Twelve medical colleges have issued a joint statement calling for the National Health and Climate Strategy to be fully funded and to do “more than just reduce health sector emissions”.
Underscoring concerns raised by a recent Croakey article, they say the strategy “also needs to build stronger, healthier communities that are able to thrive in the face of climate change”.
Meanwhile, consumer groups are calling for stronger and ongoing engagement of consumers in development and implementation of the strategy, while the Australian Healthcare & Hospitals Association is also highlighting the importance of co-design and system change.
The article below is part of an ongoing Croakey series summarising submissions to the strategy consultation.
Melissa Sweet writes:
Consumers must be much more actively engaged in the development and implementation of the National Health and Climate Strategy to ensure it is effective and equitable, according to consumer health groups.
The call comes in a submission to the strategy consultation document, from the Consumers Health Forum, together with the Health Consumers Council Western Australia, Health Consumers New South Wales, and Health Consumers Queensland.
“The involvement of consumers as a stakeholder in the health system is sorely lacking throughout the document,” says the submission. “The engagement of diverse and representative consumer groups is critical in the development of a Strategy that is both just and effective.”
The submission suggests “community engagement” should be added as an objective of the strategy, and stresses the importance of increasing the climate literacy of communities (echoing a suggestion in Croakey Health Media’s submission to the consultation).
“For a Strategy such as this to be effective, the activation of all stakeholders in the health system must be a priority,” says the submission. “Consumers make up the largest group of stakeholders in the system, and climate change is an increasing priority for health consumers across Australia.
“Ensuring that a diverse and representative body of consumers from across communities at the greatest risk of climate change are proactively engaged in this work is essential. This includes First Nations communities, rural and remote communities, and those experiencing health disadvantage.”
The submission also says that addressing the social determinants of health and inequities should be central to the strategy.
“A key element of effective preventive care is the reduction of societal inequity. Increasing the protections of people experiencing health disadvantage across all sectors should be a goal for this strategy in order to both increase public health and thus reduce the impact of the healthcare system.
“This will require a collaborative approach, engaging with diverse stakeholders, and engaging in good-faith practice to increase housing security, food security, and to reduce the impacts of the social determinants of health.
The submission says the highest priorities for the strategy must be mitigation and equity.
“Too often policies are put in place that protect economic interests at the cost of environmental and social concerns, and the strategy must, in the strongest terms, oppose this,” say the consumer groups.
While the consultation paper asks for suggestions about what ‘quick wins’ in emissions reduction should be prioritised, CHF views a push for quick wins as short-sighted.
“What is needed is a push towards a system-wide paradigm shift. It is not enough for this Strategy to prioritise a small number of high-visibility changes at the expense of greater-impact systemic change.”
The submission says is crucial that steps taken for adaptation action do not widen the gaps in available healthcare to those who are already at a disadvantage, and that access to healthcare and quality of healthcare should not be compromised.
“Many people already struggle to balance the costs of healthcare with rising rent and food costs. The choice between medication, housing, and nutrition is not something that anyone should have to make and yet we hear routinely from our consumers that this is a situation that many are in.”
Co-design and consultation critical
The importance of co-design is also highlighted in the Australian Healthcare & Hospitals Association (AHHA) submission.
The AHHA is currently represented on the Chief Medical Officer’s Advisory Group for the development of the National Health and Climate Strategy, co-leads the ‘health systems resilience and sustainability’ stream of the Healthy Environments And Lives (HEAL) Network, and is also an active contributor as part of the Health Working Group to the Better Futures Australia Initiative, a cross sector initiative aimed at reducing Australia’s carbon footprint.
The AHHA says its experience in sustainability research, policy and practice gives it important insights into what is needed to develop a practical and meaningful National Health and Climate Strategy.
“We feel it is a missed opportunity that an Aboriginal and Torres Strait Islander voice was not included within the Chief Medical Advisory Group given the prominence of First Nations leadership throughout the draft strategy and the identified impact that climate change is expected to have on First Nations Health,” the submission says.
For the strategy to be effective it must ensure the consultation process is broad and engages the diversity of the health sector, including:
- The breadth of the health and aged care workforce working at the coalface, including allied health, primary care, nursing, community care, rural and remote health workers and more.
- Healthcare leaders and executives.
- Health administrators, finance, procurement, environmental services, supply chain, transport and urban planning professions.
- Aboriginal and Torres Strait Islander peoples and communities.
- Young people as they will be the most impacted by inaction.
- Consumer voices.
- State and territory representatives.
- Rural and remote voices.
Lessons from the NHS
The AHHA says recent research on the progress of the NHS towards decarbonisation has found that initial gains towards becoming more sustainable and less carbon-intensive, achieved through actions targeting energy and transport greenhouse gas emissions, have stalled.
The research highlighted a lack of emphasis on engagement activities with clinicians, patients and partners in the process of developing plans and finding solutions as a barrier to continued progress.
Australia has an opportunity to learn from the NHS experience and embed co-design and engagement from the Strategy’s inception.
“This will ensure the creation of a more meaningful document that can support practical implementation within services delivering care,” says the AHHA. “It will also act to support the creation of a community of champions who feel ownership over the Strategy and can lead change within their individual services and broader spheres of influence.”
The Strategy must support the establishment of governance mechanisms that enable continuous engagement of all stakeholders, especially the population groups most vulnerable, in the collaborative design and decision-making process concerning the priorities for adaptation within the Strategy.
As well, the Strategy should include focus on the essential role of health systems in education and advocacy within the Australian community regarding the impacts of climate change on health and wellbeing
AHHA recommends a greater emphasis on young people as a priority population within the strategy, as an increasing body of evidence demonstrate that younger people are disproportionately reporting mental health impacts as a result of climate change.
Clear timeframes and accountability processes are needed, together with a commitment to transparency and public reporting of progress against Strategy objectives.
Climate in all health policies
In addition to a health in all policies approach, AHHA recommends the inclusion of the objective ‘climate in all health policies’ – to signal to the health sector and the Australian community that reducing the impact of healthcare on the planet is everyone’s responsibility and should be embedded in all health policy and practice decisions.
“This will be critical to support the significant cultural change that will be necessary at the service delivery level to shift practice away from care that produces unnecessary waste, is inefficient or of low value, towards care that balances patient safety with the ethical responsibility to protect population health through limiting the impacts of healthcare on the planet.”
The submission says the greatest opportunity that Australia has to reduce the impacts of climate on health is to work collaboratively across sectors, jurisdictions and within the health sector to share information and prioritise collaborative action.
“To date, however, this collegiality has been hampered by long standing policy silos and poor sector communication. Consequently, elements of the health system remain unaware, or have not considered, the role they could play through existing structures to incentivise climate action and support the creation of a climate resilient health system that protects the health and wellbeing of communities.”
The submission highlights the potential to reduce low-value pathology, low-value diagnostic testing (medical imaging), and to reduce pharmaceutical over-prescription.
It says health workforce shortages resulting from climate change must be prioritised as an area for adaptive action within the Strategy.
As well, it will be crucial to avoid constructing new healthcare facilities in areas prone to climate change-induced damages.
Croakey wonders how often this is happening??
See Croakey’s articles on consumer health matters