How the British Thoracic Society developed its position on the environment, climate change and sustainability

Recognising that climate change can cause and exacerbate diseases such as asthma and lung cancer, the British Thoracic Society (BTS) has been exploring ways to support its respiratory professional members in promoting sustainability in lung health.

BTS recently published its Position Statement on Sustainability and the Environment: Climate Change and Lung Health. The purpose of the documents was to set out the Society’s stance on how respiratory healthcare’s carbon footprint could be assessed, reduced, and mitigated. The Position Statement also clarified the areas where BTS could help shape and influence change. 

Developing our Position Statement 

In 2022, BTS appointed its first Sustainability Trustee, respiratory consultant Dr Laura Jane Smith, who was tasked with developing the Society’s work in this area. This included writing the Position Statement and developing an accompanying action plan. A recruitment call went out to members to join a Task and Finish Group, which subsequently included respiratory consultants, specialty trainees, and a respiratory pharmacist.

At the first meeting, the group decided on a framework to organise the different sections of the Position Statement, choosing headings that followed the Centre for Sustainable Healthcare’s Principles of Sustainable Healthcare. These covered Prevention, Patient Empowerment, Lean Pathways, and Low-Carbon Alternatives. BTS also added additional sections on advocacy, education and training, and roles and responsibilities. 

The sections were divided up for individual members to research, and when this information came back, Dr Smith combined the key points into a longer draft. The group then provided further feedback. 

The Position Statement had the potential to cover a huge number of different themes, but the group chose to focus on the ones where respiratory professionals could make the most impact, such as prevention, tobacco dependency and calling for action on air pollution.

The challenges we faced 

Although the group worked well together, there was a disparity in the amount of information that different members contributed, which made the document sections unbalanced. Also, the first version ran to over fourteen pages, which was too long and detailed. This led to extensive editing work and several further drafts.  

We also had to be careful to maintain a consistent and balanced approach. We wanted to highlight the positive actions that individuals, organisations, and industry could take to protect the environment, acknowledging the climate crisis but avoiding a negative or dictatorial tone.

There was debate about the level of language used. For example, ‘lean pathways’ was highlighted as a term that might be unfamiliar to healthcare professionals. However, as this model is already used by the NHS, and the Position Statement was the first output in a planned suite of educational materials, we decided to keep this in. 

A key section of the Position Statement covered inhalers, as some inhaler types contribute 3% to the NHS’s carbon footprint. It took some time to find the right balance of information needed in this section, as we were mindful that the document was not designed to offer clinical guidance.

Finally, there were challenges in signoff. This had to coincide with the BTS Board, which only met at certain times during the year. Incorporating feedback from a limited consultation with relevant stakeholders added to the delay, with the process taking a year rather than the planned six months to complete. That said, the long signoff process ensured we were confident that the final Position Statement would be useful and reflected the views of our membership.

Our next steps

Since the launch of the Position Statement, we are continuing to promote environmental topics through BTS guidance, podcasts, and conference sessions. 

We are also planning several new activities, including creating a new group to develop a sustainability toolkit, exploring opportunities to partner with other organisations, and identifying ways for our Head Office to become more sustainable. 

Read the BTS Position Statement on Sustainability and the Environment: Climate Change and Lung Health