Co-benefits at COP: four ways in which improving the environment could also improve mental health

Why am I at COP26? Well, as a doctor my ‘thing’ is health. I’ve always felt that prevention is better than cure, and yet we are staring at a planetary trajectory that will deliver massive damage to human health if we fail to act urgently. 

Looking at the health impacts of climate change, it is sobering to discover that many of these are mental health impacts – via many direct and indirect routes – and that these are already happening, especially in the global South.  

Finally, health services are part of the problem; around 5% of the problem in the UK to be precise. Healthcare is a carbon intense industry, especially in wealthy countries, and mental health services need to adapt and mitigate quickly. I firmly believe that by doing so, we can actually improve the quality of what we do. 

The sheer number of groups, organisations and perspectives here is staggering. What’s also apparent is how civil the interactions seem to be between these diverse groups – at least away from the closed doors and private negotiations.

One message I’m hearing again and again is that ‘systems change’ at massive scale is needed. That’s true for all of the sectors and it applies to the health sector’s increasing ambition to reduce its green house gas emissions and its environmental foot print.

Co-benefits

Today, I’ve been thinking about the so called ‘co-benefits’ of taking action on climate change. That is, by undertaking climate-friendly system change, what benefits for mental health might we anticipate?  

By articulating and, if possible, quantifying these benefits, it strengthens the health argument for change. If we then translate these benefits into financial terms we are then speaking in a language that is understood by every one – even those disinterested in health. So, what might the co-benefits of action on climate change be for the patients we see? Here’s my attempt at summarising them:

1. Reducing air pollution

Improving air quality would have an immediate and substantial impact on population health. Given the emerging links between air pollution and mental health impacts across the life course - from emerging psychiatric illness in adolescence to dementia – reducing air pollution is likely to have positive preventative impacts on population mental health that are substantial. 

Additionally, given that psychiatric patients are more likely to live in polluted urban areas, impacts on their physical health would be highly beneficial and require no behaviour change from doctor or patient!.

2. Improved access to urban green space

The college has been championing social prescribing and many of the best examples of social prescribing involve access to green space. Benefits from green space on population mental health are proven and there is reasonable evidence for using nature-based interventions to treat common mental disorders. 

But above and beyond this, there is a strong inequality argument to say that patients with severe and enduring mental illness (SMI) must have better access to green space and nature-based interventions.  People with SMI potentially have some of the most wellbeing and physical health gains of any group, but the most barriers to getting out into green space.

3. Championing active transport

Everyone I’ve spoken to here from the public health world has been clear that electric vehicles are not the answer to better urban transport. System, city-wide change is needed as some (often European) cities have managed in recent years.

Imagine a town centre where the car is banished and walking, cycling and excellent public transport is prioritised – how would this impact on our patients? I don’t have the figures to support this, but I suspect our patients are less likely to be car owners and this may be a further contributor to social isolation and exclusion.  At the very least, everyone’s physical health – including our patients’- would improve in better designed towns and cities.

4. More energy efficient housing

Housing is a major issue for many of the patients we see with the most serious of mental health problems.  Insecure housing, temporary housing, cold housing, no housing – we see it all as psychiatrists and often try and assist where we can. 

But for those living in fuel poverty, whose homes are poorly insulated, life is too often unbearably cold in the winter and unhealthily hot in the summer.  A major initiative to upgrade all poorly insulated homes – in whatever sector they happen to sit – would improve physical health outcomes in our patients.  And perhaps it’s not too far-fetched to think that some mental health problems could be prevented entirely with a warm home in winter.