Why they matter: Extinction Rebellion is the global climate change movement whose protest shut down significant parts of central London earlier this month. Their decentralised, media-savvy and agile use of civil disobedience has kept much of public opinion onside with their insistence the effects of climate change are not being seriously by government. Doctors For Extinction Rebellion is a cooperative of clinicians who are working to support the XR protests.  


I walk out of Westminster tube station to find all the adjoining roads closed to traffic due to the Extinction Rebellion protests. It’s a remarkably agreeable atmosphere, and the peacefulness is noticeable. The police presence is heavy, as I walk past The Treasury and into St James’ Park, where the Extinction Rebellion protest is based. But there is no hint of trouble. 

The vibe is like that of a pre-corporate Glastonbury Festival. There are tents and marching bands of drummers. There is performance poetry. There are a lot of handmade signs (although interestingly for an anti-government protest, there are none of the classic Socialist Workers’ Party/Stop the War placards in evidence). 

I’m here to meet Maria Van Hove, a junior doctor studying for a master’s in public health at the London School of Hygiene and Tropical Medicine. She is one of several spokespeople for Doctors For XR: there is no single leader, the group being as decentralised as the umbrella organisation.  

Doctors for XR is a group which advocates for and raises awareness on health effects of climate change and champions the need for healthcare to take a leading role in driving down emissions. True to the XR mantra, the group also gets involved in direct action — several members were arrested recently for gluing themselves to the Department of Business, Energy and Industrial Strategy’s Whitehall HQ. 

Does Dr Van Hove believe national and local NHS leaders appreciate the scale of the problem climate change will bring? She pauses for thought before replying: “There is some appreciation this is going to be a problem. [But] I’m not sure if people in NHS leadership across all the system fully get it. We know they’re aware, but they seem worried about it in a very abstract way.  

“[They] haven’t visualised what change is to be expected. What climate change will mean for our daily lives, for healthcare, public safety, food security, its impact on social stability and conflict, and those knock-on effects”. 

This lack of vision, she says, means insufficient awareness of what needs to happen now to mitigate climate change’s impact on the public’s health and the NHS.  

It also fails to account for the ways in which climate warming will make the fight against health inequalities, one of the goals of the NHS long-term plan, more difficult.  

“Wealthy people will be able to buy themselves out of effects of climate change”, she says, “although if we go past the tipping point, their spending will not ultimately save them. 

“We have to be bold enough to make a start and prepare for the effects climate change will inevitably have on the NHS. We need to start getting this into the medical curriculum now, so doctors are prepared for what will come in 10 years’ time.” 

Dr Van Hove thinks a sense of urgency will only come through a comprehensive and honest assessment of the environmental sustainability of NHS services and a better understanding of how much they contribute to climate warming and pollution. 

Environmental sustainability should, she judges, “be at the centre of every health and care decision we make now and every plan for the future. That hasn’t happened. It’s in the mix of considerations, but still is on the fringes. It lacks the central role it needs.” 

The precautionary principle suggests the costs of climate change adaptation are ones we should pay as soon as possible.    

Dr Van Hove offers an analogy: “Compare climate change to cancer. If a cancer treatment would give you 50 per cent survival rate if you acted now, but 20 per cent in a couple of years’ time, mountains would be moved to make earlier treatment happen. [But] on the climate, the enormous mobilisation we need just isn’t happening yet.” 

What the NHS needs to do

So how can the NHS practically and promptly reduce its carbon footprint, given that it is a labour-intensive and travel-reliant industry, particularly in rural areas? 

Dr Van Hove admits this is a very difficult question to answer, “because obviously provision of NHS services should be equitable and not disadvantage those in rural areas who depend more heavily on driving”. 

She notes approvingly the NHS long-term plan’s proposed switch to low-emission vehicles and envisages a lot more healthcare professionals adopting physically active modes to transport in urban areas. 

“We have first aiders on bikes in London as it’s quicker, and probably a lot could be delivered by some form of active travel,” she adds.

Healthcare regulators have their part to play too, she suggests. She cites the recent National Institute for Health and Care Excellence decision on asthma inhalers, which should help clinicians make environmentally conscious recommendations to patients. 

Dr Van Hove also touches on the idea of anchor institutions, with hospitals set up in ways to more broadly benefit the community around them, including helping to reduce activities that produce carbon and other pollutants. 

There are other rich seams to mine, she thinks, like “overprescribing — do people need all the treatments being offered now?” 

Social prescribing is, for the Doctors For XR, “a brilliant way of improving health without big carbon emissions”. 

Dr Van Hove continues: “Investing in prevention, keeping people healthy and active, also prevents carbon emissions. We can’t change people getting sicker in their last years of life, but from a carbon emissions perspective [as well as others], we don’t want [people] to suffer preventable comorbidities in the early ageing period”.  

Making the NHS greener will cost, she admits, but adds: “We need to consider that the money we invest now will be, arguably vastly less than in a future of constant crisis”.  

Could the NHS ‘offset’ its environmental impact? 

Dr Van Hove is not keen, suggesting that planting trees in developing countries is not an equitable way of getting rid of carbon emissions.  

“If we just do business as usual, we export our problems like we export our plastic waste,” she says. “Our priority should be to reduce emissions. First, to try offsetting them here in this country where our emissions are produced, by rewilding etc.” 

The government will not save us

More generally, Dr Van Hove suggests society will need to examine the concept of “private cars” as well as rethinking “our consumption habits: fast fashion, flying, dietary habits”.  

What is XR’s policy on nuclear technology, both for energy generation and for medical use?  

Stressing this is her personal view, Dr Van Hove says she thinks the issue “is really complicated and I’m conflicted. I’m really concerned about the area of the potential tipping point of much more carbon emissions making climate change totally irreversible, and nuclear power doesn’t have anything like the carbon emissions.  

“But the other really concerning balancing factor is things like the risk from the waste, and from accidents — the potential risk of massive environmental damage very fast, as in Fukushima and Chernobyl”. 

Does she think XR’s demand for net zero carbon emissions by 2025 is achievable?  

“Many people have criticised XR for being unrealistic about the 2025 target”, says Dr Van Hove. “I am not sure personally where I stand on that. 

“I think that rapid decarbonisation is vital: whether you do a little to mitigate or nothing, those levels of effort will not have effect on the outcome. Once we reach the climate change tipping point to a runaway situation, it’s game over”.  

She understands there is always a conflict between the politically possible and the necessary, and feels the 2025 target gives people a sense of urgency.  

“I’m not sure if 2025 is a realistic target, but if no-one shoots for it, we never get change,” she says. “If there were a social consensus to get to net zero in 2025, and people were willing to do necessary steps, and the richer people and countries to cut back more, maybe it would be possible. The government’s target of net zero carbon emissions by 2050 will not save us”. 

An implausible utopia

I mention XR’s main website talks about struggling for an “implausible utopia” and ask whether a “plausible utopia” might not be better?  

A smiling Dr Van Hove says: “For me, it sounds quite humble. We’ve waited so long to address this issue that we simply cannot be certain we will manage to turn the ship around and not hit the massive iceberg of climate change. 

“So in that regard, yes, maybe it’s an implausible goal. But it’s also a great chance to create a healthier and more equitable society, and it takes account of the fact that for a long time we’ve been exporting our emissions and waste to countries with historically massively smaller carbon footprints.  

“This is a chance to create a world [which will make] us all healthier. I cannot be sure we’ll win this fight, even together, but it’s worth a shot. We could give up a lot without impairing our real quality of life and our relationships with our families and friends. We could be more healthy and active, and be living more fulfilled lives.” 

The struggles of others

We move onto XR’s proposal for tackling climate change issues and policy-making via citizens’ assemblies.  

“There are some questions around how they could work in practice,” Dr Van Hove says. “But as a principle, they’re a good idea as they help address big, difficult issues. They could include people from all areas and ways of life, and help governments make joint decisions to hopefully mitigate effects of any measures on the balance of disadvantage. Maybe they should have proportional representation for LGBTQ, disabled, representing society as a whole?” 

She is then struck by a thought. 

“Actually, this independent advisory decision process [is what] happens now with NICE, [which] was instituted to make hard political decisions which were not easy or popular for government. NICE assess[es] the facts and the data. [Its] recommendations aren’t fully binding but have clout.  

“NICE committees are expert-heavy, with some lay representation. In general principle, NICE works as XR’s demand [for people’s assemblies] suggests. It may be unelected, but it is able to make evidence-based recommendations.” 

Rejecting any idea of eco-puritanism, Dr Van Hove states: “I think there is a real need to put empathy and forgiveness and community at the heart of the process and the change, so we can keep understanding for the struggles of others.”

I admit my five decades have scarcely been environmentally blameless. No condemnation ensues.  

“I’ve flown around the globe a fair bit, so I’m not blameless either,” Dr Van Hove says. “When people really know about the effects of climate change on children and grandchildren, I think they’re willing to make better choices for the planet. People care once they know what’s at stake and are willing to make better and more sustainable choices — as long as it will be done in equitable ways.”  

She concludes: “We can’t just impose harsh rules and let a small proportion get away with business as usual. It needs to be fair and done in ways all people can agree with.”



Coming up: Margaret Thatcher and the birth of the internal market

If there is any political or influential figure you would like HSJ to interview, please email alastair.mclellan@wilmingtonhealthcare.com.

The past five Bedpans

Mayor of Greater Manchester, Andy Burnham

Jess Phillips MP

NHS ‘privatisation’ documentary ‘Under the Knife’

David Cameron’s autobiography

Karin Smyth MP

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