The Healthy Environments and Lives (HEAL) Network’s recent conference brought timely updates on the National Health and Climate Strategy’s implementation, as well as important advice for the research translation process.
Alison Barrett reports below for the Croakey Conference News Service.
Alison Barrett writes:
Four reports were launched at last week’s Healthy Environments and Lives (HEAL) Network’s conference that form part of the implementation process for the National Health and Climate Strategy.
Updates on key action items of the Strategy were also provided at the online national two-day event.
Dr Madeleine Skellern, Director of the National Health, Sustainability and Climate Unit, said the reports, which were undertaken by the Unit and the HEAL Network, are a “wonderful example” of collaboration between academia and government and exemplify “policy-relevant research”.
“We’re hoping that all of this work will inform policy going forward,” Skellern said.
The reports would also inform prioritisation of actions in the National Health and Climate Strategy that was launched at COP28 one year ago this week – on 3 December 2023.
The four reports launched include the recently published Systematic mapping review of Australian academic literature on climate change and health interventions, as well as three still to be published:
- Review: Interventions to reduce greenhouse gas emissions from health system waste
- Review of sustainability in food and catering policies in Australian public hospitals
- Estimates of health system greenhouse gas emissions 2021-22.
The theme of this year’s HEAL Network conference – ‘healing with Country for a sustainable future for everyone’ – wove throughout many discussions.
Associate Professor Linda Payi Ford, a Rak Mak Mak Marranunggu Traditional Aboriginal Owner from Kurrindju in Northern Territory, and Senior Research Fellow at Charles Darwin University, said in her introduction that “it’s our responsibility to look after Country so the country can look after us”.
“The beauty of the HEAL project,” she said, is that it commits to supporting Aboriginal and Torres Strait Islander leadership and knowledge of healing the Country, as well as understanding the importance of traditional knowledge systems that can help inform contemporary practices.
Ford said the HEAL Network aims to address the many climate challenges through shaping research to support the National Health and Climate Strategy, as well as research from communities on the frontline of significant climate and environmental change. More will be reported on these in future Croakey Conference News Service articles.
Informed policies
Bridging the gap between research and policy was another strong theme of many discussions at #HEAL2024.
In the conference opening address, Ged Kearney, Assistant Minister for Health and Aged Care and Assistant Minister for Indigenous Health, said that through HEAL’s leadership “we’re getting better evidence to inform stronger policies that reduce the impact of climate change on our health”.
She said it’s “wonderful” that the HEAL conference focuses on the interconnection between health and Country, drawing on the leadership, strength and wisdom of First Nations people.
“It’s vital we learn from First Nations people as the leaders in holistic healthcare and ongoing custodianship of the land and waters,” she said.
Kearney highlighted the importance of having a health system that “can rise” to the challenges from climate change including extreme heat and more frequent floods.
She said that work has begun on 31 of the 49 action items to be delivered over five years within the National Health and Climate Strategy – 11 of which are complete or nearly complete. In addition, planning has begun on a further 14 actions.
Work on the Strategy has incorporated stakeholder roundtables to discuss strategies for low emissions, clinical care, supporting the health workforce and reducing emissions from anaesthetic gases, Kearney told the conference.
Also, to inform future safety and quality standards for health organisations, an Environmental Sustainability and Climate Resilience Healthcare Module with the Australian Commission on Safety and Quality in Health Care is currently being piloted, and guidelines for climate health adaptation planning in the health system are underway, she said.
Professor Sotiris Vardoulakis, Director of the HEAL Network at University of Canberra and Co-Chair of #HEAL2024, told the conference the HEAL Network aims to increase research capacity on environment, climate and health through its decentralised approach of communities of practice in all jurisdictions and co-designing research based on local needs.
He said one of the Network’s key achievements this year was the collaboration with the National Health, Sustainability and Climate Unit and supporting the work of the National Health and Climate Strategy.
HEAL Network has also been providing feedback and support to the National Climate Risk Assessment and National Adaptation Plan, Vardoulakis said.
Building relationships
The HEAL Network vision is to play a critical role in knowledge, exchange and translation of research into policy and practice and to deliver measurable improvements to health and wellbeing of communities and the environment, according to Associate Professor Carmel Williams, Director of the Centre for Health in all Policies Research Translation, SAHMRI.
Williams said the HEAL Network was set up “with a direct focus on trying to speed up the translation process”, saying it often takes 17 years for research to be translated into impact.
Williams, who has worked in government policy as well as academia, said policy translation is a “dynamic process”, but the ultimate aim is to ensure evidence is translated into practice, as well as influencing government decision-making.
However, because of cultural differences around how government, large institutions and academia operate, policy-making processes can be “quite fraught”, Williams said.
For example, governments tend to be responsive to media crises, community issues and powerful influences – which do not always align with the process of rigorous, robust and reliable research.
Policymaking can often occur very quickly and is not just shaped by evidence, even though most policymakers try to use evidence to inform their decisions. Other political, social and economic factors can influence decision-making, she said.
Williams said it can be difficult for researchers and policymakers to bridge the gap and work collectively for change.
One of the most important parts of a research translation strategy, according to Williams, is to start developing collaborative approaches and co-design at the beginning of the research project creation.
She said it is important to consider how to best bring policymakers, practitioners and community members into meaningful, engaged and important roles in the research process.
Strong communication is required to gain an understanding of all stakeholders’ perspectives.
Collaboration and communications
Professor Erica Donner, Research Director of the CRC SAAFE – a cooperative research centre for solving antimicrobial resistance – at University of South Australia, agreed with Williams on the importance of finding a common language to communicate and understand stakeholder perspectives.
Co-design and collaboration are integral to the work of SAAFE, a ten-year project funded from the Australian Government’s CRC Program, established to invest in “collaborative research to mitigate anti-microbial resistance”.
“We really need to work globally in a coordinated fashion to mitigate anti-microbial resistance,” Donner said.
Professor Geoffrey Morgan, School of Public Health and University Centre for Rural Health, University of Sydney, also emphasised the importance of building and maintaining relationships in research translation.
He said that while research should be robust and evidence-based, it is important not to focus on the minutiae when communicating about research.
Morgan spoke about using the Centre for Air pollution, energy and health Research (CAR) data (CARDAT) platform to demonstrate the impact of urban heat islands – areas of increased hard surfaces and reduced green space which increase the intensity of heatwaves – on mortality.
For example, a collaboration with the NSW Ministry of Health and NSW Department of Planning and Environment using CARDAT showed that reducing the urban heat island effect lowers the risk of adverse health impact of heatwaves.
He said the research led to discussions with the Western Australian Department of Health about interventions that could reduce the mortality and health consequences due to the urban heat island effect in Perth.
Morgan said colleague Dr Ivan Hanigan, Senior Lecturer at Curtin University, used the CARDAT platform, applied the indicators from the NSW project to Perth and developed a report for WA Health, again highlighting the significant impact of heatwaves on mortality and health system.
The work with WA Department of Health has been cited in a range of reports and seen policy change in Perth and other locations, Morgan told the conference.
National Health and Climate Strategy update
Dr Madeleine Skellern said that while the National Health, Sustainability and Climate Unit launched the four reports produced in collaboration with HEAL at the conference, three are not yet complete.
Skellern said they aim to publish the remaining three within the next few months. The first report, a systematic mapping review of Australian research on climate change and health interventions, was published two weeks ago.
Vardoulakis told Croakey last week that addressing research gaps identified in the mapping review required “sustained funding” for interdisciplinary climate change and health research focusing on solutions.
He told the conference that bridging policy and research is challenging, but it is important to focus on co-design. He stressed the value of developing a common language and understanding.
Much of HEAL’s research is focused on what is needed for policy, including research for the National Health and Climate Strategy. It is co-designed with policymakers and communities, and “has a purpose”.
The second report is a review of options for reducing greenhouse gas emissions by reducing waste in healthcare settings.
Dr Alice McGushin, Assistant Director of the National Health, Sustainability and Climate Unit, told the conference that some of the draft recommendations based on the review findings include:
- Reduce low-value care
- Wherever possible, reusable devices should be used in place of single use items
- Education and infrastructural changes are required, and policy and guidelines should be reviewed to support interventions across the waste hierarchy (which is reduce, reuse, recycle, refurbish and segregation).
McGushin said the review identified that more research is required in primary care, aged care and other hospital settings such as emergency departments and pathology. Almost all (90%) of the studies included in the review were based in hospital settings.
Skellern said this review will inform engagement with the Therapeutic Goods Administration and state and territory health departments.
Food and nutrition in healthcare
Dr Stefanie Carino, Sustainable Healthcare Manager at the Climate and Health Alliance, talked about a review she was involved with as a HEAL visiting fellow, on sustainable food and nutrition in healthcare settings.
The review aimed to answer four research questions:
- What standards and policies exist in food and beverage provision in Australian hospitals?
- Do the standards embed sustainability principles?
- How are they implemented, including any barriers and enablers?
- What are some best practice examples internationally?
The review identified 18 Australian policies, 12 international polices, seven case studies and 19 peer-reviewed publications.
Carino said many Australian food policies incorporate sustainability measures, but the approach is not consistent. All of the policies that mentioned sustainability highlighted the need to address food waste.
Some interventions to address food waste include on-site digesters and composters and donating food waste. Some included menu design and serving patients food at the time they want to eat – the “room service model”.
Two states mentioned the importance of prioritising local and seasonal food for minimising waste.
Carino said the “results show there is an opportunity for jurisdictions to share best practice and to improve coordination, and to adopt a more standardised and nationally consistent approach”.
Draft recommendations from this review include:
- Identify opportunities to update nutritional standards for food provision to include sustainability
- Provide guidance on updating hospital menus to include low carbon foods
- Review national food waste strategy and implement within the health system
- Embed principles of cultural safety in hospitals.
Carino said it’s important to take opportunities to look at what’s happening in practice, for example in food sustainability, and apply that into policy. Researchers should collaborate with health services and vice versa, and it is important to document these collaborations to help inform policy.
Emissions estimates
The final of the four reports discussed was about developing estimates of health system emissions.
Skellern said this will be “the foundation for all of our work on health system decarbonisation”, so that we can track progress.
Rachel de Sain, affiliate of the HEAL Network and CEO, Lead Advisor of codesain consulting, told the conference that while the numbers are being finalised, early estimates indicate that the total greenhouse gas emissions of Australia’s health system for 2021-22 amounted to 24,000 kilo tonnes. This is equivalent to approximately 5.3 percent of Australia’s production-based greenhouse gas emissions.
de Sain said that of Australia’s health system emissions, healthcare services contribute about 59 percent, aged care 33 percent and pharmaceutical manufacturing about eight percent.
On bridging research and policy, de Sain said it’s important to acknowledge the silos that exist in healthcare, academia and government, and then actively try to “create space for different people to ensure we work together”.
According to McGushin, other work underway as part of the National Health and Climate Strategy includes:
- A joint statement on ‘working together to achieve sustainable high-quality health care in a changing climate’, by the interim Australian Centre for Disease Control and Australian Commission on Safety and Quality in Health Care, endorsed by all specialist medical colleges and the Australian Indigenous Doctors’ Association
- A guide to support healthcare facilities reduce emissions from nitrous oxide, anaesthetic gas
- In the health in all policies space, exploring the inclusion of sustainability in Australia’s Dietary Guidelines
- Working with the Active Transport Fund to ensure health is considered in projects invested there.
Looking to the future, McGushin told the conference that while artificial intelligence and digital health are not significantly included in the National Health and Climate Strategy, they are on the “radar”.
• The main two-day national conference followed regional hubs held in most jurisdiction; some states will host their regional discussions in early 2025.
For more conference news, follow #Heal2024 on X, bookmark this link for further articles at Croakey, and also follow this conference X/Twitter list.
