This article is published as part of Croakey’s contribution to the global Covering Climate Now collaboration, and was funded by our Patreon crowdfunding campaign to support public interest journalism on climate and health.
Mark Ragg writes:
Health care is carbon-intensive and contributes to climate change; in Australia, it is the cause of seven percent of national carbon dioxide equivalent (CO2e) emissions.
The health sectors of 36 major countries are responsible for 4.4% of annual global CO2e emissions, and hospitals are the main sources of these emissions.
On 4 May 2020, The Medical Journal of Australia published a special issue concerned with sustainable healthcare.
Below are summaries of six papers from the issue, while this Twitter thread reports on the issue’s virtual launch on 5 May, where the speakers included Dr David Pencheon, the Founding Director of the Sustainable Development Unit in NHS England and Public Health England.
The carbon footprint of pathology testing
A considerable proportion of pathology services ordered are thought to be unnecessary – between 12% and 44% according to one meta-analysis.
The authors took a step towards quantifying the environmental impact of such waste by estimating the carbon footprint (as expressed by CO2e) associated with five commonly ordered pathology tests in two Australian hospitals:
- full blood examination
- coagulation profile
- urea and electrolyte levels (U&E)
- C-reactive protein concentration (CRP)
- arterial blood gas testing.
The results are in the table below.
To put it simply, ordering one full blood examination is equivalent to driving 770 metres in an average car.
For most tests, the main sources of CO2e emissions were sample collection consumables (swabs, gloves, vacutainer holders and collection tubes, specimen bags). As CRP was generally ordered together with U&E, it had no separate emissions impact during the collection phase.
More than half the CO2e emissions associated with the British National Health Service are caused indirectly by the use of consumable items, including pharmaceuticals and medical devices.
The authors say: “While the greenhouse gas impact of individual tests is relatively small, 17.8 million haematology and 56.2 million biochemistry tests were funded by Medicare during 2018–19.”
In the hierarchy of waste reduction – avoid, reduce, re-use and recycle – there appears to be great opportunities to reduce. “The main opportunities for reducing waste and CO2 emissions involve changing the behaviour of clinicians to avoid and reduce unnecessary pathology testing,” they say.
Bushfire smoke: urgent need for a national health protection strategy
While bushfires are part of national life, the risks they bring have increased with climate change.
The 2019–20 bushfires in southern and eastern Australia directly caused at least 33 deaths, extensive property damage and terrible loss of flora and fauna. A major public health concern is population exposure to atmospheric particulate matter (PM) with a diameter < 2.5 μm.
Such exposure can adversely affect health outcomes with increases in mortality rates in Sydney on days with high bushfire smoke pollution, increases in hospital admissions, emergency department attendances, ambulance call‐outs and general practitioner consultations with high levels of particulate matter. High temperatures amplify these risks, they say.
Current health protection advice related to bushfire smoke mainly focuses on short term measures aimed at reducing personal exposure to pollution.
But more nuanced and detailed advice, which considers long-term effects, could consider:
- tailoring advice so as to include suggesting outdoor activities in the early morning, when the air is generally clearer
- describing air quality by location, as it can vary significantly across a city
- considering temporary relocation in particular circumstances for particular people at high risk, whether that’s in a different location or in better housing in the same area.
The authors strongly recommend that all Australian jurisdictions present actual hourly PM2.5 data, rather than an index. Real time, hourly averaged PM2.5 concentrations are the most appropriate metric to guide personal behaviour that minimises exposure to bushfire smoke, they say.
Consistency of air quality information and related public health advice across jurisdictions is essential. It is time for an independent national expert committee on air pollution and health protection to be established to support environmental health decision-making in Australia.
This new expert committee should have a clear mandate and resources to develop evidence‐based, accurate, practical and consistent advice on health protection against bushfire smoke, and air pollution more broadly, across jurisdictions.
Hospital food environments: a human and planetary health opportunity
Healthier human diets, with more plant-based food and less processing, can reduce the risk of some chronic health conditions while also reducing greenhouse gas emissions.
Some hospitals are improving the quality of food sold in hospitals, in line with guidelines developed by state governments and healthcare providers.
But inpatient food guidelines are often outdated, and rarely consider sustainability, the authors say.
Promising initiatives include:
- NZ Ministry of Health’s Sustainability and the health sector
- Room service in a public hospital improves nutritional intake and increases patient satisfaction while decreasing food waste and cost
- Victorian Department of Health’s Healthy and high-quality food in public hospitals and aged care services.
A sustainable future in health: ensuring as health professionals our own house is in order and leading by example
Professor Nick Talley, MJA editor, called on his colleagues to step up. “The time for complacent acceptance of the status quo must end; it is time for health professionals to step up and lead on a sustainable environment and health. At the MJA we hope every health professional will work to do so with us,” he says.
The MJA pledges to do its part. AMPCo, which publishes the MJA, has no direct investment in fossil fuels. And the MJA plans a staged reduction in print, alongside a plan to reduce waste, while acknowledging that its print version is still wrapped in plastic.
Talley says health professionals should “lead by example in our homes and practices and with how we travel”.
He says: ‘we can educate our patients and those we work with and train.’ And ‘we can influence the health system we are a key part of too, for example, by working on strategies to drive down carbon emissions, waste and pollution from our hospitals’.
Acting on climate change and health in Victoria
The authors describe efforts made by the Victorian Government to address climate change, in the context of recent health events directly related to climate change such as:
- the 2009 Victorian heatwave, with an estimated 374 excess deaths and a 12% rise in emergency department presentations
- the 2014 Victorian heatwave, with an estimated 167 excess deaths, and resulted in a fivefold increase in heat‐related public hospital emergency department presentations
- a 7.5‐fold increase in Ross River virus disease following the 2016–2017 Victorian floods
- the 2019–20 bushfires which caused hazardous air quality and direct loss of life.
The Victorian Climate Change Act 2017 requires the Victorian Government to:
- contribute to whole‐of‐government emissions reduction to meet net zero emissions by 2050
- prepare whole‐of‐government and sector emission reduction pledges
- develop and implement adaptation action plans, detailing the risks and impacts on systems (including health and human services)
- endeavour to ensure that any decision made by the Victorian government and any policy, program or process developed or implemented takes account of climate change.
The authors say:
Victoria has set a foundation for fundamental change in legislation. The supporting policy and strategy elements, focused on population health and wellbeing, are additional enablers for such change. We have an opportunity to build a more resilient sector while limiting our contribution to the climate crisis. We must take it.
Climate change represents an existential threat to human health. The health sector, as a key support to human health and wellbeing, as well as a significant contributor to Australia’s emissions, has a key role to play in addressing this threat.”
Climate health inquiry: where sustainability, public health law and climate action intersect
The authors describe moves in Western Australia towards embedding sustainability in government and the law.
In 2008, the first climate change adaptation report in Australia specific to the health sector was produced in WA.
The Public Health Act 2016 (WA) followed, enunciating the following principles.
The sustainability principle requires that public health, social, economic and environmental factors be considered in decision making.
The precautionary principle states that ‘if there is a public health risk, lack of scientific certainty should not be used as a reason for postponing measures to prevent, control or abate that risk’.
The principle of proportionality requires that decisions made, or actions taken, should be proportionate to the public health risk, taking into account individual, business and community impact.
The principle of intergenerational equity states that ‘the present generation should ensure that public health is maintained or enhanced for the benefit of future generations.’
The principle relating to local government states that ‘the functions of local governments in relation to public health should be acknowledged and respected’.”
The Sustainable Health Review ran from 2017 to 2019, and made recommendations that, among other things, the health system should reduce its environmental footprint, with three components:
- reduction in environmental footprint (energy, waste, emissions and consumables), driven locally but coordinated on a system-wide basis, guided by the National Health Service model in the United Kingdom
- transparent public reporting on the WA health system’s environmental footprint by July 2020
- establishment of an inquiry under the Public Health Act 2016 (WA).
“The Climate Health WA Inquiry is, to our knowledge, the first statutory inquiry anywhere in the world focused on the health impacts of climate change. Our task is to create a practical path forward for the health sector in WA, consistent with the size and timeframe of the challenge provided,” the authors say.
The inquiry findings will form the basis of a new, coordinated health and climate change framework for WA.
Its recommendations will also be aligned with the proposed State Climate Policy — a roadmap for planning and investment across all sectors of the economy.
If the report can successfully localise the impacts, engage the public and prioritise actions needed in one Australian state, it will have broader national and global significance as a model for regional inquiries and reports.”
• Dr Mark Ragg is an editor at Croakey, and a writer, publisher and Adjunct Fellow Indigenous Health, Faculty of Health, UTS
Watch the launch
This article is published as part of the Covering Climate Now initiative, an unprecedented global media collaboration launched last year to put the spotlight on the climate crisis in the leadup to a Climate Action Summit at the United Nations General Assembly in New York on 23 September. It is co-founded by The Nation and the Columbia Journalism Review (CJR), in partnership with The Guardian. See Croakey’s archive of climate and health coverage.If you value Croakey’s coverage of climate and health, please consider supporting our Patreon fundraising campaign, so we can provide regular, in-depth coverage of the health impacts of the climate crisis, taking a local, national and global approach.
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