Unlike the sophists, Socrates believed that acquisition of knowledge was possible, but he declared that the first step to acquire knowledge was to admit ignorance. Socrates himself said that all he knew was that he knew nothing, and it was his consciousness of ignorance that eventually made him wiser than his fellow citizens. Thousands of years later we have come to face the Socratic Paradox. Having become acquainted with a new Era in Medicine, we realized that we miss a great bulk of data and that we have to walk down an unknown path towards knowledge, having no idea about what we are going to face at the end of the road.

The expansion of human activities has pushed our planet into the Anthropocene – a geological epoch where humanity has become the main driving force affecting the ecosystems. The Industrial Revolution in 1760 and the following rise of global industrial capitalism after the end of the Second World War were the harbingers for the increased greenhouse gas emissions and the resulting global warming of our planet. The levels of carbon dioxide, nitric oxide, and methane are rising, trapping heat into the atmosphere and leading to an increase in global temperature, ice-melting and ocean acidification. In addition, grounded ozone levels formed by chemical reactions between oxides of nitrogen and volatile organic compounds are hazardous when inhaled into the lungs, especially for people with existing lung diseases, such as asthma and chronic obstructive respiratory disease. It is under no question that the ongoing climatic changes of our environment and the rise of sea levels from ice-melting will have tremendous effects on our homeostasis and health. Dr Salas highlighted recently that “the full health implications of the climate crisis may be far more immense and insidious than we have so far imagined”.1 The need for physicians to act immediately and raise public awareness regarding the health effects of climate change is urgent. Besides, the political, societal and economic burden from such changes will be significant.

Greece – an island nation – having faced the sovereign debt emergency in the aftermath of the financial crisis of 2007 to 2008, will come to face a new challenge.  According to the first scientific report on climate and environmental change in the Mediterranean presented by the Expert Group on Climate Change of the Union for the Mediterranean in the UfM Regional Forum on 10 October 2019 in Barcelona, temperatures in the Mediterranean Basin are increasing far more rapidly than anywhere in the planet.2 It is estimated that temperature in Greece will rise about 3,0 ºC to 4,5 ºC at the end of the 21st century.3 Longer and drier summer heat waves, temperature extremes, decreased precipitation, wildfires, floods, increase in the mean incident solar irradiation will expose local residents to serious health risks. Physicians at the emergency departments will have to be ready to deal with patients stricken by heat-related illnesses, heart attacks or strokes, or with patients presenting with deterioration of existing respiratory diseases driven by the weather status. Ecologic disruptions due to climate-change are expected to be significant contributors in the emergence of vector-borne, water-borne or rodent-borne infectious diseases. Undoubtedly, healthcare workers must be prepared to act rapidly and recognize the climatic conditions as a potential cause of morbidity and mortality. Interestingly, the World Health Organization pointed out that the increase in Europe’s temperature could increase deaths by 30,000 per year by the 2030s, and by 50,000 to 110,000 per year by the 2080s. And yes! “Every life counts and every death is devastating, even if it is not cardiovascular!”4 Yet, little is known on the subject and the discipline of Climate Medicine is totally absent from the country’s Academic and Clinical Institutions.

Over the last decade, following the directions of the European Environmental Agency, European Governments have taken major steps towards green economy aiming to implement policies that enhance society resources efficiently and improve human well-being while maintaining the natural systems that sustain us. On February 17th 2020, our prime minister Kyriakos Mitsotakis, announced the New National Energy and Climate Plan and declared the new policy as a top priority towards obtaining a sustainable development model in all sectors of the economy, contributing in parallel to the European’s Union energy security. Part of this policy is the withdrawal of the existing lignite units by 2023 (except Ptolemais VI, until 2028) and the support towards renewable energy sources which could simplify the licensing of projects related to them, creating thus new jobs. What the post-Lignite era could mean for the post-memorandum Greece?

The stability of the health care system and a secure access to it for all citizens is critical for dealing with the health threats posed by the climate change. In addition, except from natives, health units must be ready to handle the load created by the advent of immigrants from the Middle East countries that may become inhabitable secondary to increases in local tempreratures. But could the country endure such a burden? A new humanitarian crisis could be right on our doorstep, further deteriorating the already existing refugee crisis.

The dawn of a new era in Medicine lead us to establish the Hellenic Society of the Environmental and Climate Medicine that aims to make known to Greek physicians and citizens the health effects of climate change and highlight the need to introduce this subject in Academic and Clinical Medicine. The time has come for physicians to get free of their fetters, step out of the “Plato’s cave”, face the reality and eventually recognize the effects that climate change has on humanity.



  1. Salas RN. The Climate Crisis and Clinical Practice. N Engl J Med 2020;382:589-591.
  2. Risks associated to climate and environmental changes in the Mediterranean region. A preliminary assessment by the MedECC Network Science-policy interface – 2019.
  3. Zerefos C, Capros P, Natsis A, Papandreou A, Sabethai I, Yfantopoulos I. (Eds.), 2011. The Environmental, Economic and Social Impacts of Climate Change in Greece. Bank of Greece (in Greek).
  4. Luscher TF. Current opinion. From ‘essential’ hypertension to intensive blood pressure lowering: the pros and cons of lower target values. Eur Heart J. 2017; 38:3258–3271.


The members of the writing committee (in alphabetical order: Emmanuel A. Andreadis, MD, PhD, Spyridon P. Dourakis, MD, PhD, Charalampia V. Geladari, MD, PhD Candidate, Eleni V. Geladari, MD, MS Candidate, Vasilios Papademetriou, MD, PhD, FACC, FAHA, FASH, Konstantinos Tsioufis, MD, PhD, FESC, FACC and Natalia Vallianou, MD, PhD) assume responsibility for the overall content and integrity of the article. All members of the writing committee have contributed equally to this work.