1st November 2023
For three years the UK Health Alliance on Climate Change has coordinated the publication of the same editorial on climate change and health in over 200 health journals from around the world. Working on this project, we developed the impression that many health journals had previously published nothing on climate change—despite both WHO and the Lancet declaring climate change the major threat to global health. Seven of us decided to conduct a study to test whether our impression was right, and we also wanted to see whether the joint editorial encouraged the journals to publish more on climate change and health. Our results have just been published.
Climate change from rising carbon dioxide levels was predicted as long ago as the late 19th century, and in 1988 the head of the NASA Goddard Institute for Space Studies told a US Senate Committee: “The greenhouse effect has been detected, and it is changing our climate now.” Margaret Thatcher, the British prime minister, made a speech on climate change to the United Nations General Assembly in 1989 and called for a convention on global climate change. WHO published its first report on climate change and health in 1990. The first Earth Summit was held in Rio de Janeiro in 1992.
Our study searched a sample of 330 health journals that included major journals and many that had published the joint editorials for articles on climate change and health. Two independent raters confirmed whether the articles were about climate change with a third rater resolving any disagreements. We found 2932 eligible articles.
We confirmed what previous studies had shown that a smattering of articles on climate change and health were published in a few journals in the early 1990s and that there was a rapid, almost exponential, increase, from the early 2000s. Previous studies had looked only at articles, but we looked at journals too and confirmed our impression that despite climate change being the major threat to global health many health journals had published little or nothing on the subject.
Roughly a quarter of the journals had by 2022 published nothing on the topic and almost three quarters had published five or fewer articles. If the joint editorials published were excluded then almost a third of the journals would have published no articles on climate change and health by 2022.
Three journals (The BMJ, Lancet Planetary Health, and Lancet), all based in Britain, published almost a third of the articles, and ten journals, all in English, published almost half. The leading British general journals (Lancet and The BMJ) published 605 articles whereas the two leading general journals based in the US (NEJM and JAMA) published 83. We did not have data on the country of the authors of the articles, but others have shown that most articles and research studies come from high-income countries despite the harm to health being greatest in low income countries.
Our study doesn’t answer the question of why many journals have published little or nothing, but we can speculate. One possible answer is that almost everybody has been slow: emissions of greenhouse gases are still rising, and this year’s annual UN meeting on climate change (COP) will feature health in the main agenda for the first time. Another reason may be that the subject is “too political,” and many journals are nervous of being accused of being political. That the US journals have published less than the British journals supports this speculation as climate change has been more of a party political issue in the US.
Some of the journals in our sample are specialist journals and may have felt that climate change and health was not a suitable subject for a journal dealing with a specialist area of health—perhaps, for example, ophthalmology or orthopaedics. The comparatively recent recognition that to mitigate climate change health systems will have to decarbonise will, however, change this as each speciality with have to work out how to decarbonise.
We are not sure of the type of articles we studied, but fewer than half had abstracts, making it unlikely that they were research articles—and we know from other studies and from experience that there has until recently been little funding for research on health aspects of climate change. More than half of the articles we identified were editorials, news, letters, comments, and educational articles, and many health journals publish mainly research articles, meaning they had little chance to publish on climate change and health.
A related reason for many journals publishing little may be that many journals commission few articles. They must wait for material to be submitted. Even if they did have a budget for commissioning material, many health editors would not know whom to ask to write on the subject: there have been, and still are, few authorities on climate change and health.
On the question of whether the joint editorial encouraged journals to publish on climate change and health, we found that of the 112 journals in our sample that published at least one of the editorials 32 were publishing on the topic for the first time. Yet publishing the joint editorial as their first article on climate change has so far had little impact on encouraging the journals to publish more: of the 18 journals that published the first joint editorial as their first article on climate change, only eight published at least one more article on the topic and six of these eight simply published the second joint editorial.
Articles on climate change and health in health journals are increasing, a trend that is likely to continue because of growing global concern about the seriousness of the climate crisis and the recognition of the need for decarbonising health care. Many journals seem willing to publish articles on climate change and health but lack the capacity to commission such articles. This finding supports a proposal to establish a consortium that would both lead the publishing of the joint editorials on the subject and commission and share articles with the many journals that lack the capacity to commission articles themselves. In this way material on the crucially important subject of climate change and health could reach many more health professionals.
Competing interest: RS is the chair of the UK Health Alliance on Climate Change and has worked on all three editorials published in multiple journals. He was also an editor at the BMJ from 1979 to 2004 and editor in chief and chief executive of the BMJ Publishing Group from 1991 to 2004. He wrote some of the early articles on climate change in the BMJ. The other six authors of the study have also been associated with the BMJ, UKHACC, or both, as is declared in the conflict of interest statement.