment.” The update recognizes that we care for patients in the context of an ecosystem and serve as role models to our patients when it comes to living sustainably.⁵

In the past, Canadian Family Physician has published series on the environment and health as well as climate crisis–related content.^6,7 As the crisis becomes more pressing and continues to worsen, facilitating open dialogue and scholarship in the field is paramount. This is why, over the coming months and years, we will be renewing our commitment to publishing high-quality pieces about planetary health. With Earth Day on April 22, this issue will serve as the launch of these efforts.

The rapid evidence narrative by Anawati et al (page 228) outlines a framework by which family physicians can act in the domain of environmental accountability, including at the micro, meso, and macro levels.⁸ For example, at the micro level, we can switch from prescribing metered-dose inhalers to dry-powder inhalers, while at the macro level, we can advocate for clean energy. Hale et al (page 224) outline the reasons why family physicians are ideally positioned as leaders in this field⁹: when we deprescribe, limit unnecessary investigations, and practise preventive medicine, not only is it good for the health of our patients, but it is also good for the health of the planet by reducing fossil fuel consumption upstream. They argue that simply sending someone for a laboratory test or prescribing a medication uses a large amount of energy and resources.⁹ Perhaps some of us are already acting as planetary health leaders simply by practising good medicine and using resources judiciously.

In his Third Rail essay (page 271) about the dangers of fossil fuels, Dr Myles Sergeant proposes additional ways in which family physicians can act.¹⁰ This includes discouraging consumption within the health care industry and fully opting out of fossil fuel investments, both in the institutions where we work (eg, hospitals or universities) and with their suppliers. We can even effect change by ensuring our own personal investments have a low carbon footprint. Dr Sergeant ends his essay with the question: “If Canadian physicians do not step up, who will?”

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