Where to even begin with the challenges we face?

From the climate emergency to declining population health, the challenges facing humanity can seem insurmountable. As a result, many people hesitate on how best to influence others to deliver change or believe they themselves can’t make any discernible difference at all. And yet The BMJ has many recent examples of practical actions that individuals can take to have an impact on these big issues.

There is advice on how the climate emergency can be incorporated into patient consultations, the evidence base for the effects this can have, and the barriers that might face those seeking change (doi:10.1136/bmj-2024-079831).1 We also have an interview with Sarah Benn, the first doctor to face disciplinary action after being jailed for actions relating to climate activism (doi:10.1136/bmj.q1003).2 Benn says that doctors should be leading the way in raising the alarm over the climate crisis and “showing others how you can lead a life that reduces your own impact on the planet.”

There is also advice—in the latest paper from the BMJ Commission on the Future of the NHS—on what individuals can do to halt the decline in population health in the UK. Besides actions that individual health workers can take, the examples include advocacy work, since political and societal commitment is needed to reverse this downward trend (doi:10.1136/bmj-2024-079389).3

The importance of advocacy is highlighted in an editorial about research on the link between ultraprocessed foods and all cause mortality (doi:10.1136/bmj-2023-078476 doi:10.1136/bmj.q793).45 The authors emphasise the need for wider adoption of evidence based interventions around diet and point to WHO’s “best buys” for tackling unhealthy diets. These include reformulation policies, front-of-pack labelling, and advertising restrictions.

And work still needs to be done to identify and review inappropriate use of race or ethnicity as proxies for biological differences in guidelines (doi:10.1136/bmj.q942).6 Many clinical guidelines and risk scores still use ethnicity to guide treatment options, perpetuating the false narrative that people of different races or ethnic groups are inherently biologically different.

For those looking for other actions they can take, Wes Streeting, the shadow health secretary, says that he wants doctors to help shape and write Labour’s 10 year plan for NHS reform (doi:10.1136/bmj.q992).7 “I want to hear from you about the stupid stuff we need to get rid of—the things that waste your time, that waste your patients’ time, and that waste taxpayers’ pounds,” he says.

Nonetheless, for healthcare staff who do seek to advocate for change, numerous challenges lie ahead, not least employers’ reactions. The Hospital Consultants and Specialists Association says that whistleblowers in the NHS are targeted by a systemic employer “playbook” designed to silence or remove them (doi:10.1136/bmj.q998).8 And when the healthcare system hasn’t even managed to develop systems to train and make best use of its left-handed healthcare workers, the scale of the challenge ahead becomes apparent (doi:10.1136/bmj.q933).9

Anyone seeking a metaphor for how small steady progress can lead to big achievements might like to read about how GP Adam Booth helps to maintain his own work-life balance—by climbing Mount Everest (doi:10.1136/bmj.q891).10