Emma Radcliffe is a clinical lead for Net Zero at North East London ICB. She is a GP in East London.
Sophie von Heimendahl is a GP in East London.*
The climate and ecological emergency is caused largely by the overuse and depletion of the world’s resources. This is fuelling an environment and lifestyles that are contributing to ill health and significant health inequalities. There is an enormous amount of evidence detailing climate breakdown and the impact this is having and will have on health.1 The adverse effect the health sector has on the environment as well as the potential to improve health whilst making mitigative and adaptive responses is extremely strong and well documented.2
In this context, it is essential that we use our health system wisely and transform the way we practice. However, it is frustrating that the organisation which offers ‘resources that provide high quality authoritative evidence and best practice’, the National Institute for Health and Care Excellence (NICE), offers us no significant help with this. NICE summarises its top priorities on its website and there is no comment made about helping practitioners achieve the net zero targets embedded into the Health and Social Care Act 2022.3 Although NICE have a website page dedicated to environmental sustainability4 and its commitment is stated, surely responding to the greatest threat to human health deserves a headline in its forward view?
NICE summarises its top priorities on its website and there is no comment made about helping practitioners achieve the net zero targets embedded into the Health and Social Care Act 2022.
As the net zero agenda gains prominence within the health sector, NICE guidelines are still not providing clinicians routinely with material to help decision making.
In recently published NICE B12 deficiency guidance, for example, it is disappointing that there is no section on prevention.6 This is despite there being a definite dietary cause to some B12 deficiencies. Furthermore, we argue that clinicians would benefit from some help navigating the complexity in this case because animal products are a major dietary source of B12. Given that a shift to more plant-based diets is both beneficial to patients and the planet and is an essential part of our climate action,7 this is an important omission. The guideline authors suggest that the publication will lead to an increase in testing.8 They justify this by saying that this will prevent further disease. They also have suggested that some results previously classed as normal may now be ‘indeterminate’ which may lead to more intervention in this group of patients. At their own admission the guideline is, at least in part, based on poor quality evidence, and they do not outline the case that there is a great deal of illness or disability caused by underdiagnosed B12 deficiency. It seems the guideline has not fully considered the financial, carbon, workload and patient wellbeing implications before making recommendations. In a service that needs to prioritise use of precious resources, increased activity should require evidence that this will significantly improve outcomes.
With the exceptions of asthma and desflurane guidance, we are not aware that there are any other pieces of guidance which offer advice around environmental impacts of care. The principles of sustainable health care include: prevention, self-care, lean service delivery, low carbon alternatives and sustainable operational resource use.5 Although many of these principles align with other NICE objectives including obtaining good value for the taxpayer, we find it difficult to understand why there is not more focus on prevention and self-care.
*Conflicts of interest declared: Emma Radcliffe is a clinical lead for Net Zero at North East London ICB. She is a trustee of the UK Health Alliance on Climate Change. Sophie von Heimendahl is a co-chair of Greener Practice North London. Both are writing in their own capacity and not on behalf of any organisation.
References
- Lancet Countdown: Tracking Progress on Health and Climate Change [accessed 14/2/25]
- Climate and health: applying All Our Health – GOV.UK [accessed 14/2/25]
- Forward view – our priority topics | What we do | About | NICE [accessed 14/2/25]
- Environmental sustainability | Who we are | About | NICE [accessed 14/2/25]
- The Principles of Sustainable Healthcare — Sustainable Healthcare [accessed 14/2/25]
- Overview | Vitamin B12 deficiency in over 16s: diagnosis and management | Guidance | NICE [accessed 14/2/25]
- Chapter 5 : Food Security — Special Report on Climate Change and Land [accessed 14/2/25]
- Vitamin B12 deficiency: NICE guideline summary | The BMJ [accessed 14/2/25]
Featured image by Markus Spiske on Unsplash
