Intended for healthcare professionals

Editor's Choice

Climate emergency: Treat Earth as an ancestor, not a commodity

BMJ 2023; 383 doi: (Published 05 October 2023) Cite this as: BMJ 2023;383:p2288
  1. Kamran Abbasi, editor in chief
  1. The BMJ
  1. kabbasi{at}
    Follow Kamran on Twitter @KamranAbbasi

Does the Earth belong to animals or plants, land or sea? Arrogantly, humanity has presumed the Earth to be its own. A particular world view has bent the Earth to our whims, imposing an imagined superiority over environments and other species—and other, less privileged, humans. That world view, driven by the extractive excesses of capitalism and colonialism, continues to harm people and the planet. It treats species, natural resources, and traditional and poorer communities as commodities to be exploited and profited from.

An alternative is to think of the Earth as “an ancestor to be held in good relation” (doi:10.1136/bmj.p2202).1 This is no communist manifesto. It is a reasoned reaction to a climate emergency of which we have all but lost control. The approach is to understand and absorb the values and responsibilities that Indigenous communities live by so that decision making is “conducted with a critical awareness of our place in the scheme of things and considering the impacts on all our (human and more-than-human) relatives” (doi:10.1136/bmj.p2202).1

A climate emergency not of their making threatens the existence of Indigenous or traditional communities in Brazil’s Amazon (doi:10.1136/bmj.p2188), northern Canada (doi:10.1136/bmj.p2173), and New Zealand (doi:10.1136/bmj.p2202 doi:10.1136/bmj.p2215), among others.1234 It endangers a populous and perilously landscaped country, Bangladesh, where a 50 cm rise in sea level will claim a third of the country’s land mass and displace 18 million people (doi:10.1136/bmj.p2211).5 Yet endangered peoples and nations carry the burden of climate damage without contributing meaningfully to it (doi:10.1136/bmj.p2156).6 Bangladesh produces just 0.4% of global emissions of greenhouse gases.

Evidence grows for the damaging impact of climate change. The frequency and severity of floods is increasing, and new research estimates that the risks of all cause, cardiovascular, and respiratory mortality peak around 25 days after a flood and last for up to 60 days (doi:10.1136/bmj-2023-075081 doi:10.1136/bmj.p2101).78 Another study shows the synergy of ambient fine particulate matter and ozone in worsening all cause, cardiovascular, and respiratory mortality, especially in high latitude areas and during cold seasons (doi:10.1136/bmj-2023-075203 doi:10.1136/bmj.p2020).910

One pragmatic response is to pursue legal processes, such as demanding recording of environmental hazards on death certificates (doi:10.1136/bmj.p2162), or seeking redress for government inaction from an international court of human rights (doi:10.1136/bmj.p2258).1112 Clinicians have a pivotal role in tackling climate change (doi:10.1136/bmj-2023-076963),13 and many are already engaged in championing and implementing strategies to make hospitals and clinical practice more sustainable (doi:10.1136/bmj.p2262 doi:10.1136/bmj.p1524 doi:10.1136/bmj.p2234).141516

The economic arguments for action on climate and sustainability become clearer by the day (doi:10.1136/bmj.p2236).17 Why not, as the World Health Organization’s Maria Neira argues, see the climate emergency as the ultimate health opportunity?18 With that mindset we might take action not only in healthcare settings but in other sectors that influence the health of people and planet, such as transport and housing (doi:10.1136/bmj.p2211 doi:10.1136/bmj.p2235).519 We might realise that investing in local communities reduces healthcare costs (doi:10.1136/bmj.p2239).20 We might then have a better appreciation of the influence of climate change on a person with asthma walking in a polluted city (doi:10.1136/bmj.p2144) or someone struggling in hot weather with the adverse effects of antipsychotic drugs (doi:10.1136/bmj.p2199).2122

We might understand too that rich, polluting, extracting economies must accept their global responsibility to reform and their obligations over loss and damage caused to nations that are poor, climate damaged, and exploited (doi:10.1136/bmj.p2182).23 The opportunity, if there is one, lies in the World Health Organization’s “One Health” approach (doi:10.1136/bmj.p2177), frugal innovation (doi:10.1136/bmj-2023-076381), the power of communities (doi:10.1136/bmj.p2202), political will to reshape our world (doi:10.1136/bmj.p2244), and even “friluftsliv,” a Norwegian word implying communing with nature (doi:10.1136/bmj.p2249).124252627 Earth is better viewed as an ancestor than as a commodity.

A step change would be to place health and wellbeing outcomes central to our response to the climate emergency, something that the UN’s climate conference of the parties, now in its 28th year (COP28), has summarily failed to do (doi:10.1136/bmj.p589).28 The alternative is that, once humanity and its obscene planetary destruction has passed, Gaia will eventually be reclaimed by whales and trees and other species to whom it perhaps more properly belongs.