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Climate change: a survey of global gastroenterology society leadership

Climate change is a threat to both public and digestive health. Ironically the delivery of healthcare contributes to global warming by generating waste and emissions. If the global healthcare sector was a country, it would be the fifth highest emitter of greenhouse gases on the planet. Healthcare providers and the global gastroenterology (GI) community recognise the need to break this cycle. For example, several GI societies have started climate focused action groups or committees, and the British Society of Gastroenterology has produced a firstofitskind GI society sustainability blueprint. Although promising, these initiatives are recent, geographically piecemeal and possibly limited in their impact since they require buyin and then implementation of measures to directly address the carbon footprint and wasterelated challenges, in addition to the need for goaldirected efforts by healthcare systems and providers. The climate crisis requires global, comprehensive, coordinated and urgent action if the GI community is to respond effectively. Professional societies could make an important contribution to meeting this challenge. The World Gastroenterology Organisation (WGO) is a nongovernmental organisation with 117member GI societies from 108 countries representing over 65 000 gastroenterologists worldwide. The WGO Climate Change Working Group conducted a survey of global GI society leadership to understand their views on climate change, their society’s status, perceived barriers to action, support that might be useful and plans regarding the climate crisis. In this commentary, we provide the results and implications of the survey. Global surveys of physicians on the issue of climate change have had variably low response rates. 10 This raises a concern whether the respondents, and responses, are representative. We surveyed the leadership, rather than the membership, of the 117 GI societies who are members of the WGO. Leaders are well positioned to provide insights into their society’s attitudes, are familiar with society structures in place and are likely to have an informed view on what actions might be feasible in the future. The methodology and data from this survey are available as online supplemental file 1. The high response rate in our survey (49%; 57 of 117 societies) supports this approach (see online supplemental information for the methods we used and the survey questions). Given the proportional representation from all geographic areas and economic zones, the results are likely an accurate reflection of senior GI leadership attitudes and beliefs and the structures currently in place in their societies. We cannot exclude the possibility that the respondents are biased towards those who are more concerned about global warming. Another possible limitation of our strategy is that the responses are from a limited number of older, predominantly male, members of the profession whose views may, or may not, represent the attitudes and beliefs of their membership. However, we captured not only the subjective personal beliefs of leadership but also the structures in place in their respective organisations (table 1). The majority of responders believe that climate change represents a crisis, with 86% appearing knowledgeable regarding the cause, which is almost entirely anthropogenic. The remaining minority believe that the problem is caused equally by human and natural forces, so there is still work to do on educating GI leaders. This finding is similar to previous surveys where level of knowledge was captured. A majority of leaders are personally committed to change, and a significant number have already made changes in their personal (49%) and professional (53%) lives. The level of concern did not vary by geographic or economic group, but these personal beliefs and concerns have not resulted in global warming being prioritised by their national societies. The issue receives a low prioritisation ranking in their GI society. Only 9% have a climate working group or committee in place that provides a planning and administrative structure, which would be able to facilitate change. However, 46% of those surveyed indicated that their GI society will likely form a CC working group. Obstacles to moving from concern to action could be due to prioritisation of systemic issues, psychological or financial constraints (figure 1). Leadership did provide insights, in both open text and direct questions, into the disconnect between their personal ranking of the crisis and the lack of prioritisation by their society. A lack of awareness and knowledge of the issue and the competing demands of clinical work were the major reasons cited. A smaller number believe that the health sector could not change its practices or was not responsible, that engagement was hindered by lack of organisation and resources, and a lack of advocacy. Similar themes emerged in direct questioning. Over 80% of the leaders agreed strongly, or partially, that their societies have more pressing problems than climate change. A similar percentage agreed that they do not have the knowledge to engage, and that it is the responsibility of government (69%) to deal Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada Department of Medicine, Rutgers University, New Brunswick, New Jersey, USA Department of Medicine, Monash University, Clayton, Victoria, Australia Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, UK