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Cultural context, empowered staff and local solutions are vital for sustainable healthcare

Croakey is closed for summer holidays and will resume publishing in the week of 15 January 2024. In the meantime, we are re-publishing some of our top articles from 2023.

This article was first published on Wednesday, August 16, 2023


The Greening the Healthcare Sector Forum, to be held on Noongar boodja in Perth next month as a hybrid event, could not be more timely, reports Alison Barrett for the Croakey Conference News Service.

On Twitter, follow #GreenHealthForum23 and this Twitter list of participants.


Alison Barrett writes:

Amid growing global concerns about the impacts of heatwaves upon health and health services, a regional Aboriginal Community Controlled Health Organisation (ACCHO) in Western Australia is taking steps to adapt to the changing environment.

The Kimberley Aboriginal Medical Service (KAMS), which represents eight independent member ACCHOs from towns and remote communities across the Kimberley region, is co-designing culturally appropriate heatwave adaptation resources for the region.

Community consultations as part of the KAMS Climate Health Adaptation Project found that heatwaves are a priority issue in the Kimberley region, according to Dr Sophie Moustaka, public health registrar and project officer employed by KAMS for its Climate Health Adaptation Planning project.

“We identified that there was an awareness that it is getting hotter, there is an increased intensity of heatwaves, and also less relief between the heatwaves,” Moustaka told Croakey.

Timely forum

How health services are addressing climate mitigation and adaptation will be profiled at the Greening the Healthcare Sector Forum next month, co-organised by the Climate and Health Alliance, the Global Green and Healthy Hospitals Network and Western Australia Sustainable Development Unit and hosted by South Metropolitan Health Service (SMHS).

The forum will take place on 14-15 September, in-person at the Fiona Stanley Hospital, and online, with the aim of providing “opportunities for connection, knowledge sharing, learning and upskilling for all attendees”.

Following its theme, “empowering action for sustainable, climate resilient healthcare,” the forum will focus on ‘how’ to empower action and include sessions on Caring for Country, strategy and systems, engagement, leadership and sustainability in practice.

The discussions could not be more timely, as escalating climate emergencies globally – fires, flooding, ice melt, and record high temperatures on land and in the oceans – highlight the importance and urgency of the development of Australia’s first National Health and Climate Strategy (as covered extensively by Croakey).

Protect Australians

Roland Sapsford, CEO of the Climate and Health Alliance told Croakey that the National Health and Climate Strategy “needs to be done right and fully funded – which means it must include protecting the health of Australians from climate change”.

On the climate-related disasters we have been witnessing around the world over the past few months, Sapsford said “we’ve been told for decades this moment was coming, and it’s now here. Climate change is knocking at our door, and we need to act urgently with everything we have”.

He said the Department of Health is reviewing a large number of submissions responding to the Consultation Paper on the Strategy.

“Originally the Department had planned to release the Strategy without releasing a draft. We have advised that allowing the sector to comment on a draft would be a good approach to ensure that it’s welcomed by the health sector.”

In their submission to the National Health and Climate Strategy, CAHA gave “strong feedback to advise that a draft strategy should be made available to the health sector for feedback. This is a key way to reassure people that their submissions have been heard. We know of several other organisations who have made the same request,” Sapsford told Croakey.

Roland Sapsford, photo supplied

Immediate action required

Kylie Woolcock, CEO of the Australian Healthcare and Hospitals Association, told Croakey that the climate-related disasters of recent months, including European heatwaves and fires in Greece and Hawaii, “have been devastating to watch – but not surprising”.

“Health professionals have been signalling the alarm for decades about the impacts of changing climate, yet governments and institutions have been slow to respond,” she said by email.

“We are now seeing the consequences of that inaction in real time, with devastating impacts on the health and wellbeing of people and communities.”

If Australia is to be prepared for the summer ahead, “action on health and climate needs to be prioritised immediately”, Woolcock said.

She added that the National Health and Climate Strategy “must respond to the health systems’ more immediate concerns, prioritising action that prepares the health workforce and health infrastructure to withstand the increased demand for services that will inevitably occur during extreme weather events and disease outbreaks”.

“Governments and health services must take immediate action to communicate and engage with communities to build their knowledge and resilience to respond to the impacts of a changing climate; and First Nations knowledge about environmental management must be prioritised and implemented.”

Significant work is already occurring within the sector to mitigate the health systems climate impact and build the resilience of communities. However, this work needs to be systematically supported, scaled and shared to allow meaningful impacts to be achieved. This can be underpinned by the Strategy but action to support the system cannot wait.

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, she added.

Kylie Woolcock, photo supplied

Aboriginal stewardship

The KAMS Climate Health Adaptation Planning Project is an important development to arise from the 2019 Climate Health WA Inquiry, which recommended strengthening adaptation planning as a key priority.

Additionally, the Inquiry found that “Aboriginal stewardship is as vital now as it is ever, and particularly in the climate health space”, Moustaka told Croakey.

The resources are currently being reviewed by members of the Kimberly community, and will share information on ways to prepare for and cope during a heatwave. Localised and culturally relevant resources are so important, Moustaka said.

KAMS is one of the three Aboriginal Community Controlled Health organisations in WA to receive support and funding from Aboriginal Health Council of Western Australia (AHCWA) to develop a climate health adaptation plan.

As well as developing community resources, KAMS is in the process of designing a heatwave clinic policy so their “clinics can be prepared to respond to heatwaves,” Moustaka told Croakey. An internal audit is being undertaken to look at clinical presentations related to recorded temperature that will help inform the clinical toolkit.

Kimberley Aboriginal Medical Service, photo supplied

Unique challenges

In South Australia, Aboriginal communities have been affected by climate emergencies in many different ways, according to Shane Mohor, CEO of Aboriginal Health Council SA.

The devastating floods in the Riverland region at the end of 2022 and early 2023 damaged Aboriginal heritage sites as well as disrupted health and wellbeing services. He said the impact from the damaged heritage sites was huge and “rippled through the community”.

Mohor told Croakey that during the floods Aboriginal Sobriety Group, an organisation that does a “lot of great work”, had workers who were unable to leave the Riverland town of Berri, and Adelaide head office staff were unable to visit sites in the Riverland region because of road closures.

The floods also had huge impacts on Aboriginal homeless people living on the riverbank as far south as Murray Bridge, he said.

River Murray, near Blanchetown, SA, during the 2023 floods. Photo supplied by author

AHCSA has been undertaking a scoping activity to identify climate risk issues for the ACCHO and broader Aboriginal health sector in SA, with a particular focus on regional and remote areas, which are disproportionately impacted by climate disasters, Mohor said.

Climate change poses unique challenges for regional and remote communities including water scarcity, inadequate housing and support during heatwaves, he told Croakey.

He also emphasised the importance of ensuring Aboriginal and Torres Strait Islander voices are heard and included in emergency management planning including for emergency communications.

“There is an absolutely clear need for improved communication strategies including culturally appropriate consultations that acknowledge and accommodate the values of Aboriginal law.”

He added that not everyone is in the same “communication bubble” and it is important to ascertain what communication forms are most accessible to each community.

Shane Mohor, photo supplied

Lessons from overseas

As project director for the Climate Health WA Inquiry in 2019, Dr Sarah Joyce was motivated to apply for a Churchill Fellowship to learn more about what other countries were doing in sustainable healthcare.

“It was about identifying best practice internationally and taking those lessons back to Australia,” said Joyce, who will be presenting at the Forum, on ‘How to deliver sustainable healthcare: perspectives from three countries and translation to WA’.

While Belgium, Switzerland, UK and Sweden are advanced in healthcare sustainability and practising “healthcare without harm”, Joyce said the Netherlands “is quite interesting” in what they are doing in the space by involving the private sector in the green transition through a Green Deal program.

While Joyce visited the Netherlands to learn more about the Green Deal program, once there she realised there were useful examples of hospitals “that had been designed with great sustainability features” including on biodiversity and wastewater.

For these hospitals, it’s not just about greenhouse gas emissions, but also the “broad environmental impact that the healthcare system has”, she said.

Rooftop garden at Erasmus Medical Centre, Netherlands. Photo by Dr Sarah Joyce

Joyce told Croakey the places she visited that were most successful at sustainability took a “collective approach”, empowering staff across the organisations to take action. They put a lot of effort into “building capacity across the system and making sure they were developing expertise and skill sets”.

“Sustainability really needs to be part of everyone’s responsibility,” she said.

However, to be really successful, health organisations need “high level, system leadership”.

Ambitious policies and strong governance processes are important for holding the sector to account and driving change, according to Joyce, current Lead Sustainable Development Officer, Department of Health, WA.

“As a healthcare organisation, we have a really strong responsibility to not just the current patients and population but also the future generations as well,” Joyce said.

Joyce with Professor Alex Burdof, Chair of Public Health at Rotterdam Public Health; and Erasmus MC atrium. Photos supplied

Building workforce capacity

Looking to the future, Western Australia’s Department of Health is in the process of developing a whole of health strategy that sets out guidelines for reducing emissions, operating more sustainably and implementing adaption measures to protect communities, Joyce told Croakey.

They have also established a sustainability and healthcare scholarship to build knowledge, skills and capacity across the workforce.

Joyce added they are experiencing substantial engagement from regional and remote health services likely “because they can see the impacts of climate change perhaps more obviously than we do in the metro area”.

During the 2023 northwest floods, remote health services were the ones who witnessed first-hand the implications of climate change on disruptions to supply chain and healthcare access.

Cultural lens

While learning from international colleagues is critical for sustainable solutions in healthcare, it is important to acknowledge local and cultural contexts, according to Vicktoria Blake, Te Whatu Ora Health New Zealand Interim Head of Sustainability in Aotearoa New Zealand.

“We can’t solve climate change on our own. We can’t solve it in isolation. We need to come together collectively to find the solutions,” said Blake – who will also be presenting online on ‘Te Whatu Ora Health New Zealand’s approach to Environmental Sustainability and Climate Resilience’.

In terms of international examples, Blake told Croakey the NHS in the UK has some good policy, structures and platforms for sustainability in healthcare but “what they don’t have is the cultural lens that we must apply in our context in Aotearoa New Zealand when considering Te Tiriti o Waitangi”.

The sustainability team at Te Whatu Ora look to the NHS for frameworks but acknowledge their way of doing things are not always appropriate for the New Zealand environment.

It’s important to make that “incredibly strong connection between the health of the environment being so inherently connected to the health of people – we are a part of nature and not apart from it,” she said.

Blake told Croakey that her sustainability team genuinely aims to embed te Ao Maori, the Maori world view, in addressing climate change.

Echoing sentiments by others interviewed by Croakey, Blake said we shouldn’t just be talking about mitigation – we also “have to be planning for the health impacts of climate change for our service delivery,” she said.

Blake told Croakey that an important change was legislated to include “climate change as one of the determinants of health” in the Pae Ora (Healthy Futures) Act 2022.

“Naming climate change as a determinant of health really enables our public health systems and services to take an environmental lens to its activities,” Blake said. While the health sector needs to reduce its footprint, it also needs to be “planning for the changes that are happening”.

Vicktoria Blake, photo supplied

An update on Greening Royal Darwin Hospital

Dr Mark de Souza and Aunty Dr Bilawara Lee spoke with Croakey (via email) to provide an update on the Greening Royal Darwin Hospital project that we reported in the lead up to last year’s Greening Healthcare Forum.

De Souza and Lee told Croakey they have planted 950 local native Australian trees and shrubs, half of which are culturally significant species identified by Larrakia plant experts.

“Planting zones are demonstrating a 22-degree Celsius reduction in land surface temperature, with staff and patients reporting positive impacts on their wellbeing and a desire to regularly use the green spaces,” they said.

They plan to instal additional seating and footpath infrastructure and signage, as well as “designing an app-based project to promote literacy of the climate-biodiversity-health nexus and greater engagement in biophilic encounters in the healthcare setting,” De Souza and Lee said.

They will be presenting at the Greening the Healthcare Sector forum in the Caring for Country session on Day Two. You can watch their presentation at last year’s forum here.

Aunty Dr Bilawara Lee and Dr Mark de Souza, Royal Darwin Hospital, Larrakia Country, photo supplied

Declaration: Alison Barrett, Professor Megan Williams and Dr Melissa Sweet from Croakey Health Media are presenting a workshop on climate communications at the forum.


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