Most scientists now agree that climate change is a critical and urgent issue for humanity and in our personal lives; many of us will already have made changes, whether large or small to tackle this issue. In September 2021, more than 200 health journals worldwide (including the British Medical Journal and The Lancet) published an editorial calling on leaders to take emergency action on climate change and to protect health.1, 2 Within the editorial they acknowledged that health professionals must ‘join in the work to achieve environmentally sustainable health systems’ and recognise that this will mean in our professional life we will also have to make modifications including changing clinical practice.

This year, following on from policy and legislation,3-6 the National Health Service (NHS) Wales launched a Decarbonisation Strategic Delivery Plan (2021) which sets out a framework to meet NHS Wales Net Zero target for 2030 (Figure 1).7 The framework sets out three phases to deliver decarbonisation: “Moving up a gear” (2020–2022), “Well On Our Way” (2022–2026) and “Achieving our goal” (2026–2030). In order to ‘move up a gear’ the Welsh Optometric Committee made a Declaration of Climate Emergency, and a survey was launched to try and understand where we are now.

Timeline of developments of policy drivers relating to climate change.1-7 (Infographic credit: Yasmina Hamdaoui, Pharmacist, Ysbyty Gywnedd Green Group Sustainability in Healthcare, Betsi Cadwaladr University Health Board) WHERE ARE WE AS A PROFESSION NOW?

In August 2021, a Microsoft Office (Microsoft.com) survey, based on one used by ophthalmologists in Australia and New Zealand,8, 9 was adapted for the optometric workforce and sent in an email cascade by Optometry Wales, to optometrists and dispensing opticians in Wales (about 800). It made 10 statements (Figure 2), and asked respondents to strongly agree, agree, remain neutral, disagree, strongly disagree or opt out of reacting. Additionally, there was an optional free text box. Registrants had just one week to complete the snap-shot survey. It received 71 responses and the results of the ten statements can be seen in Figure 2.

Responses to a survey sent to optometrists and dispensing opticians in Wales

The statements “Climate change is a significant issue and action should be taken to mitigate it” and “Climate change due to carbon emission from human activity is an urgent issue” got very high agreement (87% and 85%, respectively). A further 6 statements which received overwhelming agreement and disagreement of less than 10% were: Effects of climate change will adversely impact population health in Wales. Health systems play an important role in contributing towards climate change. Optometry should advocate for healthy public policy around climate change. Optometry should advocate for climate change mitigation and adaptation. Optometry professionals should adjust their practice to be more sustainable. Public health systems should have sustainability as a performance indicator.

There were two statements which caused the most diverse responses and also the most ‘disagree’ responses. These statements were: “Your employer is taking measures to be sustainable” and “Health systems in Wales are taking sufficient measures to be sustainable”. The first, regarding your employer was 29% agreed; 31% neutral and 40% disagreed. The second, regarding health systems as a whole, was 10% agreed; 36% neutral and 54% disagreed.

Free text comments provided by 27% of respondents fell broadly into three groups: suggestions for actions, support requests and urging perspective.

The first and largest group of comments offered suggestions as to what could be done. Typical examples were regarding the use of paper forms and letters:

The amount of paper I go through as a primary care optometrist is ridiculous

Plastic and packaging were also raised as important issues:

There is too much plastic involved in the packaging of almost all contact-lens related products, none of it labelled as to whether it can be recycled. Many plastic bottle products come in cardboard packaging unnecessarily.

Some mentioned the need to make recycling easier:

There should also be recycling available to all staff in staff rooms/dining areas and recycling bins available to businesses without debilitating costs,

The second group of comments wanted to do more, but requested support and guidance to do this, highlighting the paucity of discussion in this area:

I have as one of my CET goals an aim to be more Eco friendly in practice but have failed to find any CET points for which I can tick this box,

This is an important issue that has been apparently absent from healthcare agendas. It is good to see consideration given to the impact of healthcare on emissions and I look forward to seeing developments and guidance regarding how to reduce the impact caused to our climate.

The third group urged perspective on this endeavour to ensure that Optometry's principal aim of delivering primary eye care is not forgotten.

Most carbon dioxide is emitted by China, not optical practices in Wales, this is the most ridiculous survey I have ever taken part in

It's Optometry. Eyes. Not environmental sciences for goodness' sake. Let's use resources responsibly, recognise that some problems have no easy solutions, and seek to take personal responsibility for the choices we make. Short-sighted alarmist kneejerk reactions will do far more damage than sensible progression of our current behaviour.

It could be considered that in a profession with a strong science foundation it is surprising that more than 10% of the optometric profession in Wales did not agree with the statements “Climate change is a significant issue and action should be taken to mitigate it” and “Climate change due to carbon emission from human activity is an urgent issue”. However, this is similar to findings from two other very similar recent surveys of ophthalmologists.8, 9 They found that it tended to be the older members of the profession that responded in this way. This survey didn't ask the age of respondents. However, the free text responses gave a more in-depth view of their thinking and suggested that they may be aware of the complexity of the issue and some cautioning against knee jerk reactions.

WHAT SHOULD WE DO NEXT TO MOVE UP A GEAR?

Overall, the snap-shot survey found that the optometric profession in Wales accepted that anthropogenic climate change exists, is urgent, and will adversely affect the people of Wales. So, to move up a gear we don't first need to change hearts and minds but what should we do?

Highest levels of neutrality or disagreement from the survey respondents were around measures being taken by employers and by health systems in Wales. Therefore, the survey results suggest that the starting challenge is for professional bodies, employers and policy makers to explain what actions should be taken in optometric practice, with priorities and targets, and to support the workforce to adjust their practice to be more sustainable. There is also no doubt that, as suggested by the survey respondents, there may be opportunities in the solutions to also make practices more efficient.

It is good to see that the Association of Dispensing Opticians (ABDO) is already making efforts down this route, and the social, ethical and environmental (SEE) summit in September 2021 and the SEE Hub10 provides examples of what many manufacturing companies and practices are already doing.

However, as survey respondents indicated, there are complexities, and to truly move forward in a way that will benefit the environment we must look at all the associated networks that an optometry practice is linked with. We don't yet understand what the priorities for our profession should be. Should we concentrate on lighting, the carbon footprint of the products we sell, transport to work, reducing paper use or increasing waste recycling? Neither do we understand the full impact of potential solutions. For example, although we think it best to reduce plastic packaging, it provides a clean, light and transportable option for packaging and may end up being the best option for the solutions we use and sell as long as they are not transported using air freight.11

We will need our researchers to work alongside the professional bodies, employers and policy makers to be inventive, to investigate the solutions and to help set priorities. It is heartening to note that some have already started to work in this area and as a result we can be reassured that daily disposable contact lens wearers could recycle 100% of contact lens related waste.12

Optometry as a profession is good at innovation and embracing change and so it is likely that if we all join in the work to achieve environmentally sustainable systems, we can achieve net zero carbon emission practices by 2030. In the process, we may find that this also substantially improves efficiency and the environment for our staff and patients.

AUTHOR CONTRIBUTIONS

Timothy Morgan: Conceptualization (lead); Data curation (lead); Formal analysis (lead); Investigation (lead); Methodology (equal); Project administration (lead); Software (lead); Supervision (supporting); Writing-original draft (equal); Writing-review & editing (supporting). Barbara Ryan: Conceptualization (supporting); Data curation (supporting); Formal analysis (supporting); Investigation (supporting); Methodology (supporting); Project administration (supporting); Software (supporting); Supervision (lead); Writing-original draft (supporting); Writing-review & editing (lead).

Biographies

Tim Morgan is an Optometrist in North Wales. He has recently concluded the Welsh Clinical Leadership Training Fellowship with Health Education and Improvement Wales (HEIW), contributing to contract reform in Wales. This was the first time Clinical Fellowships have been awarded to anyone from the Optometric profession in UK. Explicitly, Tim worked on embedding prevention and well-being into Primary Care, exploring the social and global responsibilities for the profession.

Barbara Ryan is Chair of The Welsh Optometric Committee (WOC), the statutory committee that advises the Welsh Government on matters relating to optometry and to the optometric profession. Barbara works part time in primary care optometry in South East Wales and is a Professor in the School of Optometry and Vision Sciences at Cardiff University where she has responsibility for postgraduate education. In 2019 she was awarded an MBE for her contribution to optometry.

REFERENCES

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