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Gold, incentives and meh

We owe it to the planet to talk to patients about family size

We as doctors are increasingly encouraged and expected to become involved in health issues that are global or could affect population wellbeing.

The BMJ extols us to tackle climate change and to lead by example. Yet, the biggest driver of most of the world's problems is the inexorable rise in human numbers. There are now too many climate changers and there are dwindling resources. In the West we consume much more than our fair share of everything. It is only right that people in developing countries should be helped to escape poverty and yet this will only increase the demand on resources and increase carbon emissions.

Isn't it time for primary health workers to start talking about family size? It's very probable that your own children are going to find life much tougher in the near future because food and resources are going to start running out. Only fantasists such as Richard Branson believe we will be able to expand into space. There isn't time to wait for new technologies. We have a million more people to feed every five days and Britain will not be protected from the impact of this as we are so reliant on food imports.

GPs spend their days giving people health advice - lose weight, stop smoking, walk more and so on. Why are we not talking about the most important things? Having more than two children will contribute to rising numbers that will lead to starvation, epidemics, wars, habitat destruction and climate chaos.

I am often amazed that most people I talk to have never really considered this as an issue. Try asking someone how many days it takes for another million people to arrive on the planet - most of them will be surprised to hear the answer.

The other common thought is that we would be infringing people's human rights if we suggest limiting family size. But if our own large family indirectly leads to another's lack of resources, whose rights are really being infringed?

The other common argument is that we need more young people to support the old people - how silly is that? What we really need is to value older people, enable them to stay productive longer and to reward their carers better.

Many middle-aged GPs can justifiably say that when they had four or five children - and a visit to the BMJ obituary pages will often illustrate this - climate change and dwindling resources were not issues. Which of us now thinks that our planet is going to be in great shape in 30 years?

GPs are in a position to influence public health in the widest meaning - and possibly the survival of our species.

It is time to make a personal pledge, discuss the issues with your patients and, if you already have four children, make amends by supporting charities that enable access to contraception.

From Dr Pip Hayes, GP in Exeter, a mother of two and trustee of The Optimum Population Trust

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