Efforts to reduce the carbon footprint of medicines, and to tackle waste, overdiagnosis, overtreatment and low value care will be discussed at the upcoming National Medicines Symposium, reports Alison Barrett in this preview article for the Croakey Conference News Service.
Symposium speakers will put the focus on the importance of prevention, participatory, co-design and systems approaches, regional and local solutions, and health literacy.
Alison Barrett writes:
Australia urgently needs to change how we use medicines to support a more sustainable healthcare system – and everyone has a role to play, whether they be general practitioners, pharmacists, policy-makers or consumers.
That’s according to leading health experts who will participate in the National Medicines Symposium next week, with the theme, ‘The future of medicines: good for people, good for the planet’.
The symposium will put the spotlight on reducing the carbon footprint of medicines, tackling waste, overdiagnosis, overtreatment and low value care, as well as profiling innovation.
Health professionals especially must step up, say experts interviewed by Croakey.
“Health professionals hold power and privilege, and with that comes responsibility,” Dr Emma-Leigh Synnott, Medical Advisor at the Western Australia Department of Health’s Sustainable Development Unit, told Croakey ahead of the symposium.
Grace Wong, a pharmacist and founder of Pharmacists for the Environment Australia, said health professionals can help communicate about issues of sustainability in medicines.
“Health professionals are in a very valuable position because they are generally very evidence-based, articulate people who can help communicate this,” Wong said.
Improving sustainability in medicines requires collective and broader actions including health system reforms, with a focus on prevention of disease, as well as individual actions including package recycling and returning unused medicines, health leaders told Croakey.
According to Synnott, we can too easily become focused on conversations about what the individual can do, but “we need to recognise that as a wicked problem it requires system approaches”. We must think about what we can do as organisations, systems, sectors, and across society, to collectively “create meaningful change”, she said.
These sentiments were echoed by Wiradjuri yinaa (woman) Professor Faye McMillan AM who said the Symposium is an opportunity to talk about health and wellness more broadly.
All aspects of addressing sustainability are not in isolation, McMillan said. We need to create a sustainable supply chain, manufacturing and workforce.
She added that following the Voice referendum, a really important aspect of sustainability is asking ourselves how we have “relationships with First Nations communities and organisations that are truly sustainable in spite of political environments”.
McMillan – a community pharmacist in regional New South Wales and one of the two Deputy National Rural Health Commissioners – told Croakey that to address sustainability in medicines, we need to look at the big picture and stop operating in silos.
Synnott agreed. “Sustainability is one of these challenges where we cannot expect to solve these problems through the same thinking and ways of operating that created them in the first place,” she said.
These are some of the conversations that will be had at the Symposium, to be held online on 8 November, hosted for the first time by the Australian Commission on Safety and Quality in Health Care.
The symposium is timely as the health sector awaits further news on the development of Australia’s first National Health and Climate Strategy, which Minister Ged Kearney’s office told Croakey this week “is being informed by an extensive engagement and consultation process involving researchers, clinicians, First Nations people and the wider public”.
The Medical Journal of Australia is one of more than 200 health journals to have issued a joint climate emergency editorial calling on the United Nations, political leaders, and health professionals to recognise that climate change and biodiversity loss are one indivisible crisis and must be tackled together to preserve health and avoid catastrophe.
This overall environmental crisis is now so severe as to be a global health emergency, they state, warning:
The world is currently responding to the climate crisis and the nature crisis as if they were separate challenges.
This is a dangerous mistake. The 28th UN Conference of the Parties (COP) on climate change is about to be held in Dubai while the 16th COP on biodiversity is due to be held in Turkey in 2024.”
This year’s COP will be the first time there is a dedicated Health Day – on 3 December – at the event, including the first Climate Health Ministerial, which will launch a Declaration on Climate and Health, with the goal to “make health an anchor of the climate agenda”.
Consumer voices enable equity
Ensuring consumers are leading the conversation about sustainability in healthcare is critical, Consumer Health Forum CEO Dr Elizabeth Deveny told Croakey.
Deveny said early input from consumers will give governments a mandate to potentially act quicker than they currently do and enable responses and solutions to be more equitable.
McMillan said that effective policy is an enabler to sustainability in medicine “that is driven through authentic narratives rather than just policy” designed by those who potentially do not have first-hand experience.
“If there’s no consumers, no real voices, is the policy practical? Can it be implemented? Is it achievable?” she said.
Additionally, both Synnott and McMillan commented that solutions to big problems will often come when these are localised and contextualised.
This, McMillan said, can lead to solutions that then lead to larger conversations.
“The problems are global, but solutions must also be explored regionally and locally,” Synnott said, adding that in this we need to acknowledge cultural context and listen to, and be guided by, First Nations Elders, knowledge holders, and leaders, who demonstrate what it is to “live in balanced deep relationship with place for time immemorial”.
She said we need to also recognise the strengths of communities, and weave their knowledge into creating solutions, via participatory co-design processes.
Consumer and patient health literacy is another important aspect of the sustainability solution, according to Darlene Cox, Executive Director of Health Care Consumers’ Association.
She said Choosing Wisely’s 5 questions to ask your doctor is a useful tool for consumers to achieve higher value care and build health literacy.
Cox noted that health literacy was not included in the National Health and Climate Strategy Consultation Paper and hopes to see it in the final strategy.
“We know how important health literacy is for consumer empowerment. If we’re wanting people to be informed and empowered to take action, we have to address it in the Health and Climate Strategy,” she said.
To encourage the appropriate use of medicines, it’s important for GPs and other healthcare professionals to listen to patients, provide a good clinical examination and also an explanation as to why a medicine may not be needed, according to Dr Liz Marles, Clinical Director of the Commission.
This is one way to enable medicine stewardship – “the appropriate use of medicines” – which will be a “win, win, win” in sustainability – better for the patient, environment and the healthcare system, she said.
“When we talk about medicine stewardship, it’s really about curating the use of medicines so that they’re used appropriately and retain their value,” she said.
Marles told Croakey of a recent review that found that approximately 250,000 hospital admissions annually in Australia are medication related, two-thirds of which are potentially preventable.
She said many medications are over-used including antibiotics, opioids, treatments for reflux and anti-psychotics in aged care.
Strategies to guide and support health professionals
It’s also important to support GPs in tackling overuse. “In a system where people are time-poor, often the easiest thing to do is write a prescription and that’s what we really need to try and avoid,” Marles said.
The Commission is working on a Climate Resilience and Environmental Sustainability Healthcare Module for the National Safety and Quality Health Service Standards, anticipated for launch following a pilot in early 2024.
Marles said this will be another resource to “help practitioners and health services get to see how they can improve what they’re doing in terms of sustainability”.
The Commission told Croakey via a statement that, following the Module’s release, their initial objective will be to raise awareness and adoption of the Module.
While initially voluntary, the Commission said they anticipate “building environmental requirements into existing mandatory standards”. Health services that implement the Module will be assessed through the same accreditation and reporting processes as other national quality and safety standards. Read the Commission’s full statement on the Module here.
WA’s Sustainable Development Unit is currently developing a Strategy that will outline how WA Health will “reduce emissions, operate more sustainably and implement adaptation measures to protect the community from health risks associated with climate change,” Synott told Croakey.
“Getting the Strategy out is going to be a really pivotal body of work for the WA Health System,” Synnott said, as it will help guide the future system-wide approaches to this challenge. Extensive stakeholder engagement has been critical throughout the development to ensure the Strategy is robust and fit-for-purpose.
Returning unused medicines
Helping Australians dispose of medicines appropriately is one tool to help improve sustainability in medicines, according to Toni Riley, Project Manager of the Returning Unused Medicines program.
The fully Commonwealth-funded program has been running for 25 years in community pharmacies, and is included in the Pharmacy Board of Australia’s dispensing guidelines.
While appreciative of the Commonwealth funding, Riley told Croakey RUM is a “very lean organisation” and does not have a huge budget for marketing or raising awareness.
Riley told Croakey they collect 800,000 kg of medicines each year.
Synnott told Croakey about some non-pharmacological therapy options already in action in her hospital in WA – helping to reduce pharmaceutical use and decrease healthcare waste and emissions.
One example is the State Rehabilitation Service Garden Therapy program where patients engage in garden therapy as part of the rehabilitation in the spinal injury unit at the Fiona Stanley Hospital.
Another example is the ‘Surg-Fit’ program that has been established at Fiona Stanley Hospital, helping patients prepare for surgery through education, focusing on interventions such as physical exercise, diet, smoking cessation, and reducing alcohol to improve surgical outcomes.
Calls to action
The health leaders provided some calls to action for Croakey readers, health professionals and policymakers.
Wong told Croakey that it is important for pharmaceutical companies to be involved in sustainability solutions – and some are – but “we don’t want greenwashing”.
Acknowledging the wider actions required, Cox said “wouldn’t it be amazing if everyone at the NMS committed to reducing their work travel by half?”
Cox also said we need to increase messaging around the environmental damage from unwanted medicines.
According to Deveny, standards need to be implemented to reduce packaging waste in medicines, unnecessary single use items should be outlawed, and health equity should be improved by focusing on prevention of disease.
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