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15 Nov 2018


I have a dear friend and colleague who injects good humour into intense discussions by observing, “So many storms; so few teacups!” 

When our Editor asked me to write about climate change I took fright: teacups were scarce but storms abounded.

Our addiction to Growth

Climate change and global warming are terms that strike fear. They have apocalyptic features that make us worry about future generations.

Miles Little, an eminent Sydney surgeon and ethicist, has thought and written extensively on the topic.  In a recent email he wrote:

We live with what we condone. Western liberal societies condone almost any practices that produce "growth", and many of those practices have consequences that destroy or degrade the environment in the interests of material and short-term benefit. The destructive forces of climate change and pollution are enhanced by the laissez faire attitude our political leadership takes to the negative consequences of land resumption, land clearance and the polluting effects of industry and mining. We seem to be caught in a series of vicious vortices, in which we can no longer even acknowledge our present or future losses.

The latest from the IPCC

An October report from the Intergovernmental Panel on Climate Change (IPCC) ( claims that we are already 1°C above pre-industrial levels. Without further reduction in greenhouse gas emissions over the next 12 years, warming will increase beyond 1.5°C.

In brief, the estimates of damage due to an increase of 1.5°C are somewhat lower than for an increase of 2°C but not all that much. It’s rather like asking how much less damage would occur if you dropped one nuclear device rather than two.

Discussions about climate change carry heavy baggage. There is the science, the imputed causes, the doomsday anxiety and prophetic proclamations about the end of the world, the confusion that occurs when advocates mix science and politics (explosive) like a salad.

Blaming a single cause

We tend to seek a single entity – coal, for example – that we can blame. Unlike tobacco and lung cancer, there is no one cause of climate change. The underlying systems are super-complex, not one-germ-one-disease type arrangements. Little argues that we need a different style of thinking to handle the complexities of climate change. The risk in overlooking the complexity and multiple determinants of climate is accompanied by a second risk, that of minimising in our minds the immensity and complexity of social and economic changes required to reduce our dependence on fossil fuel. 

Banning nuclear weapons looks pretty tame fare in comparison with halting and reducing man-made global warming. Take a look at any major construction project and note how utterly dependent the project is on fossil fuel. In passing, note that the production of one tonne of ready-mix produces one tonne of CO2. 

An unhealthy debate

The debate about climate change has not been healthy. Climate change sceptics are labelled – pejoratively – climate change deniers and suffer opprobrium otherwise reserved for Holocaust deniers. This leads to predictable reaction – political pushback and paralysing polarisation.  

We need to go back to basics. Science, as philosopher Karl Popper and biological scientist Peter Medawar wrote years ago, proceeds by creative guess work, by conjecture that becomes the hypothesis which is then tested. Scepticism and humility are keys to the success of scientific progress. 

In science, formulating the hypothesis is followed by efforts to knock it down. Even if the hypothesis survives it is only ever a provisional statement. The door of science is always left ajar for new information that may lead in new directions. Uncertainty is ineradicable. This is often forgotten in the fast and furious debate over climate.

What we can do

First, as with all social factors that determine the health of our communities and set the agenda for our patients’ health problems, we can do things individually in managing our patients.  This will be critical with near-inevitable global warming.

As clinicians we use often incomplete information to achieve practical diagnosis and treatment. We can discuss with our patients the prognosis for climate change, always ending with the rather unsatisfying statement that we can’t be sure. But we can start thinking now about measures to assist vulnerable people – in the design of future nursing homes for example – to cope with higher temperatures.

Second, as a profession we can provide health-related comment for public debate and policy based on our limited understanding of the science of climate change but with more certainty about its current and future impact on human health. We can also comment on how we might cope with higher temperatures that will affect the health of vulnerable people.

Under pressure from the apparent urgency of the problem, our view of science may be distorted so it turns into a political process, where consensus rules – 10,000 scientists cannot be wrong (oh, but the history of science shows that they can) – and uncertainty is excluded. This arrogates to science a degree of certainty that it does not claim for itself and makes a mess of the debate.

When we engage as a profession in public discourse about climate change, we may support alternative sources of energy most notably hydro, wind and solar on the basis of prudence.  In so doing we assume nothing. The business case for the development of these technologies must be sound, allowing the market to operate in favour of less dependence on fossil fuels. We might support a price placed on carbon, as has been done in other countries. Revenue so generated could then subsidise renewable energy production. 

The need for civic action

The medical profession – as a profession – has an important part to play, nationally and internationally. In a recent editorial The BMJ (BMJ 2018;363:k4410 doi: 10.1136/bmj.k4410) examines the IPCC report and concludes:

Although Government action is crucial, so is civic action. In particular, doctors and other health professionals have a strong record of steering society to make difficult, unpopular, and at times expensive choices for the sake of public health and safety. This has historically included improved sanitation, housing, water treatment, and air quality and, in the 1980s, reducing the risks of nuclear war.

Such an approach accepts the science – with its uncertainties and no claim on ultimate truth – and commits to do what is within our ability and remit to do but without going beyond that ability as happens when we engage in strident polemic that demands certain actions from Government (‘Government must…’). This does not solve the problem. Instead it tears its own fabric and reduce the likelihood of political change necessary for success.

Published: 15 Nov 2018