‘History will remember 2020 as the year when the greatest public health disaster in a century struck – and this pandemic laid bare the health inequalities in our society through a disproportionate impact on the health of deprived and ethnic minority communities.

‘But, the truth is that we are in a moment of history when even this event may be regarded as transient compared with the likely health inequalities we are going to be facing if we do not rapidly avert the climate catastrophe.’

Professor Mala Rao’s grim warning demands attention and it is the relationship between health inequalities and climate change – and the role doctors and the NHS can play in averting that – about which she speaks to The Doctor.

In a recent essay for a Fabian Society collection around health inequalities Professor Rao, who is a senior clinical fellow in the department of primary care and public health at Imperial College London, argues that the overshadowing of the ‘devastating’ effects of the pandemic by those of climate change means ‘now is the time to act to ensure global warming does not exacerbate health inequalities’.

Her arguments that climate change will deepen and exacerbate existing health inequalities are numerous, convincing and in many cases indisputable: increased heat-related mortality is likely to affect those in densely-built urban areas with limited access to green space most; warming increases the risk of food-borne diseases which affect isolated older people with low incomes; air pollution is highest in crowded cities; and the brutal effects of flooding and other climate disasters are most severe for households lacking the resilience to mitigate them.

In her essay, Professor Rao also illustrates the health benefits of action on climate change. From the reduced air pollution which comes with decarbonising the transport sector, to active forms of travel reducing the risk of conditions like obesity and diabetes.

And from reducing winter deaths and the ‘heat or eat’ choice faced by low-income households by improving the energy efficiency of UK housing to reducing the incidence of cardiovascular disease and cancer through reduction of red meat consumption and, thus, the carbon footprint of food choices.

If we accept these arguments – and that doctors are ultimately advocates for patients and a healthier society – there could be a significant role for doctors and the NHS to play. ‘It is through action that we are most likely to ensure this doesn’t overwhelm,’ Professor Rao says.

‘Health services are substantial contributors to carbon emissions and there is a huge amount the NHS can do to reduce its footprint. I have been excited recently to see groups of doctors demonstrating what can be done within the NHS and the impacts this is already having on bringing down its carbon footprint and, perhaps most importantly, enthusing more people to join that campaign.’

Professor Rao adds: ‘We can put this at the heart of everything we do. From the medicines we prescribe, equipment we use, the supply chains we utilise, and the buildings we occupy. Everything can be questioned and energy efficiency and cutting down carbon emissions is possible in all the spheres in which we work.’

Some of Professor Rao’s arguments might seem like issues for managers, system leaders and clinical directors to address, but the pandemic response has shown the role all doctors can play.

‘When the pandemic began, the leadership of doctors became evident – they brought a systematic, scientific, evidence-based and pragmatic, experienced response.

I think this, in many ways, was a dress rehearsal for climate change and doctors and other healthcare workers can have the same role to play.’

The areas to tackle, according to Professor Rao, are numerous. They span from video technology showing travel to international conferences can be questioned to doctors making their own choices about consumerism and consumption – for example, in terms of their diet, car use, air travel, financial investments and home energy bills – and using that education and experience to be role models for patients.

Some of the areas may be even more significant, like managing carbon footprints and wellbeing as part of the strategy for international medical recruitment in workforce planning when ‘in the future climate catastrophe may impact on their abilities to maintain links with their countries of origin’.

The vastness of the topic is remarkable and may leave many wanting to bury their heads in the sand but Professor Rao is adamant this should not happen. ‘We only have a few years to work these things through,’ she says.

‘Incrementalism won’t work any more. We need to be looking at all aspects of our policies and procedures. We need to assess everything through a climate-impact lens. After all, what could be more important than addressing the worst health inequality we face – gambling away the futures of our children?’