• Quality improvement
• Crisis management
• Health policy

I write this commentary as wildfires rage around the world, including in Greece, Italy, Siberia, Algeria and the USA. In my own country, Canada, fires have already consumed over 130 000 km² 1—the size of Greece—and the wildfire season has not yet ended. Recent months have also seen hundreds of millions of people suffering scorching heatwaves across Europe, China and North America. Residents of Phoenix, Arizona, endured temperatures over 43°C for 31 consecutive days this summer. In Italy, harsh heat in the south occurred at the same time as storms delivered hail the size of tennis balls in the country’s north. This almost ‘end of days’ juxtaposition of extreme weather events within a single country comes as new research indicates that the Gulf Stream may collapse as soon as 2025.1 Loss of these vital ocean currents would constitute a climate tipping point, making extreme storms more frequent and leading to other catastrophic consequences we cannot even fully fathom.

With these and other long-predicted harms of the climate crisis now taking concrete form, it is only natural for those in caring professions such as healthcare to wonder how we might help address and mitigate these threats to population and planetary health. I fully support taking such action. The question is how best to do so. One increasingly popular approach consists of ‘decarbonizing healthcare’,2 a strategy now also advocated by the Choosing Wisely campaign as outlined by Born and colleagues in this issue of BMJ Quality & Safety.3 They propose three categories of action: identification of specialty-specific climate-intensive overuse priorities; advancing quality improvement targeting climate-relevant measures in the micropractice environment; and advocacy to influence change at the individual, organisational and system levels.

Commonly touted examples of the first category—speciality-specific climate-intensive targets—include replacing the widely used inhalation anaesthetic …