Climate change is a health issue: where are the health professions?

As many parts of Australia go through one of the worst droughts in centuries, the issue of climate change is on the political and media agenda.

But where is the health sector in this debate? How can health professionals and groups learn from international efforts to improve the sustainability of the health system and its capacity to meet the health challenges posed by climate change?

In today’s post, Dr Peter Sainsbury, President of the Climate and Health Alliance, and Dr David Pencheon, head of the NHS Sustainable Development Unit, discuss how climate change can affect global health and the efforts being made in the UK to reduce the environmental footprint of their health system.

Peter Sainsbury and David Pencheon write:

The facts are simple:

• the world is getting warmer, principally because we have been burning fossil fuels and pumping carbon dioxide into the atmosphere at an increasing rate for the last two centuries;
• global warming is already increasing the frequency, severity, range and duration of extreme weather events. It is also damaging land and marine environments and threatening the survival of individual animal and plant species and whole ecosystems, on all off which human life depends;
• these problems are already visible but it’s going to get a whole lot worse as we move further into the 21st Century.

In a nutshell, anyone who has been paying attention knows that global warming leading to climate change is an extremely serious environmental issue.

More facts

But wait, there are more facts:

• the extreme weather events that we are experiencing with only 1^oC of average global warming are already causing injuries, diseases and deaths throughout the world – think heatwaves, droughts, bushfires, cyclones;
• as warming increases, the harms to human health are increasing considerably. In part this is due to the already visible, more severe and more frequent extreme weather events. But global warming will also reduce crop yields leading to food shortages, reduce the availability of fresh water in more regions leading to droughts, make more places uninhabitable because of rising sea levels or high temperatures, increase migration as populations try to find a home, food and water, and lead to increased interpersonal and international disputes and violence;
• health services themselves are making a sizable contribution to a country’s carbon emissions, something in the order of 5-10 percent of the total (more on this later);
• health facilities and services will be affected in many ways by the effects of climate change and need to be prepared not only for the increasing numbers of patients that present because of climate change but also for disruptions to their ability to deliver services when a severe weather event hits them.

Climate change is a health issue

So, climate change is not only an environmental issue, it is also a very serious health issue. And ironically the health services that we expect to treat illness and save lives are, through the carbon emissions arising from their own activities, causing some of the illness and death attributable to climate change. Yet, surprisingly, these issues have slipped under the public’s and even health care providers’ radar and have not so far received the attention they deserve in Australia.

In 2007 England established the NHS Sustainable Development Unit (SDU) with the explicit task of measuring and reducing the NHS’s environmental footprint, including its carbon emissions. David Pencheon was its founding Director. His recent retirement from the role allowed him to accept an invitation from the University of Sydney to visit Australia for five weeks earlier this year to meet with a wide range of health workers across SE Australia to share some of the learnings and insights gained from the first decade of the SDU.

Carbon emissions

Focusing here on carbon emissions, when the SDU first measured the emissions of the NHS in 2008, it found them to constitute 25 percent of public sector emissions and three percent of England’s total emissions.

What was even more unexpected though was where the NHS’s emissions originated. People immediately think power supplies for energy guzzling hospitals and transport but these each make up only about 15 percent of the NHS’s emissions. The remainder, approximately 70 percent, is accounted for by what the NHS buys (and often wastes) to provide patient care.

The largest single source of carbon emissions is pharmaceuticals (approximately 20 percent of the total), while medical devices account for approximately 10 percent. We haven’t much space here so if you want to see what the SDU did in response to these findings you’ll need to visit their website.

The good news story though is that when carbon emissions were measured again in 2015 they had decreased by 11 percent, despite an 18 percent increase in activity (and they saved £1.85 billion as a result).

Carbon emissions in the Australian health sector

Australian health services are nowhere near as institutionally or culturally prepared as the NHS to act to reduce our carbon emissions, nor are we as ready for the consequences of climate change. But there are some flowers starting to bloom:

• the Australian health sector’s carbon emissions have recently been measured. They are seven percent of the national total, about the same as South Australia’s carbon emissions;
• several state health departments are now progressing emissions mitigation and/or health service adaptation planning for the publicly funded services;
• groups of health workers around the country have taken the initiative and started their own environmental sustainability programs in their wards, operating theatres, engineering departments, general practices, etc;
• some local health districts have developed environmental sustainability plans and some have appointed environmental sustainability managers;
• a Framework for a National Strategy for Climate, Health and Well-being was published by an alliance of health organisations last year and the ALP has committed to implement something similar when next in government.

Lessons from the UK

But what has been learnt in England over the last 10 years that might help Australian health services build on initiatives like these? Five points are worth highlighting:

1. Action on climate change mitigation and adaptation must become routine business for all health workers, facilities and systems – just like keeping dangerous drugs under lock-and-key, peer review of clinical practice, fire safety and financial auditing. The best way to make this happen is to build it into existing quality and safety procedures and accreditation systems.
2. Engage with staff all the time; find out their ideas and motivations. Frame plans and actions that focus on health and make the actions possible, appealing and part of the core job for staff.
3. Emphasise that action on climate change need not be an unnecessary burden on workers’ time or the budget. The English experience is that actions to reduce carbon emissions in the health service can also improve patient care, promote good health, save money and increase worker satisfaction. These co-benefits provide wins all round.
4. Measure, compare and track progress, and build this into routine governance and reporting systems. Provide staff and the community with feedback on progress, successes and failures.
5. Remember, it’s each and every one of us and it’s system change. The diversity of a health system means there is always something more that can be done by both individuals and ultimately by the whole system. Individuals look for support from above and managers need staff to get things done.

It’s time for health services and health professionals to recognise that climate change is a health issue and to take responsibility for limiting the harm it will cause.