The health impacts of climate change (CC) are becoming increasingly severe as global temperatures rise. This urgent situation needs for policy responses to mitigate these effects and protect public health. The Intergovernmental Panel on Climate Change (IPCC) predicts that in the 21st century, it will be a challenge to limit the increase in temperature to 2°C if immediate mitigation measures are not taken (1, 2). In this context, the role of public health policy is critical in shaping interventions that address the health consequences of CC, particularly by involving healthcare professionals and communities in evidence-based strategies (3). However, as seen in the various Conferences of the Parties¹, achieving effective political and policy actions remains challenging despite growing public and scientific awareness. Different social groups, particularly young² people, whose futures are at risk, have increasingly challenged the inertia and ineffectiveness of political actions.

The intersection of climate change and health equity is exceptionally pressing. Vulnerable populations, such as children, the older adult, the chronically ill, and socio-economically disadvantaged people, are particularly at risk (4, 5). The IPCC (1) report identifies climate change as a driver of increased poverty and accentuated inequalities, exacerbating pre-existing health problems. Portugal, a southern European country with a Mediterranean climate, stands uniquely susceptible and vulnerable to health risks resulting from climate change due to its geographical location and the socio-economic characteristics of its population (6).

In response to CC, individuals’ cognitive and emotional involvement is central and is affected by behavioral changes and civic and political activities (7). Several studies have emphasized the perceptions of CC at the population level, that is, how they explain and deal with this phenomenon daily (8, 9). While the health impacts of CC have been extensively studied, much of the existing research has focused on clinical outcomes, epidemiological patterns, and disease surveillance (10). For instance, Alves, Leal, and Vidal (6) warn that central and southern Portugal are areas that could suffer from the appearance of insects that transmit diseases such as Dengue, Malaria, and the Zika virus (which exist in tropical climates), thus significantly affecting public health. This presents significant challenges for public health, calling for policy-driven preparedness and mitigation strategies.

Given this, health professionals have an essential role in formulating strategies adapted to specific socio-ecological environments to reduce the impact of CC vulnerabilities and increase the resilience of populations (11, 12). Moreover, because they are well-informed and trustworthy, they are in a solid position to communicate the risks posed by CC and the benefits of adaptation (13). In addition, they can influence the organizations where they work to reduce their emissions (14). Also, Campos et al. (15) states the importance of physicians’ involvement in the fight against CC, stating that it is physicians’ ethical obligation to become actively involved in the fight against CC and environmental degradation. Similarly, André et al. (16) recognize that as an outreach physician, the family physician must actively raise awareness among their patients, influencing behavioral change by giving advice that benefits the individuals and planetary health.

Thus, our motivation for this topic arises because we recognize the significant role of physicians in response to CC, as they are the first to deal with the health consequences of CC. Also, they may influence the preparation of health systems for the health impacts of CC, as well as change the behavior of their patients and public opinion. In this context, studying physicians’ perceptions of CC in the context of the ecological transition is justified by the relevance that these professionals have in terms of public health. This research can provide valuable insights that inform health policy recommendations toward a healthier and more sustainable future for all, underlining the influential role of physicians in this critical issue.

This is more relevant since studies on health professionals are scarce, especially about physicians’ perceptions of CC. The existing quantitative studies (17–24) have primarily focused on measuring the level of awareness and concern among physicians about CC. In contrast, our quality study aims to delve deeper into their perceptions and experiences by applying semi-structured interviews. Also, our study complements other research that also uses a qualitative methodology (12, 25, 26) and systematic review (27, 28) by contributing to the literature on this subject and by presenting the first exploratory study of physicians in a Portuguese context that provides clues for outlining recommendations for health policy strategies, particularly about awareness-raising and training plans for these professionals.

Recognizing the pivotal role of physicians in the context of CC (11, 13, 15, 29), we focused this analysis on the perceptions of a group of physicians with clinical practice in Portugal, with the utmost respect for their expertise and insights. Our primary objective is to understand whether they perceive themselves as critical players in raising awareness among their patients about the impacts of CC on health, broken down into the following specific objectives:

Our study is grounded in a robust qualitative methodology (30), which allows us to understand the reality experienced by individuals, considering their perceptions, values, representations, beliefs, opinions, attitudes, and habits. We have chosen the case study strategy (31) to define boundaries and circumscribe the phenomenon within its context, enabling an in-depth analysis of its various aspects. Our decision to conduct this research was informed by a literature review that revealed a lack of empirical research on physicians’ contributions to public awareness and policy engagement regarding CC. Therefore, our exploratory study (32) seeks to address this gap, offering valuable insights that can inform future public health policy strategies, particularly around physician involvement in climate change adaptation and mitigation efforts.

In this section, we present the findings of our study, beginning with a characterization of the study group (3.1) and then the results. During the content analysis, two broad categories emerged related to the specific objectives (see Table 3). We have used these categories to organize this section: (3.2) the role of physicians, where we characterize how physicians perceive their role in adapting to climate change health impacts; and (3.3) health climate change policy aims to identify physicians’ information on CC policies in health and to understand whether these professionals believe their actions will likely influence local and national policies to adapt to climate change in the health sector.

As far as we know, this is the first attempt in Portugal to describe and understand whether physicians identify themselves as critical actors in making their patients aware of the health impacts of CC. Our findings, reveal that 11 participants (the majority) recognize that physicians can be powerful catalysts for change. They can influence their patients and workplaces to alter their behavior, potentially leading to significant health and environmental improvements. However, additional knowledge and education are crucial to translate this belief into action. Providing physicians with the necessary tools and understanding will empower physicians to confidently recognize CC as a health issue and take adequate measures to address it. They can leverage their influence as health professionals and through their organizations (such as the Order of Physicians) to raise awareness before the general public. In terms of influencing political decision-makers, seven interviewees expressed dissatisfaction with the political class, suggesting that they can only impact CC policies through organized efforts. This finding underscores the need for a policy framework that empowers physicians and health professionals to engage in CC mitigation and adaptation, with structured mechanisms for their involvement in decision-making processes.

In this research, physicians emphasize the need to discuss lifestyle choices and their impact on patients’ health to raise awareness about behaviors that may affect their health and contribute to CC. For instance, they have started advising patients on the health benefits of walking or cycling instead of driving or the importance of reducing meat consumption for both personal health and the environment. However, some factors can hinder these conversations during consultations. One such factor is the limited time available, typically used for listening and diagnosing the disease. Another obstacle is the lack of knowledge and preparation required to engage in these conversations. Additionally, patient motivation plays a role, as some patients may be unwilling to engage in these discussions. Despite these challenges, some participants have already begun addressing these issues with their patients, focusing on health behaviors without mentioning CC.

Our results reinforce previous studies outside Portugal and found in the literature review on physicians’ perceptions of this topic (17, 19, 25). These studies show physicians believe they can be essential in CC mitigation strategies. They also show that there is a need for training, with Sanderson & Galway (26) and Boer (25) pointing to a lack of training as an obstacle to communicating about the links between CC, the environment, and health, as well as how they can communicate these links without damaging the doctor/patient relationship. They also point out that CC is described as a politicized issue, representing a further obstacle. This underscores the need for the development of public health that offer training programs to equip physicians with skills and resources to effectively address climate change impacts on health.

Portugal aligns its environmental policies with those of the European Union. The country has put in place various mechanisms to reduce greenhouse gas emissions. There is an increasing emphasis on adaptation measures involving non-governmental entities in decision-making processes for CC policies and strategic document submissions for public consultation (34–36). In addition, researchers highlights communication challenges regarding CC, emphasizing the need for improved education to enhance communication strategies (37–39).

Our research, however, shows that some measures regarding the impacts of CC on health need to be improved. This is where government bodies and public health policies can play a crucial role—by providing physicians with more regular information and training, focusing on the link between CC and health, and offering measures to apply in their practice so that they can pave the way for significant improvements. Aligning with this, the participants in this research recommend that the NHS disseminate regular information that addresses current and future events and contributes other types of knowledge. For instance, they suggest sharing information about the impact of dust coming from North Africa and the best practices to address it. Additionally, they proposed improvements to the performance of the NHS, particularly in situations with an exacerbation due to CC. They also emphasized the importance of training (a recurring theme at almost every point in this analysis), strengthening primary care, hiring professionals and incentives to keep them in the NHS, and the need to prioritize prevention.

Regarding the capacity of the NHS to deal with the health problems that CC can cause, nine participants said that the system does not have enough resources and is not equipped for such an eventuality. They gave the example of COVID-19, pointing out that if what happened in Italy had occurred in Portugal, things would have been much worse; there would have been many more deaths, and it would have been chaotic. This underscores the potential for CC to exacerbate existing health challenges and create new ones and the urgent need for the healthcare system to be prepared.

Finally, seven participants (more than half) stated that individuals and politicians must fight against CC. In a study carried out in 2011, Schmidt and Delicado (40) found that more than half of the participants believed that the responsibility for combating CC is collective. In our survey, if we only count those who mentioned the individual as responsible for fighting CC, we will get a much higher figure than the one above. This could indicate an increase in individual responsibility for adopting pro-environmental behaviors. Barr et al. (41) predicted this shift in responsibility. They stated that CC policies made individuals more responsible than economic actors or public administrations. However, it is essential to note that the government, as highlighted in a recent survey by Leal e Filho et al. (42), also plays a crucial role in implementing regulations and policies to effectively address the public health hazards of CC, reassuring us about the collective effort in combating climate change. Still, as Alves et al. (3) mentioned, the responsibility must be shared, and it should be considered not only by the local government and police but also by the community’s lived experience.

In summary, the need for more knowledge and training to link CC to health and to broach the subject in a conversation with their patients was highlighted at various interviews. Moreover, these health professionals are already overburdened by their workload, with consultations lasting very short, just long enough to diagnose the patient. However, the physicians’ role as educators and influencers of changes in individual behavior is recognized, so training and support are urgently needed. On the other hand, the NHS currently needs to be able to respond to the health problems that CC can cause. Currently, there are only a few CC policies in the health sector, mainly focused on extreme temperatures.

Furthermore, the National Health Plan 2021–2023 categorizes the health impacts of CC as a problem of ‘low or no magnitude, but with a high-risk potential’ (43), only recently mentioning health professionals on its website. However, the World Health Organization (44) asserts that a resilient health system relies on well-trained staff and sufficient resources. Therefore, it is crucial to develop training that empowers health professionals to engage in climate communication and advocacy effectively. Moreover, we should reframe the narrative to underscore climate action as an opportunity to enhance individual and public health, fostering a sense of optimism and possibility.

One of the limitations we have faced since the beginning was the scarcity of bibliography and scientific literature on the perceptions of CC with a focus on health professionals, namely physicians. However, some Portuguese works at the national level emphasize social perceptions on CC (9, 45–47). This study employs a qualitative methodology and a case study approach, as it aims to explore a relatively under-researched topic. Consequently, we focused on capturing the diversity of perceptions rather than seeking their regularity. The primary objective was to map these varied perceptions without attempting to quantify or generalize them. This approach inherently limits the study’s ability to provide statistically generalizable results. However, it allows for a deeper understanding of the nuances and complexities of the subject matter. Moreover, this research makes it possible to draw some conclusions about the participants’ perceptions of CC in the defined context. It is also possible to draw some recommendations for health policy strategies, specifically regarding awareness-raising and education plans for these professionals.

CC significantly impact human health, such as an increase in respiratory and cardiovascular diseases, a worsening of allergies and asthma, an increase in the incidence of vector-borne diseases such as Malaria and Dengue, and a decrease in food and water security. In this context, physicians are critical, as they are on the front line responding to the effects of CC on health and must, therefore, have the necessary knowledge to recognize the origins of these diseases and to engage in the fight against anthropogenic CC, as they pose a severe threat to human health. Therefore, health professionals, particularly physicians, are central to developing preventive, promotional, and remedial strategies for the causes and consequences of CC on human health. Within this framework, our research explores physicians’ potential to raise awareness among their patients and influence climate policies.

This research reveals the pivotal role that physicians recognize they play in raising patient awareness about the health impacts of CC. They believe they can influence their patients and workplaces to adopt healthy behaviors and actions to mitigate and adapt to CC. However, they also expressed the need for more knowledge and institutional support to deal effectively with this issue. Importantly, they highlighted the significant role of physicians’ organizations and collective actions in influencing CC-related policies, thereby emphasizing the importance of physicians in shaping climate policies.

This study’s most significant contribution is the insight it provides into the perspective of physicians, a professional group about which we have had limited knowledge until now. Understanding their perceptions is crucial, given the substantial influence they can have in promoting changes in behavior among their patients and in shaping public opinion. The study also highlights the state of CC policies for health in Portugal, underscoring the need for more proactive measures, particularly those that involve health professionals. A robust health system hinges on a sufficient number of well-trained professionals with adequate resources. Therefore, there is a pressing need for additional training to establish the relationship between CC and health and raise awareness among health professionals.

We conclude that researching physicians’ and other health professionals’ knowledge regarding the health effects of CC is essential to preparing healthcare services. These professionals can help create rapid strategies to change individual behaviors, which are necessary for the context of ecological transition and in minimizing some of the effects of global warming. Equally relevant is the contribution to a change in narrative that emphasizes CC mitigation and adaptation as an opportunity that benefits both public and individual health.