Dr. Alice McGushin, Programme Manager, Lancet Countdown
/Three pieces of advice:
Apart from having the ambition, education is also really important. My role requires a postgraduate degree: a masters at a minimum or ideally a PhD.
Don’t be afraid of not knowing what you want to do, or if that exists yet as a job. This job didn't exist when I graduated from medical school.
Don’t be afraid to be assertive and take risks, especially if you’re young and have the time. The worst that could happen is you end up spending a year or two not working in your field of interest, but it all contributes to your knowledge, your experience, your expertise, and it is a step towards what you want to do.
“Running is essential for my Mental Health, as a stress reliever to clear my head and focus on something not related to work, whether it’s listening to a podcast, audio book, focusing on a race or just running without any distractions. It also helps me with goal setting outside of work, like running a certain time or distance or competing in a race. It’s great to shift your focus and continue achieving if another aspect of life isn’t going to plan. I developed the discipline throughout medical school, getting up each morning or training in the evening, and it’s become a daily habit for me over the course of several years where I now run most days.”
CV in brief
Education: Bachelor of Medicine and Surgery and Bachelor of Medical Science (Honours) at University of Tasmania, MSc in Public Health at LSHTM
Career so far: World Health Organization, Royal Perth Hospital, The Lancet Countdown on Health and Climate Change while serving as a Vice Chair for the WONCA Working Party For The Environment and a Senior House Officer in emergency at Bluecross Locums
Date of interview November 2019
Interviewer Martha Bowler
You started off your career with an internship at the World Health Organization. What did you take away from that experience, especially in relation to climate change?
The World Health Organization (WHO) is the peak body and voice for health. It raises awareness of the health effects of climate change and of air pollution and it works with Ministries of Health from all Member States to develop plans and actions for health adaptation to climate change.
In addition, although the WHO recognises climate change as one of the greatest health challenges of our time, it is also addressing everything else (disease outbreaks like the COVID-19 pandemic, universal health coverage etc). As it is responsive to its Member States, it is challenging for it to move as quickly or speak as forcefully on the health effects of climate change.
Did you plan to start a career in climate change while you were in medical school?
Not when I started medical school, but I did start with a strong interest in Global Health and a strong feeling of social responsibility. I grew up in an area of Tasmania which has experienced substantial environmental damage due to mining. It also holds incredible natural beauty such as the largest expanse of temperate rainforest in Australia. Before medical school, I had done high school projects on climate change, which I was very interested in. I realised the connection between my two areas of interest when I read the 2009 quote by the Lancet Commission: “Climate Change is the biggest global health threat of the 21st century”. That flipped a switch for me.
I ended up spending as much time reading up on climate change as I did studying medicine. When I finished medical school, I knew I was passionate about climate change and that I was going to pursue it to some degree. The two Lancet Commissions on Health and Climate Change bookended my medical school as I saw 2009 at the start of my degree and 2015 a few months before I graduated. After finishing my internship (F1 and F2 in the UK), I decided to study an MSc in Public Health at the London School of Hygiene and Tropical Medicine. At the same time, I started talking to Nick Watts (executive director of the Lancet Countdown) and becoming more involved with the collaboration, which publishes an annual report in the medical journal, The Lancet, tracking progress on health and climate change.
Could you describe what your current role as Programme Manager at the Lancet Countdown on Health and Climate Change involves?
I help bring together the academic work of authors from 35 different United Nations and academic institutions and compile these works into five different sections for publication in the Lancet Countdown annual indicator report. Our work also includes other academic outputs, such as case studies looking at regional and national implications of the response to the health impacts of climate change. We are currently working on a series of articles that look at relationships between health, net zero emissions and the Nationally Determined Contributions to the Paris Agreement.
How do you select experts to include in the Lancet Countdown reports?
At the Lancet Countdown, we are always looking to expand and improve our work, and this usually comes with the development of new indicators. Academics in health and climate change who wish to be involved in the reports will sometimes approach us. We support them in developing new indicators that fill important research and policy gaps in our current suite of indicators, for example, by looking at the impact of climate change on migration and its subsequent health effects. At the same time, as we identify indicator gaps, we reach out to particular experts with whom we collaborate to develop new ones specific for those areas. This includes professionals with a wide range of expertise, from the more traditional public health areas such as epidemiology and medicine, to energy experts, climatologists, political scientists, social scientists and engineers.
What do the Lancet Countdown policy briefs look like?
Contrary to our report where almost all our data is global, we disaggregate the data to the country level for indicators of most relevant in the particular contexts. For policy briefs, we partner with local health professional organisations and colleges to put together a four-page brief, which includes a series of recommendations specific to their national context. These can be found on the Lancet Countdown website.
I am aware that you were involved in the 2018 Lancet Countdown report launch. How have you found gender representation and responsivity to have evolved?
We have definitely progressed in terms of addressing the gender gaps in our team. Our central team includes several incredible women. They provide a range of expertise and experience, ranging from data science, to health impacts and health adaptation, to communications, operations and policy. This year we have also set up Lancet Countdown Regional Centres in Asia and South America. These Regional Centres are led by Wenjia Cai and Stella Hartinger, respectively, both excellent academics and leaders.
In addition to our central team we have new female authors contributing to the 2019 and 2020 reports. For example, Carole Dalin and Ruth Quinn are looking at agricultural greenhouse gas emissions, and Jodi Sherman is looking at healthcare sector emissions from the perspective of an anaesthetist in Connecticut. Zhao Liu, from our Regional Centre for Asia authors our new heat-related mortality indicator and Celia McMichael authors our new sea-level rise and migration indicator.
Listening to “Invisible Women” on audiobook while running in lockdown, I became fairly enraged at the lack of data on women across all sectors. In 2020 we don’t have gender-specific data in our indicators, but we are making a concerted effort to change this.
We have been challenged by The Lancet’s Diversity Board to more systematically address inequalities of gender and other social inequalities within our research. What this means is we are going through each of our existing indicators and identifying those where gender is relevant and seeking data that would allow us to report these links. Where the data should exist but doesn’t, we will explore additional research articles beyond the indicator report. Gender may not appear as its own indicator within the report but would rather be considered across all indicators. We’re actually holding our annual Lancet Countdown meeting via Zoom over the 10th and 11th of September 2020 and this will be one of the key topics discussed by participants across all five of our Working Groups.
What do you think a gender-responsive approach to climate change would look like?
This relates to the gender disparities and vulnerabilities to climate change. Women, in a lot of different contexts, are more vulnerable to the impacts of climate change on health. In our work, that would involve developing a gender-specific vulnerability indicator and looking at how it interplays with different climate change health exposure pathways. Comparing different regions is also really important in making sure that adaptation measures involve gender aspects and address vulnerabilities and the health inequities. Women are also crucial in leading the response to climate change, both in adaptation and mitigation. More diversity in leadership helps ensure that actions are taken in all of society’s best interest.
There seems to be an equal number of men and women speaking at the launches. Was this a priority for you?
From the inception of the Lancet Countdown, there have been efforts to achieve equal gender representation. The Lancet is particularly proactive in this area, specifically, there are policy guidelines of having at least 50% women presenting at their events and they expect us to follow this too. Despite this, we're not quite there. I guess that is related to a number of different things in terms of previous structural disparities and who is in particular positions, but we're working really hard together.
How has the Lancet Countdown helped to shape policies around climate change worldwide?
National government responsiveness varies from country to country. For example, in the UK, following the 2015 Commission Report, we met with different All-Party Parliamentary Groups (APPGs) for both Health and Climate Change, which culminated in a debate within the House of Lords. Additionally, following the launch of our 2019 report, NHS England approached us to work with them to develop a roadmap to achieve net zero emissions. This is pretty huge as NHS England is the biggest single health system in the world and the third largest employer in Europe.
In the Netherlands, alongside the release of the Dutch briefing for policymakers last year, there was the formation of a Government Committee on Health and Climate Change.
In Canada, all the policies on climate change have involved the health community. For example, when they announced the Powering Past Coal Alliance at COP 2023, they chose our lead policymaker briefs author, Courtney Howard to speak about the health effects of air pollution. They’ve also referenced our work in their communications surrounding the implementation and the announcements of policies phasing out coal and their nationwide carbon tax.
In Brazil, the authors of the Brazilian Policy Brief have used this as a tool to engage the Brazilian Ministry of Health, including the Secretary of Health in Porto Alegre who holds a prominent position in the national Ministry of Health. One of the authors of the Briefing for Brazilian Policy Makers is now acting as an advisor to a legislator in Porto Alegre. We have also worked with national health professional organisations to produce policy briefs for India, China and Chile which have been used to engage policy makers in these countries.
Significantly, during the pandemic this year, we have set up Lancet Countdown Regional Centres in Asia and in South America in order to strengthen health and climate change research and policy engagement in these regions. The Regional Centre for Asia will be publishing a Chinese indicator report at the same time as this year’s global report, presenting national and provincial data on climate change impacts on health and the response. We also plan to strengthen research and policy engagement in Africa and in Small Island Developing States in the future.
How do you see your career evolving in the future?
I see myself staying at the Lancet Countdown for the next few years. It's a pretty exciting time to be involved as we are rapidly evolving. We're going to expand and obtain regional representation through partnerships and research in different areas, both in high income settings, such as the United States, and low to middle-income settings, such as China, South America, and small island developing states. I plan to stay here and help drive that process and the world's response to climate change.
What's the biggest improvement you've seen during your time working on climate change?
The policy climate has definitely changed over time, prior to the Paris Agreement, there were no commitments to keep global temperature rise this century to below 2 degrees Celsius. Since then, we've had multiple major economies commit to net zero emissions by 2050. Five years ago, it didn’t seem like anyone would have been prepared to do that other than small island developing states and less developed countries that barely emit greenhouse gases but are still the hardest hit.
This has been driven by a change in public awareness over the last few years and a stronger recognition of the present day and future impacts of climate change. There's definitely been a stronger demand for response.
In 2020, climate change has largely taken a back seat while countries have been trying to manage the COVID-19 pandemic. But it is crucial that the COVID-19 recovery is aligned with the Paris Agreement, otherwise we may not achieve its goals. The beginnings of this have been seen with the EU’s and South Korea’s Green New Deals, but much more linkage is necessary in order to prevent further public health crises related to climate change.
Do you think we'll be able to stick to zero emissions by 2050?
We are nowhere near achieving net zero global emissions by 2050 at this stage, but it is possible. We have seen commitment from the UK, France and the Scandinavian countries and now NHS England, who are seeing if it is possible to achieve net zero earlier than this. However, we definitely haven't seen it globally, and net zero is going to require a huge response.
If you could summarise what people should know about climate change in a few words, what would you say?
Climate change is happening now and it's affecting the health of people today in every region of the world. Every child that's born in 2020 will experience the health impacts of climate change. If we don't tackle climate change now, it will affect the health of most people who are alive today.
At the same time, addressing climate change also presents a great opportunity for health: in terms of cleaner air, better physical activity and diet. To achieve that, a response is needed now from everyone, individuals, industries and governments, and that response requires an unprecedented level of ambition.
