Physicians and Environmental Change: What is Our Role and Why Should Anyone Listen to Us?

PHYSICIANS AND ENVIRONMENTAL CHANGE: WHATIS OUR ROLE AND WHY SHOULD ANYONE LISTEN TO US? TEE L. OVIDOTTI, TREVOR HANCOCK AND WARREN BELL The adverse impact of human activity and economic development on the global ecosystem and its resources is massive and is accelerating. This reality has profound implications for human health. However, physicians generally have not been conspicuous in public discussion of environmental issues. This is especially true for those environmental issues that do not directly and obviously relate to specific diseases. Even so, it is increasingly clear that "ecosystem health" issues may have an indirect but often profound effect on human health. As in many health issues, the public sees connections more clearly than those of us immersed in professional roles. The public also expects the medical professional to be knowledgeable about these issues. Numerous studies have documented the assumed credibility of physicians as sources of information about health issues and risks. One such study, conducted by Slovic in 1992, demonstrated that over 80 percent of Canadians queried expressed "a lot" or "fair" confidence in physicians speaking on such issues, by far the highest expression of confidence and far exceeding that for government sources, other scientists, or news media [I]. (The least confidence was expressed in industry sources, scoring only about 25 percent.) This confidence is somewhat alarming, considering the scant emphasis on these issues in the medical curriculum. Physicians in general are neither prepared for such a role nor acculturated to such broader issues in their medical training. The Canadian Association of Physicians for the Environment was Canadian Association of Physicians for the Environment. P. O. Box 4489, Edmonton, Alberta , T6E 4T7, Canada Support for this work was provided by the Tricouncil EcoResearch Chair in Environmental Risk Management at the University ofAlberta Faculty ofMedicine. Dr. Hancock's contribution to this paper was derived in part from work supported by the Canadian Medical Association. The Canadian Association of Physicians for the Environment, for which this work was originally prepared, is the Canadian national affiliate of die International Society of Doctors for the Environment. Ms. Komali Naidoo assisted in editing references.© 1998 by The University of Chicago. All rights reserved. 0031-05982/98/4101-1070 $01.00¦ectives in Biology and Medicine, 41, 4 ¦ Summer 1998 591 founded in 1995 [2] . We reviewed the recent literature on the role ofphysicians and environmental issues, excluding issues that dealt exclusively with human health, as part of program planning for the new organization. This literature is not extensive. A comprehensive article by McCaIIy and Cassel provided an excellent point of departure and laid out a general outline [3]. We have expanded upon this outline and added our own views. Critical Condition: Human Health and the Environment, the authoritative text produced by a team of authors associated with Physicians for Social Responsibility , refers to the role of physicians in several passages [4]. The journal Medicine and Global Survival (previously PSR Quarterly, the publication of Physicians for Social Responsibility, 126 Rogers Street, Cambridge, MA 02142 USA) also has examined many of these issues and brings together relevant material. After changing format to an on-line publication, it is now returning to print. We have discussed elsewhere the different views of "environmental medicine " within organized medicine and medical practice [5]. In this article we confine our discussion to the physicians' role in environmental issues affecting the community apart from the care of individual patients or specialized practice in public health or occupational and environmental medicine . Human and Ecosystem Health It is by now well accepted that the major determinants of health lie beyond the health care sector [6-9] . A substantial body ofwork has emerged on the determinants of population health, but the topic of ecological sustainability and ecosystem health has been given little attention [6, 10]. Nonetheless, there is considerable evidence that human activity is having an adverse effect on environmental quality and ecosystem health and that this threatens human health, in addition to threatening the health of many other species [4, 11-14]. Changes in environmental conditions and their effects on health, some quite indirect, are documented by agencies such as the Intergovernmental Panel on Climate Change (1996), the Canadian Global Change Program (1995...