Climate change and environmental pollutants - an international survey of naturopathic perceptions and clinical behaviour

Background: With rising concerns about health impacts from climate change and environmental exposures, planetary health approaches are increasingly prominent, considering connections between human health and that of the natural environment. Naturopathy is an holistic traditional medicine system characterised by philosophies and practices rooted in nature that theoretically align with planetary health. However, it is unknown to what extent these philosophies translate into consideration of relevant factors during patient care. This study describes the perceptions and clinical behaviours of the global naturopathic workforce in addressing the health impacts of climate change and environmental pollutants. Methods: A cross-sectional online survey was administered to an international sample of naturopathic practitioners, recruited through communications from World Naturopathic Federation member organisations. The survey utilised the Climate Change Perceptions Scale, and asked participants about their perceptions of the health impacts of climate change and environmental pollutants. The survey also examined participant considerations of factors relating to climate change and environmental pollutants during clinical case assessment and prescribing of treatments. Data were descriptively analysed. Results: Of n=363 naturopathic practitioners who completed the survey, 88.7% agreed climate change is real, of whom the majority were concerned about impacts of climate change on their patients' health (89.1%). Almost all participants agreed that environmental pollutants harm human health (99.7%) and were concerned about impacts on their patients (99.5%). Climate-related health factors such as water intake (74.2%) and food security (72.9%) were frequently considered during patient assessment, while impacts of severe weather events (41.4%) were less commonly considered. Consideration of factors relating to environmental pollutants was more commonly reported, particularly for food quality (83.8%) and domestic/indoor sources of pollutants (73%). When formulating prescriptions, participants reported highly frequent consideration of all climate-related factors (73%-86.8%) and varied consideration of environmental pollutant exposures (54.4%-83.4%). Conclusions: The global naturopathic workforce demonstrates a high level of awareness and engagement with factors relating to health impacts of climate change and environmental pollutants, suggesting alignment with planetary health. While this engagement is evident in clinical behaviour, some gaps between awareness and application suggest a need for greater support to strengthen the naturopathic application of planetary and environmental health.