The temperature that kills people 65+ | Dr Mark Harber

0:00Dr. Mark Harbour, thank you very much for joining me on the Climate Unfuck podcast. Well, Rob, thank you very much for the invite. I'm interested to know your expertise is around health and healthcare, and probably for the person listening, if they're not in the heatwave right now, it's at least very recent memory. So how do heatwaves or extreme heat events affect human health and the health system? starting from rather crude ways in the sense of mortality increasing when it gets hotter. So even at 24 degrees in London, the death rate starts to go up, and 24 degrees most of us think is quite nice. But it goes up exponentially. So 35 degrees, we're expecting a significant number of more deaths. And we've seen that recently in data in Europe.

0:56in heatwave. So that's a kind of crude black and white bit. But on top of that, there's a lot more exacerbation of some diseases. So people with epilepsy tend to get more epilepsy. There's more mental health problems in heatwaves. There's more premature births, heart failure, kidney failure, and so on. So quite a lot of conditions that are chronic can get worse at And then the overall footfall in hospital is higher. So there's a significant increase in the number of people turning up to hospital in that setting. So there's the workload, but there's also, more importantly for patients, the risk of a significant exacerbation. And on a very blunt level, much more broadly than the NHS, there's very...

1:54start data about survival as the temperature goes up so the younger you are the more likely you are to survive being outside in hot weather um but there gets a point where it's not survivable for anyone um so those over 65 are more likely to um to perish in in over six hours of temperature of you know above 35 or so depending on the humidity and that doesn't matter how much you can drink And it's important because London was 35 degrees a couple of weeks ago, and there are people who are working outside, there are people who are homeless, so they're at risk. And it wasn't 100% humidity, but there are plenty of other low-income countries where these sorts of temperatures are increasingly being achieved, where people don't have access to air conditioning, and suddenly it becomes an extremely hostile environment.

2:52Yeah. You mentioned about excess deaths and maybe if someone's seen in the news about, you know, this heat wave led to so many excess deaths. I've always wondered how is that? Maybe it's a bit of a basic question, but how is that calculated? Can you say this person was X percent more likely to pass away because of... Yes, I think there's quite reasonably robust stats on this. So in 2022, when it was really hot in the UK and it reached 40 degrees somewhere in Cambridge, I think, and there was a sort of conservative estimate that it was felt to be about 2,900 excess deaths at that point. And that's really in what you'd anticipate from the population. So fairly clear data on what happens.

3:44and in Europe they're already saying what the estimated increased death rate is from two weeks ago. So I think the data is pretty good. It'll be estimates and people may have decided to die for other reasons. And then you're completely different to this but equally as tragic because over 50 deaths from drowning in France during the heat wave. So more and more people getting into trouble because they want to be a milder in a very hot environment. Do you think there's a danger? Because I've wondered when I've looked at these kinds of stats and preparing for this conversation that it kind of, it almost goes under the radar unless you are looking at the big picture because if your grandma goes into hospital for some kind of chronic illness or your cousin has a baby before they should have, we we're biased to um to anecdotal personal data so these like big country-wide statistics they they can be quite lost like they don't really tell an individual personal emotional story do you think that that is i think yes and i think i think you're right i think that's inevitable and and it's um And in a way, the bigger the numbers, the more sort of meaningless they become. And yet for a single individual, oftentimes you go, well, maybe I'd have ended up in hospital anyway because my heart failure was going to get worse or my kidney failure was going to get worse. So I think we can say there's a 40 or 60 percent increase in exacerbations of this condition. And it's difficult to do.

5:31To be more precise than that, really, I think, you know, occasionally you'll hear of someone who was relatively fit and healthy, who gets heat stroke and dies, and you can't help feeling... And as I say, the graphs, I don't have them in front of me, but the graphs, in the same way that when it gets very cold, the death rate goes up exponentially. I said it goes up a bit from 24, but it goes up like a rocket as it gets hotter and hotter. So we know this happens. None of this is a surprise.

6:06But I agree, sometimes with all these things, and the planet change in general, it's a bit nebulous, unless it's you. Do you think, because on the one hand, I wonder, like, if we know this is happening, if policymakers are aware it's happening, if trusts or NHS trusts are aware it's happening, does the general public, like, how important is it to make the general public aware that climate change causes excess deaths? Or is it really a change that kind of policymakers need to make without people...

6:48kind of being made more worried about it because on the one hand i'm like there should be news stories about this but on the other hand i'm like it you know ultimately this it can feel very much outside someone's control because it's like well how do i control the heat it's yes i i think i think that's a really good question and i um and i'm my my my view is there is there's very little point in terrorizing people and not giving them any kind of agency over what they can do with it. And so there's a mixture between very simple things of saying, well, actually, there's a medical profession, we can tell our patients with epilepsy or heart failure, whatever. We know exactly when the heat wave's coming. I mean, we know several days in advance and we know how hot it's going to be. This is our advice. So You can do that and there shouldn't be a house in the country that isn't where the people who live there don't know what to do to do the best to cool it down. And we have lots of terrible housing, but there are some things that you can do that make a difference. So there should be, what's the generic advice about how to make sure you don't get frazzled?

8:02and drink lots of alcohol and be outside in the sun, or whatever it is. I don't think we're doing that well enough at the moment. And that's cheap, and that doesn't cost much. What is the general level? Because I saw you at a talk in London Climate Action Week, and you said there are a few basic things that people can do to cool themselves down or to manage themselves personally. Well, yeah, so there's a bit with... housing so any kind of shading is good so it's it's the idea is that you try and keep your windows closed and curtains down if you have something outside the house that's better than curtains inside the house but you it seems counterintuitive when you're hot but you do that in the daytime and then at night time you let all the hot air out and you try and shift the amount of air so there's those things there's there's lots of stuff online at the moment about what you can do with fans and other things that you can do to cool it down. But it's also just how do you avoid you don't go out shopping, you don't go out and spend hours in the park, or you do, if you're going to do it, you do it in the morning or the evening when you're taking the dog out. So quite simple things that you can do. There needs to be much better advice for people who are obliged to be outside so people who are working. And again, what do you do

9:22what support do we offer for people who are homeless, for instance? So in India, in Delhi, they may have rooms with air conditioning that the tuk-tuk drivers can just say, I'm not working anymore, I'm coming in here to cool down for a bit. And they're relatively simple things to do. So there's those... Designated cooling zones, is it? Yes, exactly. And then there are things that you can do for medical patients. So, you know, there are drugs that we sometimes recommend people don't take if it's very, very hot.

9:52and I think about cutting back on the diuretics, water tablets, for instance, different conditions. So, you know, if you've got epilepsy, you're going to make sure that you're not missing out on any of your tablets and so on. And just, you know, a combination of relatively straightforward, here are sensible things that you can do. And then, I guess, coming back to your point about, you know, how do we... So there's the... It's very hot today. What do we do about that for the general public?

10:22I know we've talked about this before, but there's lots of things that we can do in the medium term in terms of housing and resilience and institutions and workplaces and so on and so forth, which it's a bit embarrassing we haven't done up until now. I mean, we know this is coming. We know you can watch the graph of the temperature going up and you can watch the heat waves being A, more frequent and B, more intense. And this is just the beginning. So for businesses, public services and so on and so forth, really ought to get on top of it. And I know businesses and public services have other things to think about but this isn't going to get better. So there's that bit. And then finally, there's the, well, we could all, you know, what can we do as individuals to stop making this worse? Because, and I think that hasn't changed very much. I mean, I'm being unfair. There are, you know, plenty of people who are doing lots of things that are, you know, correct for the environment and so on and so forth. But as a whole, there's, Emissions are still going up. Emissions are still going up. The flights are increasing by 4% per annum, so 80% up in 20 years. Single-use plastics, which are a really important cause of, you know, to mostly get burnt or dumped, are set to triple in 2060. So we're doing that. We're flying as much as we were before, globally reading more and more.

11:54meat-based products and again that has a huge carbon footprint so so we're not we're not really changing our behavior we may be doing bits of it but as a population we're not doing enough of that so again we can we can either do put lots of air conditioning in but it's not going to make it go away No, no. And it exacerbates the problem. It'd be interesting to know what your role is, what it involves. And I would guess there's some kind of there's like talking to the general public. You know, you get interviewed by The Guardian to talk about heatwaves, for example. But also, I would imagine there's some kind of...

12:35policy, you know, you may be feeding into members of parliament or people who are making policy or at least in the healthcare sector of the trust that you're within. It'd be interesting to know like what your work looks like around this. Yes, well, my background is I'm an aprologist, kidney specialist involved in transplantation amongst other things, but I'm an advisor to the having had a sort of long history in sustainability. And they're one of the things that they want to educate positions about this, but they also have a role in advocacy and lobbying. And there are a whole series of organizations that... I mean, the strength of this is organizations, the gravitational force of this, of people then going to parliament and...

13:28writing policy statements and so on and so forth. Also, I would just say that the healthcare sector has its own huge carbon footprint, which is about 5% of the carbon footprint of the UK. That's about standard for a Western country, much more in the States. We're generating lots of CO2 whilst we're trying to do the right things to make people better. and and part of this is um in 2019 um the greener nhs so a policy to get to net zero in the nhs so the first health care sector in the entire world to say well we've got to do something about this and and that's been very very positive because lots and lots of other countries said well hang on a minute they're doing it we should do it um and and now there are many many countries with healthcare sectors that have their own carbon reduction plan. So I guess the question is, can people like me or the Royal College of Physicians and other organisations accelerate the transition to decarbonise healthcare? Because that would be good. That's currently more than aviation, the carbon footprint of healthcare. That's wow. Wow.

14:48Well, it's a bit of a race, but we'll see. But I think, can we do that? And then are there other things that we can do in terms of spreading this? So in terms of the economy, the healthcare sector has a huge amount of GDP and, And actually, if we say we don't want things that have a huge carbon footprint, we want to select things that have a smaller carbon footprint, then suddenly that starts to shift things. If all the electricity we buy is from renewables, then suddenly that huge amount, enormous amounts of money, go into renewable production. And that's really positive. Yeah. So there are those elements to some of what I do. We'll try and do working with lots and lots and lots of other people Which part of it all do you find the most heartening or optimistic? And which part do you find the most frustrating or like you're banging your head against a wall? I think, well, so I'll do the annoying bit first, if that's all right. So it's, we're very bad at change.

16:05generally speaking, you know, safety buildings. Yeah, I think we're not good at it to start with. Once we've done that, we're fine. So plastic bags not being free in supermarkets, well, there's no longer an issue. You know, we just... So lots of things look like that. And if you're working in institutions, I think it's very difficult. It feels incredibly rare that you come across people who can... well, what's the answer to the possible here? How can we do this? Is there a way that we can do it? And most of the things in healthcare that you can do that are greener are also better for patient care and they save money.

16:44And that's quite a common finding. You know, renewable energy is cheaper than any fossil fuel energy at the moment. So, brilliant. This is fantastic. Why don't we say we spend how many billion in the NHS on electricity and that's only going to go up? Why don't we commit that to renewables, for instance? But it's... And it's incredibly frustrating. Anyone in the healthcare sector, I don't think it's just healthcare sector, I think it's anywhere, in general, will find institutions not wanting to make those changes. And I think the NHS has been running on fumes for years and years and years and been asked to reduce this.

17:27funding by 5-10% ever since I was about this big. So you can see why they're focusing on cancers and weights and so on and so forth. So you can see why this feels like a nice-to-have rather than an essential. But if you can do things that save money and are better for patient care, and anything that saves money is better for patient care is going to make you good for staff morale, particularly if it shows that this is green, it would be nice to have some help with that. And it does, you know, not often in faced with things that may save hundreds of thousands, if not millions. And, and just not getting anywhere with it. So that's very frustrating on the positive side. Pretty promising side. And I've just keep meeting lots and lots and lots and lots of, bright, enthusiastic people who get this, want to make changes, and want to... And the zeitgeist seems to be changing. So it's a very different world today in 2026 to how I and many others first got involved in this.

18:35having podcasts like this and having conversations like this and no longer being seen of some kind of lunatic. It's definitely helpful. Yeah, I was interested to ask about that because my mum was a nurse. She was a nurse in hospitals but then in a GP practice. And I don't, I mean, I was chatting to her just before this conversation and I was saying about kidney dialysis being incredibly energy and water intensive. And we were saying that you would never normally think about that in the healthcare sector. Yeah.

19:11And I just wondered what's people's reaction and how has it changed over time for this phrase that I've heard you say that the climate crisis is a health crisis. And I think it's, you know, it's quite a well understood phrase. Yes. I mean, I guess just going back to the carbon footprint of medicine, we... So kidney patients have a very big carbon footprint, largely because of the nice thing is you can keep people alive and hopefully well for a very, very long time with kidney disease. And diagnosis is a huge carbon footprint. People have to go very often to hospital. There's lots of plastic involved and so on and so forth. So on average.

19:59A kidney patient is about 16 times the carbon footprint of an average NHS patient. And that's a whole mixture. So that might be someone who's just broken an arm or it might be a hole, whatever. But it has a really big carbon footprint and it's not difficult to go through four or five hundred litres of water for each dialysis per person. So dialysis is basically doing the function of the kidney but external to the body. Exactly. So that's if you're a hemodialysis, which you've probably seen on TV and people going in two or three times a week.

20:30to have darsus and each one of those might be 400 litres of water. So you can imagine if you live in a country that's currently water depletes, so North Africa or so on and so forth, they're doing everything they can to reduce that and still deliver good care. And it turns out you can reduce it by quite a lot. And I think I'm going to forget my statistics here, but I think it's 2050. UK is going to be about 6 billion litres of water negative per day.

20:59So this is a problem for us. We don't have unlimited... As in water scarcity of the UK for what we use for all our water needs? In general, to what we currently are needs, we're going to be in a deficit by 6 billion litres a day. So, you know, we use more water, we're going to need more water, but actually, you know, and we've been running through our aquifers. All I'm trying to say is that there are very few countries in the world where water will remain cheap, plentiful and clean.

21:29And so we have a bit of a responsibility. And if you can say, well, we've switched this thing on our diastasis machines, and you can go home and tell your family we've saved over a million liters of water each year just by switching this to do it a different way, that's a really lovely thing. It may not save you much money, but it's a really positive thing. So there are lots and lots of things, and there's an organization called Centre for Sustainable Healthcare, which has been doing this sort of thing for years, saying what bits of medicine can you do that if greener save money and so on. And there are other organisations that are working with them to do that. And again, you know, the UK has definitely been ahead of the game with this and lots of other countries sort of collaborating with the UK, which again, that's really positive. It's just frustrating that implementing things that we know are beneficial is so slow.

22:22And I think that's probably often the case, but what you really want to do is take bundles of things that we know and take this hospital and say, well, we put these in. By the way, you can save a million quid and see what can happen to a carbon footprint. So we dived into the, or I dived in right into heat waves and was quite like specific, partly because I feel like this can get quite big, very big numbers very quickly that are quite hard to wrap your head around. But for someone who hasn't thought about the intersection of climate change and health, If you were giving them like an idiot's guide to the intersection of those two things, we've talked about heat waves, but there's lots of other ways. What are the other ways that they intersect? Well, yeah, so that's, again, great question. So, I mean, just to say in the UK in terms of resilience, 90% of hospitals are at risk and ward spaces are at risk from overheating so the hospital i'm in at the moment is designed built for 28 degrees which it's wow you can't cope for cooling when it's 35 um and yeah so staff working really terrible conditions and patients who are clearly not here for fun but because they're very little and well sometimes dying are finding themselves very hot conditions

23:47But the other side of this is that, and this is just the laws of physics, you know, the 10% of hospitals are at risk of flooding. In London, I think it's 30%. So a few years ago, two London hospitals were taken out simultaneously with flooding. So that's so and and when people get flooded, you know, ruins their lives. You know, it's a horrible, horrible event. Not only is it very dangerous, but there's a lot of depression that comes off to having your home flooded and so on and so forth. And then there's the the, you know, the other bits of the system that break down. So if your hospital is too hot, like St. Thomas's was about three years ago when two of the servers went down and tiles went out of action.

24:30because of that. So there's the critical infrastructure bit and how do you get people to and from hospital if your main roads are flooded, even if your hospital isn't flooded. And then there's supply chain things. So, well, just a good example of that, in Hurricane Katrina in New Orleans, there were thousands of patients who couldn't get access to dialysis. And the thing about dialysis is that you have a very limited amount of time. You can't just wait days and days and days till you have it. So this huge area disrupted and suddenly you've got all these patients who have a time-critical treatment and everything's possible.

25:08it'd gone to buggering really so the so there's that and then um another good example of a huge factory that made darsis equipment but this could apply to anything in north carolina got flooded um really flooded and then so you suddenly you there was none of this kit for patients. And the same, there's an increased supply chain issues with drugs, greater than there's ever been. And there are multiple reasons for that, but the climate crisis and climate events will do that. So there was all that. There was something else. Infectious diseases is another thing. So if you have floods, you get more, organisms that are related to floods. So cholera you're familiar with after great big floods, but there are other infections like leptospirosis and hantavirus and other things that are born by rodents and mosquitoes. And then as the world gets hotter, these infectious vectors can move.

26:10So there's a mosquito that's now in Italy and France established and in fact been found in the UK that carries Zika virus and dengue, neither of which have ever been found in this country before. And France had something like 500 cases and Italy's cases, homegrown cases of viruses that we have no immunity to. We're not. if someone comes into casualty, we're not expecting them to have Zika virus or dengue. And so there'll be more of those sorts of infectious diseases, emerging infectious diseases. So quite a lot of things for us to think about. But actually, I think probably the heat and the impacts on general supply chain like food and water and so on and so forth will be bigger and they're certainly bigger in low income countries where essentially 40% of the world's children are at risk from extreme weather events so that's a lot UNICEF data and 40% of the world's children are in areas already at risk of extreme weather events so you can either stay there and see what happens or you can try and move So that was a really depressing, but very interesting also list of all of the ways that, you know, climate and health intersect. But, and I think that the ones that maybe are probably most intuitive for people are the heat and the flooding. Yeah.

27:54which, you know, if you were to have an attention spotlight, you know, where you could make every or all 8 billion people kind of focus on one part of the health and climate change intersection for 20 minutes or an hour of their day tomorrow, that to kind of bring awareness to, what do you think people most need to understand more or we need to be thinking about more? I think that's a really good question. I think lots of people have struggled with how do you get this out there. UN and lots of organizations have produced very, very, very stark data. Tens of thousands of climate scientists produced all this data. The question is, how do you make any sense of that? How do you just avoid not getting completely depressed? I think in terms of the things that we can do, So here's the positive bit. We are never better than when we collaborate, cooperate, innovate, and invent. This is what we do best. Actually, if we come together to do that, and there's lots and lots that we can do, we just need to do it now. And the first and foremost is...

29:15stop burning fossil fuels. So do everything you can to reduce your fossil fuel consumption. And they're really simple things like switching your energy provider to one that just does renewables, for instance, and you can do that in about 10 minutes. That's pretty easy to do. And probably get a cheaper tariff. You may well get a cheaper tariff. Exactly that. And then, you know, not everyone can have solar panels on their house or whatever it is, but you can do that. You can work out ways to reduce the amount of energy you're using and you can think about how you travel and whether you need to do that travel process It's two miles by car, whether you can walk or cycle or take public transport. So there's quite a lot of things that you can do. Exactly. And that would make a big difference. And then there's, and again, it's very easy to get overwhelmed. And you see kind of billionaires doing what they do. And they're responsible for a very, very disproportionate amount of this. But they only have one stomach.

30:09So, you know, methane is incredibly important as a greenhouse gas, about 80 times more potent than CO2, but it breaks down really quickly. So if we can reduce the methane that's being produced at the moment, that's incredibly important. That gives us, it buys us a lot of time. And if you, this isn't, you know, if basically we eat a lot less meat, well, particularly, you know, herbivores, we're going to produce a lot less methane and you know like eight billion stomachs if we decide to eat things that are going to keep us healthier and and have less cancer and survive longer anyway that's not a bad thing um but but at the same time you're able to feed more people and you can produce less methane so there are really very positive things you can do and again if you shift the market and say well i'm going to buy this product that isn't I'm not going to go and buy, get the whole family to come out to a beef burgers once a week as a treat. Steak restaurant. Exactly. And say, she in that restaurant, can I have something that's vegan or vegetarian? And it may seem a bit odd to start with, but actually we move our stomachs and we move our money. This is all about moving money. So the other thing you can do is tonight is you change your bank.

31:21So if you if you it's very easy to work out you look at bank.green or other websites say if your bank is terrible bank and investing in fossil fuels and decided it wants to make its money by that or or chopping down trees and rainforests and you want to change. very easy to change your bank statistically you're more likely to leave your long-term partner than you are to change your bank i've heard that stat it's crazy isn't it unless your bank manager is incredibly fit i think it's inexperienced i think you should do so it's really easy to do and if and and the thing about these things is that it's a social movement so If you put solar panels on your house, your neighbor's 50% more likely to put solar panels on their house. If you get an EV car in your street, more people will see this and see if it's normal. If you say, actually, I'm not eating so much meat because that's likely to happen. And that's incredibly important. And if you say, well, we've changed a bank, it was easy and don't do that. Then the bank's know exactly where the money is going.

32:24So if you shift the money, that's really positive. And it also feels really good. You get rid of your gas hob and you replace it with an electric hob. You go, well, A, we're less likely to burn the house down and B, that's a good thing. And improve our indoor air quality as well. Exactly, yeah. And I think it's also, some of this is, you know, I think it's really difficult. You know, families, you've got kids, you kind of go... we're just going to get really, really depressed about this, or we're going to do some small wins. Once you do a small win, you feel good about it, and you do the next thing and the next thing and the next thing. And that's quite, I think it's pretty important, particularly for young people who, you know, inheriting something that's been, that's a mess.

33:02So I think there are many positive things that we can do. Despairing isn't the right solution to this. I think getting together groups and having really constructive things that you do would have lots and lots of benefits, you know. Yeah. It was coming into my mind as you were talking about that, that a lot of these are behavior changes. And I don't think there's any, there's maybe not a profession that I can think of that I associate maybe more strongly with getting people to change their behavior. As the medical profession, you know, you're recommending that people do something to make that, to improve their health. Do you find that you get any pushback or because if you say to someone for example you should be eating it's better for the climate if you eat a more plant based diet and cut out red meat where you can then if they perceive that you are coming you are saying that because of a a climate objective rather than a purely what is best for my own health and i think the two are very aligned here but like some people would disagree do you do you find that it can be hard to kind of use the the medical voice uh or the the trust that society has in the profession for that purpose does that make sense yeah no it does i think just just to go sideways a bit with this i mean you you you're

34:31you know doctors nurses allied therapists you know have a training in science and medicine and you know this this should be really important to us and we should understand it all um and just going back to the point that if you know the nurses are the most trusted profession in the uk and doctors come second um and so they carry so i think i think the bar is quite low generally but i think but i think it's politicians but i think you know so so it's good that that you know nurses trust and what have you if you know if i decide i need a I don't know, an enormous SUV BMW with a petrol engine, and that's in my street outside my house, that's sort of saying, you know, I don't think it matters to me and actually is the prestige thing that does matter. Whereas, so, you know, what we do matters. If we take multiple flights for whatever, for short distances and times and what have you, we're not changing our behavior, then that's...

35:38You've got a wall to wall. If, on the other hand, we go, well, I'm doing this. And then coming back to, so I don't say to patients, I don't think I've ever said to patients, you know, I think you should do this for the environment. I encourage people to try and, you know, we do some virtual clinics because it saves them time and saves them money and they get results faster, oddly enough. I encourage patients to be active all the time because I would do that even if there's no climate crisis.

36:05And, and essentially, if you took the entire country and made them vegetarian tomorrow and not suggesting, you do this, you do that. You'd save about 17,000 lives a year. So, there's really less diabetes, less cancer, lots of things. It's basically a healthier population. So there are lots and lots of reasons for saying to my diabetic patients, my obese patients, whatever it is, actually, I'd like you to be doing this because it makes a material difference to your health. And it turns out that that is also a good thing for the environment and that's good for their children. But I'm not selling it on that. Actually, so I wouldn't...

36:45Yeah, and there's a danger that you say, well, we don't want to do this because this piece of medicine has a big environmental footprint. And it's not about the rationing of that. I think we should be careful not to take on things that are marginal, that have a huge carbon footprint. But I think there's quite a strong argument for saying, you know, we're going to treat you as an individual regardless, but we're going to take on... So NICE, for instance, you know, So NICE is the organization that, which is actually a brilliant idea. And what it will say is that if someone comes along with a new cancer drug that costs, I don't know, £100,000 and increases someone's life expectancy by two months, they'll go...

37:30this isn't a good use of money. We could do 100 hips with this or whatever it is. So it's sort of quality. It's working out what works and what has a good value for money. And, you know, there are many healthcare systems I could mention who are, you know, being bankrupted by, you know, some, you know, not having a system that is going, what's the best use of our resources? And anyway, so nice, I think it is, I know, is thinking about how it can incorporate a bit of what, is this medicine the right thing? And also, does it have an enormous carbon footprint or environmental impact? And as an aside for that, it wouldn't be difficult, it really wouldn't be difficult, I think, to say to everyone who produces same products for the NHS, say, well, in terms of our procurement, the first thing you can do is make sure all the energy you use is 100% renewable. So that has an enormous ripple effect, and that would be quite good. And then the second thing is, single-use plastics so we use tons and tons of plastics and i've already said this is set to grow we know that you can find nanoplastics and microplastics in most organs that you look for them and it's difficult to know how much damage they're causing but they weren't there in my parents generation so it doesn't seem sensible to be filling up with plastics we know that these are getting into babies and uh and you know through placentas and into your brain so that's not good and there's lots of chemicals involved but

38:57single-use plastics come from virgin fossil fuels. So there's about, for each kilo of single-use plastic, it's about three kilos of oil. Whoa! I didn't know that. The bottles of, I don't know, Coca-Cola depict the world's greatest plastic pollution, you know, get thrown on the street there. Not only is there... I think they've won six years in a row. I don't know if that's deliberate. I think not only would that take 400 years to break down an ordinary plastic bottle, but...

39:31and the amount of pollution will be going up but there's also lots of chemicals like endocrine disruptors and phthalates that we know can cause problems that are involved in this anyway so a small proportion about nine percent of those are recycled but most of them either go into landfill or a burnt so that has a that has a polluting effect because of all the plastics and we use plastics and in the healthcare sector less than 5% is recycled. And that's because it's deemed clinical waste. So it's then often burnt at very high temperatures because we think there are terrible things on it. So you can see there's lots and lots of things about what we're purchasing, which are really terrible and completely unnecessary and end up being very expensive. So lots to do. We just need to get the industry to come up with a better plan.

40:22I'm interested in what you said a bit earlier in what you were saying about nurses, the most trusted profession, and then doctors, the second most. Because I think there's a lot of mistrust, especially now in the world. Social trust, I think, is being eroded in people around... you know, people around you or your government. How do you think medical professionals, maybe a doctor or a nurse who's listening to this or someone who has a friend who in the profession that has a lot of social trust could leverage that or how can the profession as a whole leverage it more, do you think? So I'm going to make that a bit more broader than medicine. It's just how do we get the climate change message out?

41:12And I agree that we're probably more siloed now than we've ever been. And so how do you do that? I think there are... And we're kind of into sound bites and so on. So I guess what we really need is people who are very good orators, who don't have a secondary gain... to be able to say this is what it is. So the National Emergency Briefing, which you may or may not have come across, but if you search it... I went to it, yeah. Yeah, so... It's really awesome. So for those in the audience who may not have done, do have a look at the website, the National Emergency Briefing, and there were about nine international speakers who talked for about 10 minutes, and you can download each one of those from the website...

41:58and have a look and hear what they say about it. So really... Or you can attend a screening. Exactly. Locally. Or in your workplace. Exactly. So you can hear about this. And the idea is, in exasperation, I think, a very clever idea, Mike Bannesby and others, to say, well, this needs to be up there on the news. The government needs to be talking about this. And I think the tragedy of this is that you know this current government has done more for renewables than any previous government and and there does seem to be a movement but each government um um what's the word uh sponsors fossil fossil fuel industry by billions literally billions subsidizes yeah yeah subsidizes uh taxpayers money uh every year and you think well we'll that's not so good. And we could use that for other things. So there's, there's what you, you know, what I would love, I think actually most British public and probably most people in most countries would love is someone to stand up and say, I'm going to tell you how it is. And this is what we're going to do. And this is what we need you to do. And there's some of this is going to be difficult because it's changed some, and it's going to be particularly difficult for, you know, people who work in the fossil fuel industry, people who, who, who,

43:13who produce meat and so on and so forth. But the income stream from renewables and sustainable industry seems to be much better. And that could be, yes, we're not good at, as we said before, we're not very good at transition. But you need to, I think if someone said, this is what we've got to do, and we have to do this for our children's generation right now, How am I going to spell out why we have to do it? And it's complicated by the fact that, like the tobacco industry, there are industries who have a very vested interest in giving lots and lots of misinformation. And that's been clear from the fossil fuel industry, who by their own records have said, we know what's happening, but we're going to give false information on this. And it's very, very easy to put out stuff that throws people off and say, well, I don't know what to believe now. But I think what's been lacking...

44:10on a government level and i for one i just think that so many people would go thank god you're saying that and telling us yeah um a bit like covid when chris witty did it at the stand and was like this is a real problem but i feel like it galvanized people yeah probably without the bit i think yes yeah yes but i think you i think you can i think people rise up to it i think go this is the challenge this is what we need to do this is why it's good um and i know you think In COVID, you risk infecting other people and people potentially dying from it. It was a profound effect for every other generation. Yeah.

44:53If you were maybe chief medical officer or you had a public information campaign, what would you kind of target it at? Because I think something that I've spoken to a couple of psychologists and a common theme is making it personal to your own life and your own health. You know, you can benefit financially or you can live a healthier life. what would you kind of point the the the attention uh canon at yeah i mean again i think that's a really good question something i and many other people i think have struggled over a bit i i i completely agree it's people don't want to be just upbraided by what they're doing in their lifestyle and i think There's a lot you could do in terms of diet and being active that is just very good for you and will save you money. And it costs about, I don't know, £3,000 a year to have a car in London. Actually, if you can, most of the journeys that we make are less than two miles. You're contributing to the air pollution that people are breathing in and you're contributing to the air pollution that you're breathing in when you're driving. So there's quite a lot of things you could say, well, actually, maybe you'd be better off financially if we could do this.

46:15and your health will be better. So, but so will those around you. The EULA thing has been interesting because it was quite controversial. It took a while to see the data showing the nitric oxide and PM2.5 particles going down in London. But very recently, there's data showing, well, look, there's less sick people because of this, which is brilliant. You just go, what's not to like about this? I mean, I don't feel good about driving around in my car and doing this. So although it was controversial, I think if you can say This is how many lives I say, this is how many kids aren't off school because of asthma, blah, blah, blah. So that's good. I think air pollution is a really important one because the data out there is so strong. And most of the things that cause air pollution are related to burning of fossil fuels, burning of anything. So there's a lot of data on that. Less dementia as we cut it down and definitely less heart disease and...

47:13emerging evidence in China looking at this and saying there's an association with how much PM2.5 and chronic kidney disease you have. Is that like a toxic air pollutant? Yeah, so there's particles. So there's things like nitric oxide, which can make asthma and so on, so forth, which are gases. And then there's particles and they're different sized particles. But PM2.5, we know, causes lots of problems in terms of definitely lungs but it looks like there's an association with the more you have in your area the more kidney disease you have more heart disease and and possibly more dementia so we've we've been doing what we do because that's what we do without really realizing what the price was for those around us and and you know often that gets people's back up but you go well we you know it's no longer acceptable to drive drunk anymore so you know there are things that we can do can we reduce the impact of travel and transport? It doesn't mean we don't do travel and transport, people need to travel and get around. But actually, can we make it better? Can we make you healthier from that? So I think it's about how you join those dots and how do you say what we're proposing is going to be healthier, safer, and save money. Yeah. For you as an individual and for actually UK PLC.

48:36and the sums of money in terms of health from air pollution, from people driving badly and having accidents and so on and so forth, are eye-watering. I mean, the amount of money that we spend on road traffic accidents, people driving fast in built-up areas and so on, and the consequences of ill health because of what we do are billions and billions. And again, wouldn't it be better to spend that on, I don't know, whatever you like, schools or whatever's your thing, really?

49:09yeah yeah that I I liked um when I saw you doing the talk at London Climate Action Week you I I really liked how the tone of it was very uh things are bad but actually by acting on it there are so many co-benefits and um you were also talking in in some detail about what um is it the nhs uh trust or hospital that you're at has has like green measures that you've made is that so it's a mixture of um i guess a lot lots of hospitals are traveling at different speeds and it depends depends on how enthusiastic the board i guess in every institution you know have you got a board that's So, you know, they're trying to retrofit hospitals for very good reasons. You'll save money if you're not hemorrhaging heat from every single building. Some hospitals have built extensive solar farms, you know, next to them and sailing. A couple did that before the Ukraine war, so they must be very pleased with themselves. Yeah. Quite rightly so. And again, it's just that, There are many things, as I say, that save money and you go, well, I'm glad we're not. We spend a lot of money on waste. As I say, we burn a lot of it, but a lot of it goes, we pay companies to get rid of it. Well, if we produce half of that, that would be a good thing.

50:39So, I mean, I find... Are there any particular success stories of... Because I was reading, for example, in prep for this conversation that... Is it somewhere in Wiltshire that's the first net zero healthcare centre that it's... I think it's run on heat pumps and... Or there was another one that kind of rewilded all of their green... Or like, stopped mowing as much all of their green space. Is there any... I mean, I think there's probably bits of stuff happening all over the place. And there are very frustrated individuals in institutions that they have no interest. And there may be two or three people in another institution that go, of course, let's do it. And just not mowing grass until September is a really, really good way of getting biodiversity back in. And you save the money on not.

51:34not mowing grass and you get lots of wildflowers. So it astonishes me so much. We're kind of moving everything down to a bowling green all over the place. So there's lots that you could do with that. There's, you know, there's a model that looks at one of our hospitals, you know, where you can put solar above the car park, for instance. So in France, it's quite law. If you have more native places, apparently you have to put solar above the car park.

52:03Really? Oh, wow. But if you do that here, and the NHS has lots of big car parks, then not only can you manage downpours of water more easily and keep the cars cooler and have some shading, but the one that we looked at with a company who said that they would pay for it and then they'd get their money back over time would save about £30 million over 25 years. So you're doing the right thing. it's greener and it's good for morale and you can by the way manage downpours and you can keep things a bit cooler so there's there's lots of stuff happening but i think as i say it's very patchy and what you'd really want to do and we've had meetings with the world health organization based in europe and what are you and say well one isn't why isn't this happening faster you know How do we do this? And I think it only really works if you go from the top. And what the top needs to be is to say, this is a bundle of things that you can do. We'll have some experts come in and say, up to you. But if you do this, this and this and this, you'll be, I don't know, five million quid better off every year till the end of time. And you'll get this. And here's the easy win. So you definitely want low hanging fruit in an NHS that has very little money.

53:20The same thing applies to every business, every institution. There are some simple things you can do. You've mentioned morale and then also easy wins there. And I think in terms of understanding people's psychology and getting them to act on a far away, quite hard to understand, wrap your head around threat, that's like something that the medical profession needs to do well. What do you think the general climate movement maybe could learn, or do you think you would like to see more from the approach that the medical profession takes to getting people to deal with far away, big, hard to make concrete threats? Because I feel like what you just said there of getting some easy wins is a good example of that kind of overlap where that thinking translates.

54:22Yes. It's very close to my heart. I used to be a governor of a local school, and we were talking about climate change and the importance of it. There was obviously a lot of climate anxiety amongst children because they're sensible and thoughtful, and they hear what's going on, and they want to do the right thing. The point I was trying to make was that you have to give them something you you can't say just pick up a list picking up this is important but it's you have to say actually this is what we're doing as a school this is what you can do and here's some positive things and as i said before it's quite infectious if you if you do something that's anything well actually that's that's great we've done this and And that's a good thing. What's the next thing I can do? I don't feel so crap about this all day. It snowballs. And you want to do the next thing. But I think we have a moral responsibility to our staff, to our children, to our whole population, but particularly young population and staff to say, this is what we're doing and this is how you can contribute to it. I feel really strongly about that. And I, and I think it's, it's neglected spectacularly. And that issue, you know, in institutions, you're often given as a bit of greenwashing, which is nothing, nothing more can turn you off than a bit of greenwashing. And I think to say genuinely, this is what we're doing. This is what we'd like you to do. It comes back to the point, you know, I would love for politicians to stand up and say,

55:58This is how it is. This is what we've got to do. This is the challenge for us as a government. This is what we're going to try and do. This is how we'll help industries that need to shift, even though they're frightened and people have got jobs that they love doing might have to move to other bits. This is how we're going to help you do that. And this is what we needed from society and individuals. And honestly, I could probably give my right arm for that. I mean, I'm left-handed, but I think it wouldn't be great to have someone say, okay, we're taking bull-bun horns and we're doing this stuff and we need your help. Yeah. Yeah. Yeah. I really, I really appreciated the national emergency briefing for that and kind of giving people the tools. Like, like you said earlier, I had, um, uh, Nick Aldridge who set it up on the podcast and, and hearing about the, like the background of why they did it and, and the success it's had. I mean, I think, um, they're at like 1,300 screenings around the country and each screening is probably 30 people. Yeah. So that's, and the quality of the information from the people who've given talks is really impressive. Yeah. What question do you wish people asked you more or do you wish people asked more in general? I think it's, what can I do? What in practical terms,

57:22yeah i can i do that um and because it is about moving money and and that you know they had some terrible terrible tipping points but actually there's some really positive tipping points and if let's say everyone moved all their energy to renewable energy companies that that would you know that's massive if people say oh actually i'm going to do one flight a year or i'm going to that's huge. If the pension companies go, do you know what, I'm going to spend less time investing in fossil fuels and so on and so forth, that has a massive... But I think the main thing is, you know, some people can only do very small amounts.

58:06The tragedy is that the people were most impacted at the beginning of this. There's a huge inequality in it. It's the poor, the dispossessed, those in low-income countries, those in low-income status in this country. But they can be reassured by the fact that we'll catch up very shortly afterwards and it doesn't really matter how rich you are if you go to the Maldives and everything's dying. It doesn't matter how rich you are. So I think there's a lot that one can do and i wish i think i think asking the question is actually almost enough because yeah you've you've said i i want to do something it's an active question rather than feeling like a passive actor exactly exactly and and the inverse what do you get fed up of being asked um well we don't know the answer to that um yeah That's a good answer, though. I mean, yeah, I think I think just my biggest frustration is to say, you know, this is a positive thing. Can we do this? And it just getting lost in our in organizations that that don't have a can do attitude or don't. You know, there are definitely ideas that won't work for very good reasons, even if they have a good output. But I think you want people to say, OK, we'll have a look at this. We'll dissect it. If we can do it, we'll do it.

59:31um i mean god wouldn't that make a difference just in life in general if that was yeah the response um uh i'll i'll phone you back if i can think of what it is no that's a good answer no that's a yeah that's really good um where would you where would you point someone if if they've come away from this conversation feeling like yeah i want to do something like i i want to i want to i want to contribute in some way um is there any of Well, it would be great. I mean, I think it very much depends what your circumstances are, what your job is, what your, you know. So a couple of very obvious things. The first is if you go to a whole variety of websites, but one is Real Zero, for instance, they've got seven things that you can do. But have a look around other websites. And the most important thing is what can I do as an individual? And you can do your own carbon footprint first and foremost.

1:00:30and your carbon program won't be zero straight away. It's kind of, well, am I doing better now? now than i was a few months ago and and what can i change and embed and so on so forth and then so there's that the second thing that you need to do is that we we need to change everyone else so you know if i change i changed my bank to an f5 many many many years ago but i mean quite a lot of other people have ended up changing to the same bank for the same reason and i'm not saying you know it's it's and changing energy suppliers and so on so forth so it's so that's not me being brilliant it's just saying what you've got to do is cut and paste this to bigger things so you know the uk being good at doing some of the nhs greener nhs stuff is lovely but then we thought well that's we can't wait six years for every other country to do that we've got to say this is what we're doing take what you want cut and paste it translate it and so on so that's what we've tried to do in renal medicine we're having an international organization so What can you do? Have discussions about it. The other thing that I dismissed quite a lot before, but I think it's probably just make more difference, is that if someone comes to your door saying, I'm the candidate from whatever it is, and most of us, I have to say, hopefully politely say, that's fine, I'm busy, or I've already worked at it, whatever. If you say, actually, the thing that really matters to me is climate change,

1:02:00And once that starts happening, once and it's, you know, there's pretty good evidence that happens. If that's what people are getting on the doorstep, they're saying, you know, whichever candidate is standing outside, this is what really matters to me. suddenly the politicians, so rather than being led by the politicians, they're kind of following on behind us. And they won't do radical stuff if they think we're not going to vote for them. But if they say, actually, I've got three small kids and this is really, really important, then hopefully we can embolden governments to do stuff. But I come back to that, if politicians were bold and brave and said, this is what we've got to do, it would just be amazing.

1:02:44Yeah. Yeah. And either attend a screening or host a screening of the National Emergency Briefing. Yeah. Sorry. Yes. No, definitely that. Yeah. Yeah. sounds like we're sponsored by them but we're not but we're not no yeah it does sound like it really well if you're not if you haven't been involved in this it's it's um it's very eye opening yeah thank you very much mark i've i've really really enjoyed this it's been a fascinating conversation to research and to have so yeah thank you very much thank you real pleasure thanks rock thank you