BMJ Impact Report 2023

Improving health outcomes for all Impact report 2023

Improving health outcomes worldwide

Impact report 2023

Better evidence

Better decisions

Better systems

Impact report 2022

Delivering tangible impact with global reach

Partnering with over 11,000 institutions

31,000 clinicians, funders, and key decision makers attended our BMJ-led events this past year

Serving 10 million online users every month

Publisher of The BMJ , the world’s 4th most cited general medical journal

Making evidence-based information and research available in 20 languages

Advancing healthcare since 1840

Our purpose provides clarity to what we do and the impact we have

BMJ is a global healthcare knowledge provider with a vision for a healthier world. We share knowledge and expertise to improve health outcomes.

As a global healthcare knowledge provider, our vision for a healthier world lies at the heart of everything we do. Our clinical decision support tools, educational resources, events, and careers services empower health professionals to make better evidence-based decisions and improve patient outcomes. While we are a wholly owned yet independent subsidiary of the British Medical Association (BMA), we serve a truly international community, with five offices worldwide - in the UK, the Americas, India and China. In our journey to make a real difference, we refer to our impact measurement framework (right). It operates as our compass, helping us not only understand and evaluate but truly celebrate the incredible impact we create.

We do this by providing a continuum of services

Delivering quality research

Improved health outcomes

Policy and guidelines influence

Synthesised learning and best practice

Strengthened workforce

Clearer clinical decisions

Which leads to

Better evidence Patient engagement Improved research quality and integrity Faster and wider access to latest evidence

Better decisions Ability to apply best evidence Improved knowledge, skills, and career development Improved practice and patient care

Better systems High quality policy and guidelines Open research systems Improved healthcare provision

This ultimately results in

Improved health outcomes

In this third annual impact report, we are excited to present tangible examples of how our people, products and services are making a meaningful difference in creating a healthier world. We do this through sharing knowledge and expertise with healthcare professionals globally. Welcome to our 2023 impact report

At the 2023 International Forum on Quality and Safety in Healthcare - Copenhagen, organised by BMJ, I had the opportunity to hear the most inspiring story from three Ukrainian doctors. They spoke about how they are working hard to maintain the resilience of the Ukrainian healthcare system and the professionals working within it. What we see of the conflict on television news only scratches the surface of the horror that Ukrainian doctors face daily. It was humbling to hear Dr. Olesya Vynnyk extend her appreciation to everyone who works at BMJ from all the healthcare professionals in Ukraine. Providing free access to our learning resources and BMJ Best Practice has greatly helped those working on the frontline. Her thanks are powerful because they inspire and challenge us to do still more. My own gratitude extends far beyond the incredible staff at BMJ. It reaches out to all those who have collaborated with us, offering their support and expertise to help us achieve the positive impact we strive for.

Within these pages, you will witness the collective impact we are making together, transforming lives and communities. It is a testament to the power of collaboration and the shared vision we hold. You will see the stories of individuals whose lives have been touched, the communities that have been uplifted, and the lasting change that has been sparked. It is a reminder of why we do what we do and the importance of the work that lies ahead.

Chris Jones Chief Executive Officer, BMJ

Better evidence Staying at the forefront of scientific advances

media mentions of articles published in 2022** 770K

11 th

BMJ articles were cited in 6K policy and clinical guidance documents published in 2022* 14K

most cited publisher in Clinical Medicine, 8th in Public Health, and 8th in Health Services Research***

of our journals are in the top quartile of their category, with 15% ranked in the top five for their categories Over 60%

BMJ journals received their first JIF in 2023****

34.5K

of BMJ’s 65 journals have a Journal Impact Factor (JIF) 56

news mentions of documents published in 2022, a 34% increase year on year

87%

of BMJ journals indexed in Scopus saw an increase in their CiteScore in 2023

*BMJ Impact Analytics I Only impact tool dedicated to health care [Online] https://impactanalytics.bmj.com/ **Altmetric

***Analysis of most cited publishers ranked by total citations in 2020, 2021, 2022, Broad Research Areas, Dimensions 2023

****Seventeen BMJ journals received their first JIF in 2023, including, General Psychiatry 11.9, Family Medicine and Community Health 6.1, BMJ Open Sport & Exercise Medicine 4.8, and BMJ Health & Care Informatics 4.1

Retaining impressive rankings BMJ publishes 65 journals, many of which are the most influential titles in their field

Journal of Neurology, Neurosurgery and Psychiatry Number 3 out of 212 in Surgery 11 JIF | 15.9 CiteScore

British Journal of Sports Medicine Number 1 out of 87 in Sports Sciences 18.4 JIF | 25.1 CiteScore

GUT

Number 5 out of 93 in Gastroenterology & Hepatology 24.5 JIF | 47.4 CiteScore

The BMJ

Thorax

Journal of Medical Ethics

Number 4 out of 167 in Medicine, General & Internal 1 105.7 JIF | 15.3 CiteScore

Number 6 out of 65 in Respiratory System 10 JIF | 14.3 CiteScore

Number 2 out of 16 in Medical Ethics 5.1 JIF | 6.2 CiteScore

Regional Anesthesia & Pain Medicine Number 8 out of 35 in Anesthesiology 5.1 JIF | 7.6 CiteScore

Journal of NeuroInterventional Surgery Number 2 out of 17 in Neuroimaging 4.8 JIF | 10.7 CiteScore

Tobacco Control

Number 4 out of 21 in Public, Environmental & Occupational Health 5.2 JIF | 10.6 CiteScore

Advancing how the real-world impact of health and medical research is measured Research that improves patients’ lives matters deeply to the funders, institutions and researchers who dedicate their resources to medical and health research. But evaluating the impact of this research on policy and guidelines is traditionally measured by standard scholarly metrics in the absence of more targeted analysis that relates explicitly to health improvement.

BMJ and the pioneering technology start-up, Overton, set out to address this challenge by collaborating to develop BMJ Impact Analytics , the first research impact tool focused on health and social care. It was launched in January 2023, and shortlisted in June 2023 as a finalist for the prestigious Association of Learned and Professional Society Publishers (ALPSP) Award for Innovation in Publishing 2023. 2

The concept of real-world impact has gained importance in the past decade due to budget cuts and the public questioning the value of research funding. Traditional scholarly metrics do not sufficiently measure impact, since they need to capture how research improves people’s lives. BMJ Impact Analytics helps to fill this gap by providing evidence of research being cited in policy and guidelines. Advanced tracking Previously, tracking this impact was time-consuming and costly, but BMJ Impact Analytics simplifies the process and provides more comprehensive insights. It shows links to patient outcomes (citing decision support tools), and enables a wider range of research to be assessed. Real-world focus

We chose to partner with BMJ because of their expertise and reach in the medical research community. Their existing relationships and global presence made the organisation a valuable partner. Additionally, BMJ’s mission-driven approach aligned with our values at Overton.” Euan Adie Founder and Director Overton

BMJ Impact Analytics contributes to shifting the focus of research assessment systems towards real-world impact and recognising the diverse contributions of researchers. The tool supports evidence-based policy decisions by providing evidence of the impact of research in the real world. It helps researchers understand and showcase the value of their work.

Kamran Abbasi, Editor in chief, The BMJ Delivering impactful science and journalism

Holding politicians accountable In the UK, we continue to influence government and health policy, 8,9 by championing evidence-based decision making, patient and public partnership, and openness and transparency. In 2022, The BMJ’s UK Covid Inquiry Series highlighted how the political response to the covid-19 pandemic often failed to properly consider science. The articles 10 raised important questions about the transparency and accountability of political decision making during the pandemic. They question the government’s resistance to scrutiny, lack of transparency, and failure to correct mistakes as knowledge and experience accumulated. Modelled after the UK Covid Inquiry Series, The BMJ’s Canada Covid Series called for a national inquiry and accountability for the failings in Canada’s response to covid-19. That week, four out of five of the top-read analysis articles were from that series, and 52% of The BMJ Analysis readers were from Canada. It received lots of attention online, in the news, and the research community, and led to a statement provided by the office of Health Minister Jean-Yves Duclos. 11 The UK issue covered points that question the evidence behind government decisions, 12 all of which has been submitted as evidence to the inquiry.

Impact, influence, and healthcare expertise are all the mainstay for global organisations, and we are benchmarked against the very best. Through the voice and global recognition of our flagship journal, The BMJ , we stimulate informed debate and encourage better medical research and education that lead to improved patient outcomes. Our Investigations Unit’s work adds to The BMJ ’s reputation as a world-renowned agent of change. Over the past year our investigative journalism has: Raised questions over lack of “substantial evidence” for FDA approved antibiotic, Recarbrio. 3 We highlighted the deterioration of safety standards at the FDA 4 and warned of an era where drug effectiveness becomes an afterthought in regulatory approval. Uncovered that the National Health Service (NHS) paid private hospitals £2bn in the pandemic to meet NHS demand, but that some private hospitals still treated more private patients than NHS ones, 5 reflecting a lack of transparency and accountability between public funding and private delivery of healthcare. Led an investigation in partnership with The Guardian , finding that hospital trusts fail to protect staff and patients against sexual assault and harassment in the NHS. 6 Our investigation revealed that only one in ten NHS trusts has a dedicated policy to deal with sexual assault and harassment, leading to a call in Parliament for a new and improved sexual complaints system. 7

Influencing with evidence-based advocacy Showing impact at select committee governmental level

T he BMJ is also influencing parliamentary select committees, with one such example occurring on 21 February 2022. Chris Whitty, the Chief Medical Officer for England, gave evidence to the Health and Social Care Committee at the beginning of the inquiry into prevention in health and social care. 13 At the hearing, Whitty discussed an editorial 14 he co- wrote for The BMJ with other chief medical officers. In the editorial, Whitty and colleagues argued for restoring and extending secondary prevention in the NHS, highlighting that such efforts had declined during the pandemic. With further work underway to evaluate the impact of the covid-19 pandemic on the United States and Canada, as well as a Commission on the Future of the NHS, our science and journalism is focused on achieving impact in clinical practice and policy making.

Leading the world of medical journals in patient partnerships

Providing increased access to the opinions and perspectives of patients; unfiltered and first hand Patient insights and experiences bring a critical dimension to our work and thinking. We view these partnerships as an ethical imperative, essential for enhancing the quality, safety, value, and sustainability of health systems. 15 Whether in research or education, we collaborate with patient editors, patient and public reviewers, and a patient advisory panel to ensure our content and information are directly relevant to policy making and clinical practice. Our proactive measures to promote patient and public involvement in the co-production of research help us recognise its significant impact on improving healthcare delivery and outcomes. 16 A few journals have embraced patient and public review, but it is The BMJ that continues to lead the way in this important initiative.

87% of research papers first submitted to The BMJ in 2022 and sent out for peer review were also sent to a patient and public reviewer for their opinion

89% of BMJ Best Practice patient leaflets have been reviewed by the patient panel (as at end 2022)

At BMJ, we want to support authors from low and lower-middle-income countries (LMICs) to publish their research by means of open access in their journal of choice. Our waiver policy has been updated so that all BMJ journals offer waivers for the full Article Processing Charge (APC) with a 100% discount for authors in LMICs. 19 We will always consider discount requests from countries not currently covered by that policy on a case-by-case basis. Advancing equity in open access publishing

This shift is driven by empirical evidence 17 showing that involving patients in healthcare decision-making enhances overall satisfaction with care, regardless of the decisions made and clinical outcomes. Shared decision- making particularly yields the highest satisfaction levels. 18 In the past

three years, between 60% and 75% of our annual events have included a patient representative on their committees, and we’re working hard to increase this. It is essential to acknowledge the challenges associated with this endeavour, particularly the considerable resources required to establish and manage new patient and public reviewer lists. Despite these obstacles, we are always looking for new ways to build better processes and maintain the high standards we have set.

BMJ has been giving free online access to our journals via Research4Life (R4L) for over 20 years. With other publishers participating in the R4L initiative, resources have collectively

been provided to more than 11,000 institutions in 125 LMIC countries.

BMJ involves patients from the outset. Engaging communities in this way has gained traction and is growing, such as helping to build resilient healthcare systems in response to health emergencies. It’s one of those occasions where BMJ got ahead of the game from its competitors. Dr Luis Gabriel Cuervo Senior Advisor, Washington, USA and Colombia

In 2022, 55.9% of all LMIC-originated research was published open access, up from 36.4% in 2021.

Better decisions BMJ Best Practice and the Comorbidities Manager

BMJ produces the only point of care tool to support the management of single conditions and patients with more complex comorbidities.

Providing clinical decision support for institutional subscribers in over 50 countries

Accessed in over 100 countries worldwide throughout 2022

~ 850,000 NHS clinicians across England and Wales now benefit from access to the Comorbidities Manager integration

BMJ Best Practice is the highest rated clinical decision support tool app in the world, rated 4.8/5 in Apple and Google Play

Accredited by over 60 institutions across the world **

* 99.5% surge in BMJ Best Practice sessions with electronic health record (EHR) integration: Q1 2023 vs same period in 2022.

99.5% surge in sessions seen with electronic health record (EHR) integration *

** BMJ Best Practice users can now claim CPD/CME points for time spent reading topics.

Helping to drive quality and reduce costs

Quality improvement, patient safety, and cost efficiency are important considerations for healthcare organisations in the UK and beyond. Various interventions can address these issues, including improving staffing levels, applying clinical improvement programmes, and seeking consultancy services to manage costs. 21 While these approaches can be beneficial, they often require financial investment. Another alternative is to explore existing resources that may not be fully utilised within local contexts. Decision support tools can be particularly helpful in improving patient safety and lowering litigation costs.

BMJ Best Practice is one such tool, which is freely available to healthcare professionals in NHS England, Scotland, and Wales due to subscriptions provided by these nations. Patient lawsuits stemming from misdiagnosis or delayed diagnosis carry substantial financial implications. NHS Resolution 22 reveals that noteworthy diagnostic delays, such as those involving cauda equina syndrome, can lead to costs exceeding £2 million. BMJ Best Practice encompasses cauda equina syndrome and critical conditions like meningitis, aiding precise and timely diagnosis. This can directly contribute to enhanced quality of care and cost reduction.

We are very grateful to BMJ Best Practice Podcast for helping to promote the importance of best practice care and reduce the variations in standards of practice that can exist. Through promotion of these messages, which the BMJ Best Practice Podcast has helped to facilitate, we aim to support improvements in patient safety, a reduction in avoidable harm and of course linked to that a reduction in clinical negligence claims.” Nicole Mottolini Clinical Fellow – Diabetes and Lower Limb, NHS Resolution

The pace of knowledge growth surpasses healthcare professionals’ capacity to effectively absorb and apply it. 23 That’s why updating BMJ Best Practice topics with new and practice-changing evidence remains a priority for us. Evidence shows that integrating BMJ Best Practice into Electronic Health Records (EHR) systems is a highly effective way of improving patient care, with a recent study highlighting the enhanced diagnostic accuracy of clinicians when utilising clinical decision support systems integrated with BMJ Best Practice. 24 Bringing the evidence to the bedside with electronic health record integration

We recently witnessed a 99.5% surge in BMJ Best Practice sessions with electronic health record (EHR) integration. 25

Meeting the changing and complex needs of patients

Staying abreast with the latest research alone is not enough. Health professionals must consistently improve their knowledge and skills. Equally, students need to prepare for practice. BMJ Best Practice provides students with the information and tools they need to meet the changing and complex needs of patients. It also supports educators in preparing students for the next stage of their careers. One in three adults suffer from multiple chronic conditions and most patients in the acute setting have more than one medical condition. 26 This is a significant and costly global problem. Managing patients with comorbidities is hard - clinical guidelines only focus on single conditions - but failure to manage comorbidities leads to worse clinical outcomes and longer lengths of stay. In response to these challenges, we integrated the Comorbidities Manager into BMJ Best Practice.

BMJ Best Practice - Comorbidities Manager is the only point of care tool that supports the management of the whole patient by including guidance on the treatment of a patient’s acute condition, alongside their pre-existing comorbidities. In 2023, NHS Wales and England extended their national access to BMJ Best Practice to include the Comorbidities Manager for all NHS Wales and England health and care professionals. 27

The BMJ Comorbidities Manager makes it easy to add comorbidities and see their effect on any treatment plan. It also provides clear guidance of additional considerations in one singular view for the clinician.” Geraint Walker Clinical Informaticist Critical Care, Digital Health and Care Wales

Demonstrating the impact of guidance in effectively managing patients with comorbidities

An article published in Future Healthcare Journal 28 outlines the importance of taking into account comorbidities when managing patients, and how BMJ Best Practice Comorbidities Manager can support healthcare professionals with this. The paper demonstrates the impact guidance can have by outlining how the healthcare system needs to change so that it can provide a better service for patients. The lead author and his colleagues, of whom all are clinical specialists, discuss how common comorbidities can interact with other conditions, and the risks associated with these interactions:

For people with diabetes presenting with sepsis, [BMJ Best Practice] advises a foot examination to be undertaken on admission, as foot infection and/or osteomyelitis may be the original source of infection. It is not uncommon to encounter patients with systemic infection in whom bandages have not been removed for several days. Delay in its detection may result in worsening foot sepsis and tissue necrosis.” Gerry Rayman Diabetes and Endocrinology Lead, Ipswich Hospital, and specialist medical adviser to Diabetes UK

Ani Orchanian-Cheff helps residents in family medicine develop the skill of accessing information at the point of care by incorporating BMJ Best Practice’s treatment algorithms into her teaching sessions. Enhancing medical education and training in Canada During the morning ward rounds, she introduces the evidence-based healthcare (EBHC) pyramid 5.0, a model that guides clinicians to start with synthesised summaries for clinical reference, where BMJ Best Practice plays a crucial role. The information specialist finds that clinicians, nurses, and practitioners of family or general internal medicine, who are the primary recipients of her teachings, favour BMJ Best Practice due to its ability to offer fast and dependable answers.

Some of the things I look for in a tool are whether it’s peer-reviewed and what the reviewers’ disclosures are. I also look to see when it was last reviewed or updated, who put the tool together, and their disclosures. All of that is included in BMJ Best Practice.” Ani Orchanian-Cheff Information Specialist, University Health Network (UHN), Toronto, Canada

Better systems Today’s health systems rely on robust policies and guidelines to deliver the best care for patients.

Our specialist skills and services help organisations improve their processes and achieve results.

Delivering nearly 100,000 total medical job applications through the BMJ Careers job board (39% increase year on year)

87% of respondents said they plan to make changes in their organisation or how they work as a result of attending the International Forum - Copenhagen 202 3

Championing open access publishing, with 86% of funded BMJ research articles being published under an open access licence

14K BMJ articles were cited in 6K policy and clinical guidance documents published in 2022*

Seeing a 99.5% surge in BMJ Best Practice sessions with EHR integration**

*BMJ Impact Analytics I Only impact tool dedicated to health care [Online] https://impactanalytics.bmj.com/

**99.5% surge in BMJ Best Practice sessions with EHR integration: Q1 2023 vs same period in 2022.

The BMJ Technology Assessment Group (BMJ-TAG) conducts health research to help decide whether new drugs should be made available in the NHS. This year’s work has included several “me too” drugs, that is, drugs that might be considered to have the same efficacy and safety as other available options in the NHS but at a lower cost. The importance of these drugs lies in the savings achieved for the taxpayer and importantly, much needed cost savings for the NHS. Our team independently assessed two new treatments for diabetic macular oedema (dexamethasone and brolucizumab), a condition that can result in blindness, with both treatments. Providing expert methodological advice to the UK’s National Health Service

BMJ-TAG is also called on to conduct its own research, when several new treatments need to be compared with current practice. This year, BMJ-TAG looked at three treatments for severe atopic dermatitis for use in adolescents and adults. As a result of our work, all three treatments were approved. Patient groups commenting on the appraisal highlighted the debilitating nature of severe atopic dermatitis, which goes beyond uncontrollable and persistent itching, to detrimental effects on a person’s mental health and self-confidence.

BMJ-TAG contributed to 12 policy docs in 2022, which touched an estimated 235K lives of patients 29 .

The Eczema Outreach Support group highlighted that these new treatment options offer hope to patients who have exhausted all available treatments and have the potential to improve a patient’s quality of life.

The pandemic has profoundly disrupted the provision of health services across the globe, particularly in remote and rural regions. Helping to influence health policy in Peru Mamás del Río (Mothers of the River) is a multidisciplinary initiative that improves the health of mothers and newborns in remote and rural indigenous communities along 1,000 kilometres of the Amazon river in Peru and Colombia. The initiative uses social innovations to empower community health workers by addressing the healthcare delivery gap using mobile devices with relevant information to ensure the best patient outcomes. A special collection on social innovations in health 30 published by BMJ in 2022 helps to showcase the Mamás del Río programme’s success in helping community workers adapt in response to communication challenges posed by a strict, national lockdown. In their paper, Dr Magaly Blas and her colleagues evaluate how technological interventions help communities adapt to a new clinical setting within a post-pandemic context. Since the BMJ Innovations publication of the collection: Social Innovations in Health, Mamás del Río has expanded into remote regions of the border between Peru and Colombia. The Peruvian Health Minister is also considering the evidence provided in the paper to inform a policy change that will formalise the Mamás del Río programme throughout the region as part of the national health system.

This policy change will help build capacity and efficiency amongst community health workers and supervise the community workers in the field in a programme they need to improve maternal and neonatal health. Blas believes that having an evaluation of her work published in a reputable and robustly peer-reviewed journal from BMJ provides credibility that can help influence the Peruvian government to consider implementing critical policy change. This change will promote better health systems by preventing diseases in Amazonian communities.

We found in BMJ a voice to report on what was happening to us during the pandemic to the international world.” Dr Magaly Blas Medical epidemiologist, professor and researcher at Cayetano Heredia Peruvian University in Lima, Peru

Connecting communities to inspire change At the BMJ Research Forum 2022, attendees had the privilege of hearing Dr. Katherine Freeman from the Engineering and Physical Sciences Research Council (EPSRC) deliver a thought-provoking presentation on the “Sandpit Methodology” for awarding research grants. This innovative approach aimed to unleash free thinking and inspire interdisciplinary collaboration to tackle significant challenges.

One attendee from UCL Trust embraced this idea and brought it back to an organisation that manages 17 hospitals who provide care for over 6 million patients. Such impressive statistics highlight how a single idea implemented within a large healthcare system can yield significant change. The success of the Sandpit Methodology has led to its presentation at the International Forum, this time to an audience of over 3,000 attendees. The potential for these ideas to spread across organisations worldwide is immense; all it takes is one individual to carry them back to their respective institutions. The impact of BMJ’s events extends far beyond the conference room. By connecting communities, inspiring change, and facilitating the exchange of knowledge and experiences, these platforms can transform entire sectors and healthcare systems. The success story of the Sandpit Methodology and its implementation at UCL Trust exemplify how a single idea, shared among passionate individuals, can create global ripples of change.

Among the attendees was a representative from UCLPartners, a healthcare organisation, who was deeply inspired by the Sandpit Methodology’s potential to encourage collaboration and co-production. Determined to bring about change, she took the concept back to UCLP and applied it to their Climate Collaborative project 37 —an initiative aimed at implementing the NHS Green Plan in their hospitals. The implementation of the Sandpit Methodology involved bringing together doctors, nurses, estates staff, and IT teams from across the entire UCL Trust to work collectively towards achieving Net Zero emissions. The success of this collaboration was so remarkable that Dominique Allwood, Chief Medical Officer at UCLPartners, volunteered to chair the sustainability session at the BMJ Forum on Quality and Safety in Healthcare - Copenhagen 2023, sharing insights and experiences from their work. In December 2022, our inaugural BMJ Research Forum saw 300 individuals gather in BMA House, London, where the concept of the Sandpit Methodology took root.

BMJ’s global reach and its ability to convene diverse audiences of leaders, innovators, and specialists are what make such knowledge-sharing and expertise exchange possible. The organisation has demonstrated its commitment to amplifying the voices that deserve to be heard, enabling experiences and insights to be shared, and inspiring individuals across functional and national boundaries. Dominique Allwood Chief Medical Officer, at UCLPartners; Senior Visiting Fellow at The Health Foundation; Director of Population Health at Imperial College Healthcare NHS Trust, England

Campaigning on the climate emergency and changing how BMJ operates in pursuit of a healthier world

The healthcare sector contributes 4-5% of global greenhouse gas emissions. The physical health effects of climate breakdown are well established and occur through diverse pathways often disproportionately affecting vulnerable populations the most. There is increasing evidence that the climate emergency impacts mental health and wellbeing too, with “eco-anxiety” a growing problem for patients and doctors. 31

action. 35,36 The joint editorial emphasised the health impacts of the climate emergency and the need for governments to do more, and act faster to limit global temperature increases, restore biodiversity, and protect health. In order to align BMJ’s editorial voice with its internal operational practices, the business has become a signatory of the UN SDGs Publisher Compact and has also signed the ten commitments established by UKHACC, promoting positive impact on people and planet in all aspects of its operational activities. A healthier world requires a healthier environment and therefore BMJ is committed to global sustainability and becoming carbon neutral as a business by 2040, at the latest.

The BMJ has been raising awareness about the climate crisis since the 1990s, 32 emphasising its impact on health through changing patterns of disease, extreme weather events, loss of biodiversity and disruption to healthcare. 33,34 Our collective failure to respond to the climate crisis means we cannot reverse the damage already done. However, with urgent action we can mitigate against further damage to create a more sustainable future. Doctors and other health professionals have a key role to play in this change. The BMJ collaborated with the UK Health Alliance on Climate Change (UKHACC) to simultaneously publish a joint editorial in more than 200 journals calling on world leaders to take emergency

In the 2021 Climate issue, The BMJ published an opinion piece 42 by Mala Rao and Richard Powell, highlighting the increasing levels of eco-

Fostering positivity and activism through the climate issues themes Ahead of COP26, 37 The BMJ published its first themed issue on the climate crisis, 38 which focused on tangible actions for health professionals to empower them to make change. The second climate issue in October 2022 focused on hope 39 , arguing that hope is “a powerful driver to achieve change” 40 in the face of government and corporate inaction to mitigate the climate crisis. Through ongoing coverage of the climate emergency The BMJ proactively empowers practising doctors to recognise the urgency and severity of the climate crisis, fostering a sense of collective responsibility including discussing the topic with patients. 41

anxiety, especially among children and young people, and its potential negative impact on individuals and society. The publication raised awareness and prompted action on the issue of eco-anxiety. It gained national media attention and was featured in The Guardian . 43 Following the publications of the opinion piece, Professor Mala Rao OBE, one of the authors of the piece and a member of The BMJ’s climate steering committee, was invited to lead a special issue on eco-anxiety for the Royal College of Psychiatrists. 44

The [Climate Issue] is so fantastic, and everyone ignored the first hour of work to read through it cover to cover. There’s such a diversity of thoughts, all positive and pulling in the right direction.” Nick Watts Chief Sustainability Officer of the NHS

Unveiling the multifaceted dimensions of sustainability A final word from BMJ CEO Chris Jones, on the importance of social mobility

Future Frontiers, a remarkable education charity. Through this collaboration, twenty of our dedicated team members become mentors of students who face disadvantages, right at BMA House. In June 2023, we welcomed our first cohort of students to begin a series of coaching sessions that will help them learn more about themselves, their capabilities and identify a suitable career path. This endeavour is a victory for all involved: equipping these bright young souls with the skills to chart a brighter future while enriching our own abilities as caring mentors and perceptive leaders. With the wheels of planning already turning, I’m eagerly looking forward to witnessing the growth of this initiative. It’s destined to become a cornerstone of our commitment to making a positive impact and embracing our social responsibility.

Exploring the intricate tapestry of sustainability reveals a truth that goes beyond the confines of climate concerns. While protecting our environment remains crucial, we can’t overlook the intricate threads of social mobility woven into this narrative. It’s disheartening to see that even today in the UK, the circumstances of your birth can cast a long shadow on where you’re headed in life. The struggles faced by young people from less privileged backgrounds run deep— limited educational opportunities, barriers to higher learning, and dreams of fulfilling careers hindered. As a CEO, I passionately believe that businesses like ours should play an active part in empowering these young hearts to shape their own destinies. That’s why I’m immensely proud of our partnership with

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1. In 2023, The BMJ observed a JIF 10% increase of over 9 points to 105.7. Announcing changes to the 2023 Journal Citation Reports, Clarivate [Online] 2. ALPSP Impact and Innovation Awards 2023: Shortlists announced https://www.alpsp. org/News/alpsp-impact-innovation-awards-2023, Tuesday 13 June 2023 3. Wilkes M. Investigation: Did the FDA break its own rules in approving the antibiotic Recarbrio? The BMJ 2023; 381 doi: https://doi.org/10.1136/bmj.p1048 (Published 15 May 2023) 4. Ross D. The decline of science at the FDA has become unmanageable , The BMJ 2023; 381 doi: https://doi.org/10.1136/bmj.p1061 (Published 15 May 2023) 5. Oxford E. The NHS paid private hospitals £2bn in the pandemic: did taxpayers get value for money? The BMJ 2023; 380 doi: https://doi.org/10.1136/bmj.p329 (Published 15 February 2023) 6. Feature BMJ Investigation, Feature BMJ Investigation, Medical colleges and unions call for inquiry over “shocking” levels of sexual assault in the NHS , The BMJ 2023; 381 doi: https://doi.org/10.1136/bmj.p1105 (Published 23 May 2023) The BMJ 2023;381:p1105 7. Sexual safety incidents involving patients are reported through the National Reporting and Learning System, a central database of patient safety incident reports, which is being replaced with a similar system this year. https://www.bmj.com/content/381/bmj.p1105 8. Lord Bethell, Conservative mentioned BMJ Global Health in an Online Safety Bill - Committee Day in the House of Lords 11 May 2023: I also remind noble Lords that foreign actors and states are causing severe trouble in this area.“Foreign disinformation” social media campaigns are linked to falling vaccination rates, according to an international time- trend analysis published by BMJ Global Health . 9. Wilson SL, Wiysonge C, Social media and vaccine hesitancy BMJ Global Health 2020;5:e004206. [Online] https://gh.bmj.com/content/5/10/e004206.citation-tools 10. Dyer, C. Covid-19: UK’s pandemic inquiry prepares to hear from witnesses BMJ 2023; 381 doi: https://doi.org/10.1136/bmj.p1314 (Published 08 June 2023) 11. Pelley. L, Top medical experts call for national inquiry into Canada’s COVID-19 ‘failures’ , CBC News, 24 July 2023. https://www.cbc.ca/news/health/top-medical-experts- call-for-national-inquiry-into-canada-s-covid-19-failures-1.6916419 12. Gurdasani D, Pagel C, McKee M, et al. Covid-19 in the UK: policy on children and schools BMJ 2022; 378 :e071234 doi:10.1136/bmj-2022-071234

25. 99.5% surge in BMJ Best Practice sessions with electronic health record (EHR) integration: Q1 2023 vs same period in 2022 26. Hajat C, Stein E. The global burden of multiple chronic conditions: A narrative review. Prev Med Rep. 2018 Oct 19;12:284-293. doi: 10.1016/j.pmedr.2018.10.008. PMID: 30406006; PMCID: PMC6214883. 27. BMJ Best Practice Comorbidities Manager is now available across NHS Wales. BMJ corporate announcement. January 2023. Available online: https://www.bmj.com/company / newsroom/nhs-wales-e-library-extends-release 28. Rayman. G, Akpan. A, Cowie. M, Evans. R, Patel. M, Posporelis. S, et al. Managing patients with comorbidities: future models of care. Future Healthcare Journal . July 2022. Available from: https://www.rcpjournals.org/content/futurehosp/9/2/101 29. The allocation of BMJ-TAG assessments by national HTA bodies varies significantly from year to year, presenting both challenges and opportunities. In 2022, BMJ-TAG had the opportunity to work on multiple assessments focusing on drugs targeting conditions that impact a considerable number of patients. Although these drugs were categorised as “me-too” drugs, meaning they were similar to existing drugs already available on the NHS, this provided an important avenue for evaluating their potential benefits and value for patients. BMJ-TAG conducts research for the National Institute for Health and Care Excellence (NICE) and other policy makers in the UK to support national decision making and improve health outcomes. 30. The BMJ Innovations social innovations for health special supplement highlights some of the most important research work, concepts and practices in the area of social innovations in health. It also showcases the best available case examples where significant improvements in health outcomes have been made. [Available online] https://www.bmj.com/company/social- innovations-for-health/ 31. Rao. M, Powell A Richard. The climate crisis and the rise of eco-anxiety , The BMJ Opinion, October 6, 2021 [Online] 32. Tropical diseases move north with global warming BMJ 1995; 310 :1027 doi:10.1136/ bmj.310.6986.1027a https://www.bmj.com/content/310/6986/1027.2.full 33. Wedmore, F. This is climate breakdown, and it is having a real effect on our patients. The BMJ Opinion, August 12, 2021, [Online], https://blogs.bmj.com/bmj/2021/08/12/ florence-wedmore-this-is-climate-breakdown-and-it-is-having-a-real-effect-on-our- patients/

34. BMJ is a founding member of the UK Health Alliance on Climate Change (UKHACC), and in 2020 made a call for the WHO to declare a public health emergency. 35. In September 2021, The BMJ and 50 BMJ Journals were among 233 journals across the world to simultaneously publish an editorial calling on world leaders to take emergency action to limit global temperature increases, halt the destruction of nature, and protect health. The full list of authors and signatories to climate emergency editorial September 2021 https:// www.bmj.com/content/full-list-authors-and-signatories-climate-emergency-editorial- september-2021 36. Wise J. Climate crisis: Over 200 health journals urge world leaders to tackle “catastrophic harm” BMJ 2021; 374 :n2177 doi:10.1136/bmj.n2177 https://www.bmj. com/content/374/bmj.n2177 37. 2021 United Nations Climate Change Conference, more commonly referred to as COP26 38. The BMJ special issue on the climate emergency 2021 https://flipbooks.bmj. com/26532/63293/ 39. As above 40. Frumkin H, Cook S, Dobson J, Abbasi K. Mobilising hope to overcome climate despair BMJ 2022; 379 :o2411 doi:10.1136/bmj.o2411 41. Nazari. P and Jones. M, What can clinicians say to patients who ask about climate change? The BMJ Opinion [Online] January 22, 2021 https://blogs.bmj.com/ bmj/2021/01/22/what-can-clinicians-say-to-patients-who-ask-about-climate-change/ 42. Rao. M, Powell A Richard. The climate crisis and the rise of eco-anxiety , The BMJ Opinion, October 6, 2021 [Online] https://blogs.bmj.com/bmj/2021/10/06/the-climate-crisis-and- the-rise-of-eco-anxiety/ 43. Gregory. A, Health Editor, ‘Eco-anxiety’: fear of environmental doom weighs on young people , The Guardian , Wed 6 Oct 2021, [Online] https://www.theguardian.com/ society/2021/oct/06/eco-anxiety-fear-of-environmental-doom-weighs-on-young-people 44. Eco distress for children and young people , Royal College of Psychiatrists, [Online] https://www.rcpsych.ac.uk/mental-health/parents-and-young-people/young-people/ eco-distress-for-young-people

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