Writing about sustainability so readers can use it
Writing about sustainability asks a writer to carry clinical research's habits of disclosure, open access and plain language across to climate research, to handle terms whose meaning varies or misleads, to state carbon figures readers can make sense of, to choose what to write about and whom to address, and to frame an environmental threat so that readers can act on it.
Disclosure and open access in climate research
In 2022 the healthcare industry was spearheading initiatives for public disclosure, open access and plain language summaries in biomedical research, and these initiatives were being mirrored in other fields of research, including climate research.
Open access was making headway in biomedical research while climate research lagged behind, and there was an urgent call for open access to environmental research papers as health and environmental crises converge. One argument for it is that open-access research has a greater impact than research behind a paywall: it is read and cited more, other researchers can build on, reproduce, validate or refute it much more easily, and members of the public, educators, clinicians, journalists and policy makers can use it to spread awareness of pressing issues. Electronic Information for Libraries, the Scholarly Publishing and Academic Resources Coalition and Creative Commons started a campaign to increase open access to research on climate science and biodiversity, aiming at a truly global campaign that promotes open access, open science and open data as effective enabling strategies to accelerate progress towards solving the climate crisis and preserving global biodiversity.
In one medical writer's conclusion, knowledge not communicated is knowledge wasted, and transparent communication is of prime importance in any field of research. In the same view, clinical research is paving the way, climate research is playing catch-up but seems to be headed in the right direction, and both fields can learn from each other.
Terms whose meaning varies or misleads
Plain language is vital to communicating with the public, and in 2022 the healthcare industry was leading in it. The 2021 report of the UN Intergovernmental Panel on Climate Change was criticised for using complex and highly technical terminology. A study that interviewed members of the general public found that common climate change terms, as listed in the panel's glossary, were fraught with confusion and misinterpretation among the climate-concerned, the ambivalent and climate change doubters alike. The study proposed strategies for communicating climate change in plain language, among them the following.
- Mitigation. Defined as a human intervention to reduce emissions or enhance the sinks of greenhouse gases. Suggested as "policies that reduce emissions to stop climate change (from getting worse)"; references to specific climate change actions or policies should reduce confusion with other contexts, in which mitigation may mean something different.
- Carbon neutral. Achieved when anthropogenic carbon dioxide emissions are balanced globally by anthropogenic carbon dioxide removals over a specified period, and also referred to as net-zero carbon dioxide emission. Spelling out "carbon dioxide" may avoid confusion about the type of carbon involved, and referring to "no net increases in carbon dioxide in the air" or to "balance out the carbon dioxide we put into the air" may help to avoid confusion with "zero carbon"; to clarify the process, these descriptions may need to include examples of carbon dioxide removal.
- Unprecedented transition. A transition is the process of changing from one state to another in a given period of time; it can involve individuals, firms, cities, regions and nations, and can be based on incremental or transformative change. No definition of "unprecedented" transition is available. Suggested as "making big changes together to stop climate change", with examples specifying which big changes are required.
- Tipping point. A level of change in system properties beyond which a system reorganises, often abruptly, and does not return to its initial state even if the drivers of the change are abated; for the climate system, a critical threshold at which global or regional climate changes from one stable state to another. The findings suggest a need for descriptions that highlight the connection with climate change, the seriousness of the issue and the role of cascading effects in the climate system; this may include a phrase such as "point at which we can no longer undo climate change (and its effects on…)" or "when it is too late to stop climate change (and its effects on…)", with specific examples.
The terms for balancing and reducing emissions, such as carbon neutral, net zero and real zero, are complicated, often confusing and ambiguous, in the view of one researcher on the carbon footprint of the pharmaceutical supply chain, and for that reason she holds that communicating these issues is crucial and getting the language right is really important.
In 2011 "green medicine" was called a movement, and its meaning depended on the article: integrative medicine, "natural" medicine with plenty of herbs, or, in one holistic medicine practitioner's account, a stretching of the boundary beyond its environmental connotation to include what lies beyond physical medicine, so that the physical, mental, emotional, environmental, energetic, psychic and spiritual aspects of human experience become equally important to health and healing.
Carbon figures readers can make sense of
An advertisement for rail travel across Europe in a free Swiss commuter magazine, competing with car and air travel, showed no price and advertised instead 2.4 kilograms of carbon dioxide per 100 kilometres. In 2020, in the view of a speaker trained in carbon accounting, some people had a feeling for what that figure means and why it is better than car or air travel, but many had no idea yet. To him the advertisement showed that carbon dioxide was now being pushed even in everyday life.
The writer's part in communicating sustainability
Medical communications sits in a good position, in the view of the same researcher on the pharmaceutical supply chain, because its practitioners know how to communicate and communicating sustainability can sometimes be really challenging. She would like to see the communications community take a leading role in translating complex scientific, climate and environmental topics into easy terms for people to understand, within the context of pharmaceuticals and healthcare.
Medical writers are better placed to be agents of change, in the view of a South African professor of public and environmental health, and they should bring sustainability to the fore in whatever pieces or articles they write.
Subjects to write about
The professor names several subjects for medical writers: the climate change and healthcare strategies that countries in Africa and across the globe have developed, and how those countries deal with healthcare and climate change; the role of artificial intelligence and digitisation in decarbonising healthcare systems, such as telemedicine in place of visits; how to assess water usage; the technologies being used to solve problems in healthcare, such as an MRI scanner one manufacturer has developed; and the stories of those doing good in healthcare. He also asks how the massive deployment of artificial intelligence will affect the carbon footprint of healthcare, through its electricity use among other things, and holds that this should be assessed by life-cycle assessment and the results published so that people understand what is happening.
The people and stakeholders to address
A writer should write in a way directly linked to the individuals or groups concerned, in the professor's view, so that they understand it and change their behaviour; the aim, he holds, is not only to share information but also to see how the information shared affects sustainability.
Achieving sustainable health services, he holds, requires coordinated action from various stakeholders, among them academia, the public and private sectors and civil society, and medical writers working in this space need to be mindful of them. Writers should call on academia and research institutions to integrate sustainable health concepts into training, to restructure education so that students work with communities to solve the challenges, to expand research to address evidence gaps, and to create sustainability-friendly innovations and technologies. They should call on the public sector to use the knowledge that academia and research institutions have developed in its policies and programmes, and to create relevant policies, coordination mechanisms and data management systems for tracking progress towards sustainable health. They should call on the private sector to adopt sustainable practices in its operations, to invest in sustainability-focused solutions and to create businesses that directly address health, environmental and social challenges. They should call on civil society to lead advocacy for sustainable health, because the voice of society is very important and powerful. Civil society, in his view, must also evaluate whether healthcare facilities and industries adhere to sustainability principles, and call on communities to take an active role in demanding commitment and accountability from all stakeholders, including for new projects through public participation, which in South Africa is part of every project. Medical writers, in his view, are better placed to interact with every stakeholder, and they must lead the way in ensuring that all sectors integrate sustainability into their work.
Reaching a community
Reaching a community follows a set process, in the experience of the professor, whose university sends its students to various areas of South Africa, in most cases to rural villages. The country has about 11 official languages, so a visitor who does not understand them meets a problem, and villagers do not like to be addressed in English. Entering a village starts with the traditional council: a visitor presents themselves, having first been taught how, wears something on top, and does not sit wherever they like. A message goes through a gatekeeper, the chief's own person, rather than to the chief directly, and a campaign goes through the chief, the municipality and the district management team so that they prepare the platform for it; otherwise it becomes a problem. When his group put up a solar-powered water purification system in one village, it invited other chiefs around to the launch, so that people understood the system and protected it.
Different ethnic groups in Africa subscribe to different cultural norms and belief systems, and in the professor's view a messaging strategy, the way a message is crafted and how it is presented to various people must take note of them. Medical writers in Europe, the US and Africa, he holds, must collaborate to share this information and teach others how such things are presented, so that an intervention or a message is accepted. Information that people cannot understand or make sense of, he holds, becomes useless for those providing it.
Framing an environmental threat
Writing about the environment and health mostly presents the environment as a source of threats, of bad air, too much heat, too many pathogens and too many pollutants, rather than as the foundation of health, in one practitioner's view in 2026.
In a small town on the west coast of Vancouver Island, whose community-based aquarium depends on the health of the harbour, talking about cleaning and dealing with the harbour left people divided, in conflict and pointing fingers. A healthy-harbour programme started differently, by asking the community what they love about the harbour and what they value and want to protect, maintain and sustain. Behind it lies a principle the practitioner takes from sociology or psychology: people will work harder to protect what they value than to avoid what they fear. Finding what people share and love together, he holds, increases their desire to work together, so that the work is about collaboration rather than blame.
The same practitioner calls for empowerment, not just education or convincing. Empowerment means knowing what to do, understanding why it matters, feeling able to do it and seeing the value in doing it. A project in the Caribbean that set out to empower a new cohort of early-career professionals to advocate and make change in climate change and health mostly helped them understand and feel confident that they could do something, and he calls it an empowerment programme rather than an education programme.
He holds that the opposite of catastrophe is optimism, that people should be made optimistic rather than hopeful, and that optimism is hope plus possibility. His son once questioned whether older people are more scared than the young: his generation had grown up with 24-hour news and the internet, had seen only the problems and never stories of the solutions, and so had some hope but was not optimistic. Changing that narrative to build optimism, the practitioner holds, is a key to empowerment. The most important thing medical writers could do, in his view, is create the message of possibility and of the need for disruption, and highlight the changes being made so that young people feel the work is worth pursuing; otherwise the profession will spend most of its time documenting demise in better and better detail.