Why doctors must fight against climate change (and what they can do to do so)

“As a member of the Medical Profession
I solemnly pledge to dedicate my life to the service of humanity;
the health and well-being of my patient will be my first consideration. “

– Declaration of Genève –

Every medical doctor’s career begins with the Oath.
That Oath represents a commitment to Society.
Every medical doctor swears to pursue the protection of physical and mental health.

Every doctor swears to promote the elimination of all forms of inequality in health. This means many things, well known to most. But this Oak also stands for a matter less considered by many medical doctors, but significant: climate change is their problem, and fighting it their duty.

Why is that? What does climate change have to do with the medical profession?

It is simple: climate change is also a medical problem. Climate change is also a matter of health.

The consequences of climate change on health are now witnessed and no longer only hypothesized or predicted. There are now several scientific studies available in the literature supporting this.

The increase in temperatures is associated with a higher frequency of extreme events, specifically floods and droughts, both at the base of a compromise of the agricultural sector, particularly sensitive to climate change. This impacts on the availability of food for the population and, consequently, on their health status.

The number of injuries and deaths caused by extreme weather events is (and will be) always higher. The Nargis cyclone in Myanmar with over one hundred thousand deaths is just one example.

Water is essential for hygiene and extreme phenomena, such as drought, may reduce their availability. On the other hand, extreme events in the opposite direction, such a flood, may impact health due to a rise in diarrheal disorders. This group of diseases is today responsible for one million eight hundred thousand deaths each year and represents the second cause of mortality due to infectious causes during childhood.

Heatwaves increase morbidity and mortality in the elderly suffering from cardiovascular and respiratory diseases. In Europe, it was estimated that in 2003, 70,000 deaths were associated with excessive heat.

Changes in temperature and precipitation patterns could lead to changes in the distribution and frequency of infectious diseases. The spread of vector insects would lead to an increase in infectious diseases such as malaria and dengue fever. Similar phenomena were already observed, such as the spread of Plasmodium falciparum (responsible for malaria) in East Africa, schistosomiasis in China and tick-borne encephalitis in Europe.

Rising temperatures will increase the mobility of pollen, other airborne allergens, and pollutants in the air we breathe every day.

Moreover, recently, some researchers have also brought evidence on a potential direct relationship between climate change and an increase in mental disorders.

A side effect of climate change will also be mass migrations and conflicts. Hunger, floods and the collapse of infrastructures will contribute to a further increase in the migration phenomenon, with the consequent spread of infections, mental disorders such as post-traumatic stress disorder, depression and post-partum depression, and overload of the health system of the countries of ‘arrival. Precarious social and health conditions accompany the migration phenomenon. Furthermore, the growth of the migration phenomenon will also lead to an increase in protectionism on the part of affluent countries concerning their resources, with political and health consequences already evident today.

Within this framework, there is so much that doctors can do every day to combat climate change.

In 2008, the British National Health System created a Unit for Sustainable Development intending to reduce the impact of the NHS itself.

Also from the United Kingdom, there are six indications for medical doctors, a re-adaptation of the Council’s recommendations on Climate and Health.

1. Encourage patients to walk and use bicycles whenever possible, both to improve their cardiovascular health and to improve the quality of the air they breathe.
2. Suggest dietary changes, advising to reduce the amount of meat taken drastically. A great contribution to global warming is due to breeding and meat production. If the entire population of the United Kingdom did not eat meat for a day a week, it would be like removing 5 million cars from the road. This would also have a double impact, given that the consumption of meat is associated with an increase in cardiovascular and cancer risk.
3. Raising awareness and offering a model of a sustainable lifestyle is another weapon doctors can use. This can be done for what concerns mobility and energy, but also in terms of living arrangements, trying to adapt your home to reduce energy consumption.
4. To prescribe participation in voluntary activities can have beneficial effects both on the well-being of the most socially isolated individuals, and on those struggling with mental disorders and self-esteem. Taking part in voluntary associations committed on the environmental front would be another way of bringing benefits to the patient and at the same time to the entire Society.
5. Make yourself a spokesman in the Commissions and in the meetings in which you take part, in an attempt to reduce the environmental impact of the Health System where possible.
6. Set an example by trying to drink tap water, consume local and less processed foods, use bicycles and public transport for travel.

Perhaps among the images in the head when studying to become doctors, there was not that of the activist on the front line against climate change.

It does not matter.
It does not matter if
they like it or not,
every doctor,
when he swore,
he has sworn to do so.

Fabio Porru

REFERENCES

• Declaration of Geneve (https://www.wma.net/policies-post/wma-declaration-of-geneva/)
• Death toll exceeded 70,000 in Europe during the summer of 2003 (Robine et al.)
• Effect of 1997-98 El Niño on highland malaria in Tanzania (Lindsay SW et al.)
• Potential impact of climate change on schistosomiasis transmission in China (Zhou XN et al. )
• Climate change: present and future risks to health, and necessary responses (McMichael, Lindgren)
• Empirical evidence of mental health risks posed by climate change (Nick Obradovich et al.)
• Climate change: what can doctors do? (Micklewright)

Pubblicità

We need to talk about suicide (but in the right way)

A friend of mine typed to me. She asked me if I had some material about suicide among students. Wished I could tell you that was due to curiosity, but it wasn’t. One of those things you never believe it’s going to happen to someone around you happened.

The 10th of September was the International Day for Suicide Prevention 2019. Talking about it is the best way to take part in it.

It’s been two years since I started to work on mental health and to use social media to talk about that. One of the things I experienced is that when you say you work on mental health, most of the time people wonder about it. Another thing I experienced is that when you talk about mental health, especially with young people, often you end up talking about suicide. One thing I realized, is that much more people we can guess truly feel like talking about it. Much more people want to talk about it. Much more people need to talk about it.

Let’s talk about it, then. Let’s start to get an overview of suicide.

According to the World Health Organization, every year about one million people commits suicide. The limitation of big numbers is that we don’t really feel them. We aren’t able to perceive them.

According to the World Health Organization, every day about three thousand people commit suicide. It’s probably more than the number of people you would be able to list as relatives, friends and acquaintances. Every day.

Worldwide, every 40 seconds, one person commits suicide. Since you started to read this article, a couple of people did. Before you will finish reading this article, a few more will be gone.

Suicide is the 10th cause of death in the USA, and it is the second or third cause of death among young people from most Western Countries. Moreover, for every completed suicide, we have about 20 attempts.

In the last 45 years, the suicide rate rose by 60%. The fact in the past suicide was often hidden due to cultural and religious reasons doesn’t explain this all.

Despite all this data, we can’t talk about suicide. We don’t talk about suicide.

In scientific literature, there are plenty of studies about what is called “Werther Effect”. The phenomenon took its name from the famous Goethe’s characters because, after the publication of his book, a rose in suicide was registered due to emulation.

Nevertheless, talking about suicide is not a problem. The real problem is talking about it like something spectacular. It is not a matter of contents, but it is definitely a matter of approach. Often people talk about suicide as a way to get rid of problems. After Robin Williams committed suicide, those from the Academy posted these words on Twitter:

“Now you are free.”

This is the problem.

Robin Williams is not free. He is dead.

He did not get free. He killed himself. And the difference is quite big.

“So, why if talking about it is fine, there is so much going on about Thirteen reasons why?”

Because it is exactly the same: make suicide spectacular is not the right way. It does not matter if the suicide is real or fictional. Celebrities like artists and fictional characters like those from movies and books are both taken as models by entire generations. It does not matter if the person exists or comes out from a script: words and behaviours from that person can deeply impact people, especially young people. Thirteen reasons why is about the suicide of a young high school teenager, and its impact on her acquaintances. A recently published study detected a rose by 28.9% in suicide among young Americans aged between 10 and 17 after the TV series was out. According to experts, the explanation can be found in the spectacular idea of suicide given by the TV series. In the last year, many Italian university students committed suicide. Many journals published articles about those facts well-describing all available details about the dynamic those students used to kill themselves. The World Health Organization published the guidelines to report news about this complicated topic.

1 – While giving info about suicide, always give info about suicide prevention (contacts, numbers, etc);

2 – Never spread around prejudice and myths about suicide;

3 – Never describe a place as “commonly use for suicide” and never give details about the place a person commit suicide, especially if the person was famous.

4 – Always write about how to handle suicidal thought and suicidal ideation, giving info about services for help-seeking;

5 – Never give excessive space and importance about news concerning suicide;

6 – Never use click-bait titles and never use the word suicide in the title;

6 – Never present suicide as an alternative to a problem, avoiding in any way to describe suicide as something spectacular;

7 – Never report explicitly the way used to commit suicide;

8 – Never share photos of the body, neither social media profiles of the person who suicided.

9 – Always use particular attention while talking about the suicide of a famous person;

10 – Always use particular attention while interviewing someone who knew or was somehow related to the person who suicided, because they are at higher risk to self-injure and suicide as well.

Talking about suicide in the wrong way may increase the risk of emulation. But we also know that talking correctly about it may have the opposite effect. A well-done report may become a tool to inform and raise awareness about suicide.

Informing about coping strategies to adverse life-events may protect from suicide. On the opposite side of the Werther’s Effect, we find the so-called “Papageno’s Effect”. The name finds its root in the Magic Flute of Mozart. After the loss of his beloved one, Papageno, close to killing himself, remembers alternatives and takes another path: he chooses life.

In a study published by King’s College in 2014, talking about suicide decreases suicidal ideation both among young people and adults. Asking people if they ever thought about suicide was associated with an improvement in mental health in the long term. These are the facts.

Admitting an experience with suicidal thoughts may be help-seeking. It may be a chance for dialogue, a chance for intervention.

Talking about it may be an effective strategy to free the person experiencing this from such a heavy burden. The problem is not when someone talks about suicide. The problem is when a person should but does not talk about it.

Talking about suicide may be the best thing we can do to avoid suicide to happen.

Fabio Porru

——————————————–

Painting: De-pre-ssion, Eva Charkiewicz (from The Perspective Project)

——————————————–

WHERE YOU CAN FIND HELP:

If you are in an emergency situation, call 118. If you or someone you know is experiencing suicidal thoughts

In the UK, Samaritans can be contacted on 116 123 or emailjo@samaritans.org. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at http://www.befrienders.org.

In Italy, you can call “Telefono Amico” at 199 284 284 every day from 10:00 to 24:00, or Samaritans at 800 86 00 22, or 06 77208977 (from mobile phone) every day, from 13:00 to 22:00.

 

---

BIBLIOGRAPHY:

• WHO, mental health
• Samaritans UK
• Suicidology
• Befrienders
• Bridge et al., Association Between the Release of Netflix’s 13 Reasons Why and Suicide Rates in the United States: An Interrupted Times Series Analysis (2019)

Out of the Closets and into the Streets: un approfondimento sulle teorie di conversione per omosessuali

Sebbene nella maggior parte del mondo non si faccia al giorno d’oggi più alcuna distinzione discriminatoria tra etero e omosessuali, esistono realtà nascoste all’interno delle quali avere un orientamento sessuale diverso dalla tradizionale eterosessualità viene considerato un peccato, una deviazione mentale, una patologia psichica o, addirittura, una distorsione genetica o un reato. Esistono, invero, delle vere e proprie “terapie di conversione”, dette anche “riparative” o “di riorientamento sessuale”, metodi intesi a cambiare l’orientamento sessuale di una persona dall’omosessualità originaria all’eterosessualità, oppure ad eliminare o quantomeno ridurre i suoi desideri e comportamenti omosessuali.
In Italia, così come negli Stati Uniti ed in altri Paesi, questo tipo di terapie sono state categoricamente vietate dall’Ordine professionale nazionale, e ci sono state sanzioni significative nei confronti di vari psicologi che hanno operato nel campo. Non è però così, ad esempio, in Cina, dove sono circa 130 le cliniche che offrono terapie di conversione per “guarire” dall’omosessualità. Tra le strutture che praticano questo tipo di trattamenti ci sono ospedali sia privati che pubblici, rispettivamente controllati e gestiti dalla Commissione nazionale per la salute e dal governo. Alcune delle vittime hanno dichiarato di aver subito, senza consenso orale o scritto, l’elettroshock e di essere state costrette dai medici a ricevere iniezioni, ad assumere pillole e farmaci e a confrontarsi con consulenti (perlopiù religiosi) che avrebbero loro spiegato che essere gay è immorale e nessun genitore potrà mai perdonare un figlio macchiatosi di un peccato tanto disgustoso e grave. In Ecuador, invece, a mettere in atto queste terapie sono circa 200 centri teoricamente specializzati nella riabilitazione di persone alcoliste o con dipendenze da diversi tipi di droghe; ma che in realtà nascondono in cella persone omosessuali costrette a subire sevizie contro la propria volontà (nella maggior parte dei casi sono proprio i genitori a rivolgersi a determinate strutture per far “guarire” i propri figli). I pazienti vengono violentati, sottoposti a percosse e frustate, alienati e costretti all’isolamento. Oltre a dover studiare la Bibbia e dedicarsi alle pulizie del centro, le pazienti donne sono obbligate fin dal risveglio a truccarsi, indossare gonne e tacchi per “imparare ad essere vere donne”. Questo e molto di più ci viene raccontato, tramite il progetto “Untilyouchange”, con l’ausilio di una sequenza di fotografie e didascalie della fotografa Paola Paredes. Paola è una fotografa ecuadoriana, lei stessa omosessuale, che ha sempre dedicato il suo impegno e il suo lavoro alla comunità LGBT, esplorandone, in particolare, gli aspetti del suo stesso Paese. (Qui Untilyouchange ed altri progetti correlati: https://www.paolaparedes.com/).  
Sebbene la maggior parte delle persone che sono state vittime di taluni modelli di terapie riparative abbiano riscontrato traumi a livello psichico e abbiano dovuto affrontare periodi di depressione e diversi disturbi post-traumatici, esistono invece associazioni di matrice religiosa nate negli Stati Uniti intitolate “gruppi di ex-gay”, che hanno lo scopo di dimostrare che sia possibile “guarire” l’omosessualità essenzialmente attraverso la preghiera e la forza di volontà. Gli “ex-gay” sostengono di esser stati omosessuali per un periodo della loro vita e di esser poi completamente guariti grazie alla vicinanza e al supporto di persone “alla pari”, sul modello degli alcolisti anonimi. Per loro l’omosessualità è infatti una devianza, una condizione di disagio mentale, così come la bisessualità e il transgenderismo, considerati condizioni patologiche che possono però essere curate e guarite, o quantomeno represse.
L’impossibilità di classificare scientificamente le teorie dei movimenti degli ex-gay è stata riaffermata dall’Organizzazione mondiale della sanità, che a partire dal 1974 ha riclassificato l’omosessualità da “disturbo” a “variante dell’orientamento”, proprio di fronte all’impossibilità di trovare nelle ricerche scientifiche elementi che supportassero il carattere di “patologia” delle varianti dell’orientamento sessuale.
Pertanto, citando il motto della Queer Nation, una delle tante associazioni attiviste della comunità LGBT, “Out of the Closets and into the Streets“!

Francesca Moreschini