Sustainability is more than just cutting carbon emissions. It means creating a system where all of us can thrive—not just survive.
COMMENTARY: FROM THE GROUP FOR THE ADVANCEMENT OF PSYCHIATRY CLIMATE COMMITTEE
As we prepare for the second online annual meeting of the American Psychiatric Association, it is a safe bet that few of us are thinking how wonderful it is to stay at home. While online conferences have much to offer, many of us miss the collegial interactions and invigorating break from office routine.
At the same time, we have become accustomed to the efficiency of online meetings—the decreased time and cost of travel, the comforts of controlling what others see and do not see, and the chance to spend more time with family. The environmental benefits of online meetings are also enormous. Large conferences can produce the carbon dioxide equivalent (CO2e) emissions of an entire city in a single week.1 In our recent JAMA Network Open study on the carbon footprint of APA meetings, we found that by holding its 2020 Philadelphia meeting online, the APA saved roughly 20,000 metric tons CO2e emissions—the equivalent of burning 22 million pounds of coal or 500 acres of dense forest.2
Psychiatrists increasingly appreciate the costs of this carbon. Climate change affects mental health in a myriad of ways, through temperature changes that impact pharmaceutical safety and neurophysiology,3 existential stressors and eco-anxiety in a whole generation of young individuals, and climate-related traumas from forest fires to coastal flooding.4 Some of us are also aware of the degree to which we, the health care system, are the problem. American health care generates more greenhouse gases than many countries, and it impacts more than 400,000 disability-adjusted life-years annually.5 The APA has wisely recognized climate change as a top priority,6 and our response must be to reduce our carbon emissions—as well as respond to the damage they cause—bringing our practice in line with international goals for sustainability.
But sustainability is more than just cutting carbon emissions. Sustainability means creating a system where all of us can thrive—plants, animals, humans, and planet. This requires adequate financial resources, social justice, and social connectivity, while also decreasing the destruction of our planetary home. As we prepare for this second online meeting, it is an opportunity to reflect: Where can psychiatry become more sustainable? What can online meetings accomplish? What parts of in-person contact are important to retain, and how?
During our panel discussion, “The Carbon Footprint of Cancelling the APA, a Virtual Match, and More: Impacts of Psychiatric Activity on Global Warming and How to Respond,” we will explore these issues, presenting research on the carbon footprint of residency interview travel by Daniel Brooks Bernstein and our research on the APA’s carbon footprint. We found that the carbon footprint of APA meetings may vary 3-fold by location in the United States, with northeastern locations optimally minimizing the aggregate carbon footprint. We also analyzed how the APA’s carbon footprint would change with different kinds of meetings—regional, online, and so on. For example, we have found that regional meetings could cut carbon emissions by 24% to 53%, and as much as 85% to 86% if nonregional attendees participated online.
Bernstein, a Stanford medical student, found that each of his classmates generated an average of 12,331 pounds of CO2 to complete their residency interviews, with 1 candidate generating as much as 44,000 pounds of CO2. Surely some of these flights are unnecessary to the development of these gifted doctors, especially given the climate and health costs of their travel.
Professional meetings are crucial for socialization, networking, mentoring, and learning. The casual conversations and meals that surround the program are important for the development of a professional identity and lead to creative advancement in clinical practice, research, and policy. Psychiatry especially prizes sustaining connections. But, in truth, many of our assumptions about what binds us to each other have been challenged by the ways we interact now through social media, telecommunications, and our recent rapid adjustment to telepsychiatry. The APA could achieve emissions reductions well within the target of the 2015 Paris Agreement by adjusting either its APA Annual Meeting or residency interview procedure, which would help our profession fulfill the Hippocratic Oath to “do no harm.” Using our experiences from the past 2 years, we can find ways to make changes that not only maintain sustainable connections to one another and our patients, but also contribute to the sustainability of our planet.
The panel will also include an overview of the carbon footprint of US health care and a discussion of its sustainable solutions by Todd Sack, MD, FACP, and panel chair Elizabeth Haase, MD. We look forward to sharing ideas and discussing what psychiatry should relinquish and what must be retained as we innovate for new climate-changed realities.
Mr Jeremy Wortzel is a medical student at the University of Pennsylvania School of Medicine. Dr Joshua Wortzel is a resident at the University of Rochester School of Medicine. Dr Haase is associate professor of psychiatry at the University of Nevada School of Medicine at Reno and acts as medical director at Carson Tahoe Health, Outpatient Behavioral Health Services.
1. Klöwer M, Hopkins D, Allen M, Higham J. An analysis of ways to decarbonize conference travel . . . Nature. 2020;583(7816):356-359.
2. Wortzel JR, Stashevsky A, Wortzel JD, et al. Estimation of the carbon footprint associated with attendees of the American Psychiatric Association annual meeting. JAMA Netw Open. 2021;4(1):e2035641.
3. Wortzel J, Haase E. The effects of rising global temperatures on mental health. Psychiatr News. 2020;55(8). Accessed March 8, 2021. https://psychnews.psychiatryonline.org/doi/10.1176/appi.pn.2020.4b24
4. Hayes K, Blashki G, Wiseman J, et al. Climate change and mental health: risks, impacts and priority actions. Int J Ment Health Syst. 2018;12(28):1-12.
5. Eckelman MJ, Sherman J. Environmental impacts of the U.S. health care system and effects on public health. PLoS One. 2016;11(6):e0157014.
6. Ursano RJ, Morganstein JC, Cooper R. APA official actions: Position statement on mental health and climate change. APA Official Actions. 2017:1.❒