Knowledge, Attitude, andPractice of Physicians inJapan on Climate Changeand HealthNiaya Harper Igarashi
D2 – International Cooperation for Medical Education
February 14, 2023

BACKGROUND

(IPCC 6th Assessment Report, 2021)

(Watts, et al., 2015)

Number of heat stroke deaths in Japan(MHLW, Vital Statistics, 2022)

The World Health Organization (WHO) named climatechange the biggest health threat facing humanity.
The consequences of climate change directly affecthuman health, the practice of medicine, and the stabilityof healthcare systems.
Climate change disproportionately impacts vulnerable
populations (i.e., elderly, children, LMICs, etc.)(WHO)Literature Review

Literature Review

What are the views of physicians in Japan?

Objective: assess the knowledge, attitude, and practice (KAP) of physicians inJapan toward climate change and health, their willingness to provide climatespecific advice to patients, and their advocacy for more sustainable healthcare
practices and climate change policy.

Methods
A cross-sectional study using a web-based self-administeredquestionnaire (32 items).
•••

Licensed physicians who are actively engaged in clinical practice in Japan
Data collected through PLAMED a medical research platform (Nov. 21-27,2023)
An incentive of 100 PLAMED pts (1pt = 1 JPY) was provided

Variables of interest•••••Knowledge of climate change
Awareness of climate change and its impact on human healthParticipation in delivering climate-specific advice to patients
Advocacy on sustainable healthcare and climate change policy
Demographic characteristics

RESULTSSociodemographic characteristics of the physicians
Table 1: Sociodemographic characteristics of the physicians
Total(n=1,100)

Characteristics
nThere were 1,100 physicians
included and analyzed in thisstudy.
••••

Mean age 51.2
86.5% male
53.7% practice in hospitals
Most represented field wasinternal medicine (16.1%)• 64.9% working 20yrs +Age mean (SD)20-30s40-50s60-70s80-90sGenderFemale
Male
Non-binary
Declined to respond
Field of practice (top 6 out of 42)
Internal medicine
Gastroenterology
Psychiatry
Orthopedics/Plastic Surgery
Pediatrics
Cardiology
Facility where practicing
Medical clinic
Hospital (excluding hospitals affiliated withmedical schools)
Other facility type
Years working as a physician
1 to 9 years
10 to 19 years
20 years or more%
51.2 (SD11.9)
212
19.3
571
51.9
313
28.5
40.4
133
952
141

12.1
86.5
1.3
0.1

177
88
88
71
58
57

16.1
8.0
8.0
6.5
5.3
5.2

385

35.0

591
124

53.7
11.3

107
279
714

9.7
25.4
64.9

Knowledge of climate change
Number ofcorrect
answers

Percent (%)

521

47.4

374

34.0

Which health outcome in Japan wasclassified as high importance due tothe impact from climate change?

306

27.8

What percentage is Japan's
healthcare sector's climate footprint?

272

24.7

Knowledge itemsHow do you think climate change ismainly caused?

Without any intervention to reduce
GHG emissions, over the next 20
years the global temperature isexpected to reach or exceed how
many degrees of warming?

Awareness of climate change and its impact on humanhealth• 78.1% of physicians perceive climate change is impacting people's health inJapan, with 51.4% recognizing this impact among their patients.

Heat-related illness
Cold-related illness
Respiratory illness
Arthropod-borne diseases
Water-borne infectious
diseaseFood-borne infectious
diseaseAnxiety, depression, or othermental health conditions
Physical harm and/or injury
from extreme weather events
Undernutrition

Participation in delivering climate-specific advice topatients

Agree
56.7%

Agree
59.7%

Participation in delivering climate-specific advice topatients
33.2%

36.9%

32.6%

Barriers to engagement in delivering climate-specificadvice to patients

Barriers to engagement in delivering climate-specificadvice to patients

Advocacy on sustainable healthcare and climate change
policy

Agree
57.5%

• 73.9% would personally consider participating in advocacy• 68.8% of physicians want more environmentally sustainable options

Advocacy on sustainable healthcare and climate change
policy
79.9%

37.5%

• 96.6% are unaware of any climate change-related initiatives or
advocacy within the medical associations they are a part of.

DISCUSSION

Physicians have insufficient knowledge about climatechangeØ The data suggests that physicians have insufficient knowledge of climate change, previousstudies conducted among physicians in other countries had similar findings, that lack ofknowledge impeded physicians from engaging in more climate-related initiatives. (Kotcher etal.,2021)
Although physicians recognize the need to advise patients on the links between climatechange and their health, they may feel averse to doing so due to insufficient knowledge.
Ø A study conducted in Thailand showed that physicians’ knowledge of the links between theecosystem and health is significantly associated with whether or not physicians give advice
to their patients on how to reduce environmental health risks and increase exposure to morepositive environmental factors. (Volker et al., 2022)

There is limited access to education on climate changeand healthAs adverse health impacts of climate change are expected to become more severe overthe coming years, physicians must be sufficiently knowledgeable to assume greater
responsibility for patients and public education.
Ø A German study showed that patients who were informed by physicians about the links
between climate change and health had a higher awareness of climate-related health risks
and were more willing to engage in more environmentally sustainable lifestyle choices.
(Reismann et al., 2021)

Healthcare facilities lack environmentally sustainable
healthcare practices
Ø According to a policy paper by Health Care Without Harm, the climate footprint of Japan’s
healthcare sector as a percentage of national emissions is 6.4%, placing the nation among
the top major emitters by healthcare sector.
More than half of the physicians in this study responded that the facilities where theywork, do not support sustainable healthcare practices.
Ø Greening the healthcare sector has been a growing trend; for example, in England, the NHS
England's 2020 strategy outlines a plan for "Delivering a Net Zero National Health Service”.

Physicians are willing to engage in advocating for climatespecific policy changesØ More than half of the physicians feel they should advocate within their facilities to promote
mitigation measures for more sustainable healthcare practices, but less than half actively
engage in any advocacy.
Despite the physicians’ high level of interest in engaging in advocacy on climate-specificissues, only 3.4% responded that they were aware of any climate-related initiatives oradvocacy opportunities within the professional associations they are a part of.
Ø A multinational study showed that affective issue involvement has a strong positive
association with the perception that climate advocacy is the responsibility of healthprofessionals, which in turn has a strong positive association with willingness to advocate.
(Lee et al., 2021)

CONCLUSION

Conclusion•

The climate crisis must be aggressively and quickly addressed at all societal
levels to mitigate its effects.

•Physicians are uniquely positioned and committed to participating at various
levels in efforts to combat climate change, but they will need to be better
equipped with the knowledge, materials, and support to do so.

•Future research could look at longitudinal studies of sustainable behavior
change in patients in Japan who have been given climate-specific advice by
their physicians.

THANK YOU!

32

APPENDIX

Medical associations

How do we address climate change?

(Image: Calgary
Climate ChangeProgram)Potentialhealthco-benefits
thoughmitigation(Future Earth, The EarthLeague, WCRP, 2021)

Source:https://www.nejm.org/action/showMediaPlayer?doi=10.1056%2FNEJMdo005586&aid=10.1056%2FNEJMp1906035&area=

What are health professionals saying about climatechange?