‘A new world of possibilities’: Climate change and its impacts on health

My name is Emma Iovoli and I'm a medical doctor by background. I completed a PhD in respiratory medicine and also a medical degree at the University of Manchester, what seems like a really long time ago. After that, I made my way into the pharma industry, where I've had several different medical director roles. I've worked at a global level with markets all over the world to launch new medicines. I've also worked within the European region. And my most recent job within the pharmaceutical industry was as the medical Head of Global Health at GlaxoSmithKline (GSK). So my background is medical academic, a corporate leader - so I have got quite a diverse background and experience.

I first discovered systems change when I was working as the medical Head of Global Health at GSK. I was being tasked with a project - a planetary health project - to understand the links between climate change, loss of biodiversity and other environmental problems and how that was impacting on human health. I started working with Forum for the Future who introduced me to this whole world of systems change. We applied some systems change tools to the challenges of our project and I found it to be incredibly helpful.

I personally feel like I’m a systems change thinker naturally. But because I'm a scientist by background, and because I've been trained in academic science, I've trained myself to think about mechanisms and details, to think about things in a very linear way. But when I came across systems change for the first time, it really expanded my mindset to understand that there are different ways of thinking, different ways of approaching problems, complementary ways.

It was a bit of a relief that I was able to put words to something which I was intuitively already doing, and that there were tools there that can help me to really harness that particular approach to thinking about solving big and complex problems. From there, I decided to do the Delta programme, which I did earlier this year, which was also immensely helpful to some of the work that I've been doing. And then my systems change journey was launched.

I learned an enormous amount from the Delta experience. One of the things that was particularly helpful was - alongside the regular workshops that we had as a team - I had one-to-one coaching sessions. It was really for me during those one-to-one coaching sessions where I had the time to process all of the new information that we were learning together as a group, and reflect on that new information and how I was going to be applying it to my particular challenge. There were so many different things that I came out with, but I've come down on two important ones that I think have really transformed the way I think about the challenge.

One is (because I'm working within the pharmaceutical industry and seeing the pharmaceutical industry as a kind of whole system) recognising that there's already a lot that's going on within the industry to tackle this problem of climate change because of its impact on human health - that being particularly important for an industry which is focusing on improving health. We're really starting to see the industry focusing on finding manufacturing efficiencies, or transitioning to clean energy or looking at the whole supply chain and finding quick wins to reduce carbon impact. But in order to accelerate that impact, the next stage inevitably means scaling up the efforts. And that means broader engagement across the business. Doing the big systems mapping exercises through the Delta programme really helped me to understand that companies might actually not yet know what's the most efficient and effective approach to begin to scale up their efforts on climate and health action. And so that could be a barrier that's worth bearing in mind.

The second key learning was that the source of the project's potential to regenerate the system doesn't actually lie within the project itself. It lies in the project's relationship to the larger system in which it's nested. So for me, I'm working with medical doctors, medical affairs leaders, who work within the pharmaceutical industry. But the potential to create change doesn't necessarily lie just within those medical affairs teams within industry. It lies with the change that can happen within the industry overall, and then broader than that out to the entire health care system. So just understanding how the work I'm doing in a very focused and very particular area can have knock-on impacts more broadly across wider systems, and then understanding that bigger picture, really helps orientate me and creates a real sense of purpose as well for me in the work that I'm doing.

There's two areas at the moment that I'm working on simultaneously. Half of my work at the moment is really thinking about how can I persuade business leaders, particularly medical affairs leaders, working within the pharmaceutical industry that this whole topic of climate change and its impacts on human health is business critical? And I believe it is business critical, but it's trying to convey that in a way that makes sense to medical affairs leaders who are really, really busy, they've got multiple priorities, are under enormous amounts of pressure, organisations are constantly changing, they can often be working in toxic and difficult environments. So for me to come in and try and throw another priority at them is very difficult to do.

So it's trying to be thoughtful about what's the best way to persuade these medical leaders that it's going to make their life easier in fact, if they start to take a hold of some of these challenges that we're facing in climate and health. That it will not only lead to business impact, but also patient impacts and that’s what our entire purpose and reason to work within the industry is linked to. So there's a whole persuasion piece working across industry to set the leadership agenda and make sure that climate and health is high up there on the priority list. So that's one half of the work.

The other half of the work is thinking for companies who have already done a lot of thinking in this space: what's the best way that I or others could help them to scale up their efforts to find what are the things that they're doing that are working really, really well? How can those be scaled up as quickly as possible? And how do you create consistency across an organisation in terms of understanding, not only understanding the science of climate change and its impacts on health, but why it's relevant to them and their role? And what are the key activities that they could undertake that would make the biggest difference? So that we're not losing energy anywhere in the system, but we're really focusing on the changes that matter. So half of it’s persuasion and half of it’s really around scaling up and being efficient and effective in that scale-up process.

Medical doctors working in industry have got a really important role to play in this broader system change which is happening right now. We're starting to really think about health differently. In the past, climate change has really been thought about as an isolated environmental issue. And whilst it's a good thing to protect the environment, it's always been this kind of seen as a separate entity and itself. Something that's good to do but something that is other than from what we're working on within health care. Now there is a growing recognition that that is just not true. That unless we have a healthy environment, we will never have healthy people. And therefore, if we're working within the health care sector as medical doctors, our role and our remit and our understanding of health is really getting much broader. That's quite a big paradigm shift for medical doctors to start to get their head around.

But when I'd describe it as a penny drop moment - when you start to recognise how important the environment is to broader health care considerations - then it opens up almost a new world of possibilities. So that's where it can seem a bit overwhelming, because all of a sudden you're opening the door to this much more complex system of health care. It's very hard sometimes to know, where do I even start? What can happen is that people just want to close the door again because it's too much. So I think if we're going to be helping medical doctors to open that door, then we also have to help them to understand, where do they start? How do they navigate this complexity? And what does it really mean for them in their day-to-day job? I think that's where systems change can really come in and it can really help. I don't think everyone needs to be a systems change expert. But I think there's a lot of the tools that come from the systems change field that can be applied and can be used to help medical doctors to navigate that complexity. And we can certainly turn to those experts to help us to do that.

The first time I tried doing some systems mapping, I must admit, I did start to feel a little bit overwhelmed at times. Because once you start to kind of map out this complexity, and realise how big it can grow, then it can feel a little bit overwhelming - especially at the beginning. But after a while, I just started to accept the complexity, and recognise that there was absolutely no way that I would ever be able to understand all of it completely. And so I think just letting go of that need to break everything down into its component parts and really understand exactly why something's happening, and just allowing this big picture to kind of form.

And then just looking out for the patterns within that bigger picture. What are the patterns that seem to be repeating themselves or that seem to be particularly important? What is it that draws your eye? What is it that you get curious about? Are there bits of the system where you can see that there's a lot of connectivity going on and so you kind of get a sense for 'there's something going on over here, maybe this is an intervention point that might make a difference'.

And then just test out things, just get curious. Test out hypotheses that you think ‘maybe if I did this, it would help this over here’. You can just test these things out  recognising that no one has a perfect view of everything. There's no right answer at the end of the day. And it's okay if something doesn't work. And so I think more than anything, letting go of that need for perfection, need for complete understanding, and just accept that the complexity is there. And it's unlikely I'm ever going to understand, even like the majority of it.

The key questions that have emerged are how to disband some of the myths that have occurred around climate change and human health, and to create language which is very business-oriented and doesn't perpetuate those myths or those misunderstandings. So that in a very clear-headed way, we can help people to almost look at this problem again with fresh eyes, and let go of all that baggage that they might be bringing with them and all those misperceptions or perhaps false ideas, and seeing this for the business opportunity that it actually is. So I think that question is something which I'm constantly thinking about, and trying to refine my approach to this persuasion narrative based on data, but also building a story which people can relate to and can understand that there's a vision at the end of this that others would buy into. So I'm definitely playing around with that.

And then this other question, which I've mentioned already around how to help pharmaceutical businesses scale up engagement and education in this space. What's going to be the most efficient and effective use of everyone's time to drive the right kinds of interventions? Those are the two things that I'm continuing to focus on.

If anyone wants to contact me or connect with me, then they can do that through LinkedIn or by email [via Emma’s website]. I'm especially keen to hear from anybody who's working within the pharmaceutical industry, especially medical affairs leaders, and anyone is welcome to ask me about the health impacts of climate change, why it matters to the pharmaceutical business, and what medical leaders can do about it.