A forum on sustainable healthcare has heard about the importance of embedding cultural safety in the movement to green healthcare, and about the need to move from a culture of efficiency to valuing sufficiency, while waste in healthcare should be addressed as a design flaw.
Below, Remy Shergill from the Climate and Health Alliance, shares other key takeaways from #GreenHealthForum21.
(And on Thursday, 2 December, follow #healthclimatesolutions21 for more discussions on sustainable healthcare).
Remy Shergill writes:
On 30 November, the Greening the Healthcare Sector Forum was held by the Climate and Health Alliance, the Global Green and Healthy Hospitals Pacific network and UnitingCare Queensland.
Hundreds of people gathered in Meanjin/Brisbane on Yuggera/Turrbal Country, and were joined by hundreds online across Australia.
It was a bumper agenda, packed with new research, innovative solutions and thoughtful reflections. Attendees reported they felt inspired, hopeful and motivated after the event.
What do we do with such a wealth of information? Here are eight key takeaways.
1. We need a culture shift, starting with cultural safety
Dr Janine Mohamed, CEO of the Lowitja Institute and a keynote speaker, set the scene early with a call for the health sector to shift from cultural awareness to cultural safety.
Cultural safety is requiring people from the dominant culture to “gaze inwards”, identify their biases, understand where they come from, and to challenge them. It’s meant to make you feel “uncomfortable”.
This is different from cultural awareness as many of us know it, where the process casts anyone outside the dominant culture as “other” and doesn’t tackle the entrenched biases and myths which perpetuate racism.
Mohamed said “unlearning entrenched systems” was crucial to reaching the conference’s theme goal: “net zero emissions, climate resilient, equitable and environmentally sustainable healthcare sector, ensuring good health for all”.
Climate change is rarely acknowledged in health policies targeted at Aboriginal and Torres Strait Islander peoples, even though it is inextricable from good health outcomes and connection to Country.
Allies are asked to implement the four outcomes on page seven of the Lowitja Institute’s discussion paper on climate change and Aboriginal and Torres Strait Islander health.
2. Efficiency to sufficiency
The negative health effects of poor resource use were pointed out over and over, from low value testing and procedures, to using desflurane and metered-dose inhalers (carbon hotspots in healthcare) to diets which didn’t meet daily nutritional needs.
But it’s not enough to “technically green” processes and products in order to reduce their carbon footprint, pointed out Martin Hensher, Associate Professor, Health System Financing and Organisation at Deakin University.
The culture which drives them must also change.
When we speed up processes, make products cheaper, reduce the carbon footprint, and other ways to increase “efficiency”, we tend to increase our consumption, leading to overtesting and low-value and harmful healthcare.
Instead, the health sector needs to focus on doing enough really well and not doing too much.
3. Waste is a design flaw
Ashleigh and Jaine Morris are sisters who have founded Coreo to bring the health sector into the circular economy.
COO Jaine Morris said: “The linear economy is the interconnection of three things: Fossil fuels providing cheap energy; cheap credit providing buying power to the masses; and economies of scale, meaning we’re producing and consuming more and more.
“The linear economy is driving an unsustainable health system.”
CEO Ashleigh Morris said: “A circular economy asks us to turn this around… We design out waste and pollution; we keep products and materials in use at their highest value for as long as possible; and we regenerate natural systems.”
Circular economies could generate USD 4.5 trillion in annual economic output by 2030.
4. Lessons on making it happen
Dr Ben Dunne, thoracic surgeon at the Royal Melbourne Hospital, provided advice on how to get these cultural shifts considered and implemented by leveraging key moments.
For instance, when a $10 billion redevelopment of the Royal Melbourne Hospital and Royal Women’s Hospital was announced, Dunne got in touch with Doctors for the Environment’s Sustainable Healthcare Interest Group for advice on how to advocate for all-electric hospitals.
Dunne’s presentation was a highly practical guide to the who’s who of decision-making in the construction of a hospital. He advised to “get in on the ground floor”, recruit some sustainability champions with the senior executive staff, and to utilise care when deciding whether to involve the media.
5. Move beyond passion projects
Despite the clear evidence that climate change and unsustainable practices are having a tangible impact on health, speakers lamented that much of this work is still left to dedicated staff volunteering time (or actual volunteers).
An attendee asked Dr Kate Charlesworth, climate-risk lead at North Sydney LHD, how to make sustainable healthcare work paid.
Charlesworth agreed with the premise, saying that a lot of the work she’s seen in sustainable healthcare has been driven by passionate people in their own time, rather than integrated into their normal workload.
Dietitian Stefanie Carino presented her part-time role at Eastern Health, an innovation to improve food and nutritional sustainability in the hospital.
“There’s a real need to have a dedicated role to provide the leadership and strategic guidance to get the work done.”
Many viewers left comments wishing for similar roles to be in their workplaces.
6. Telehealth is climate action
Professor Anthony Smith is a world expert in telehealth, working at UQ’s Centre for Online Health.
Though telehealth has enjoyed an elevated status in the past two years, academics and practitioners have been advocating for improved access to telehealth for decades.
Smith has worked closely with clinicians to develop multiple remote models of care for different patient types, like diabetes patients and aged care patients.
7. Tackling every piece of the pie
One chart came up again and again yesterday – this one from The Lancet in 2018.
While it’s clear that hospitals emit the most, there is plenty that smaller pieces of the pie can do to reduce their emissions – like in general practice.
Dr Kate Wylie from RACGP clearly demonstrated how GPs can play a major role in reducing healthcare emissions indirectly – by the pharmaceuticals prescribed, by reducing the burden on hospitals and by using their position as a community leader to talk about climate change.
To further the role she can play, Wylie would like to see carbon footprint information on competing drugs.
“I would love to know which drug is more environmentally friendly: Lipitor or Crestor.”
8. Healthcare decarbonisation is inevitable
It can be easy to see sustainability as a step-by-step process, so it was good to get the big picture from Dr Nick Watts, the Chief Sustainability Officer of the NHS in the UK.
Watts is Perth-born and was referred to as the “rockstar of sustainable healthcare” by one enthusiastic speaker.
Watts guided the NHS to be the first healthcare system in the world to have a net zero emissions target.
“For the emissions we can control directly, we’ll reach net zero by 2040. For our scope 3 emissions, 2045.”
“We need interim targets which make us feel uncomfortable to get things moving [80 percent reduction by 2028].”
Watts said the COP26 summit has made him “cautiously optimistic”.
“A year ago, we were the only healthcare system with a net zero emissions target,” he said.
“In Glasgow, we went from one to 14 healthcare systems with this commitment.
“The only real discussion now is, what are we doing to do tomorrow morning? Not 2028, not 2050. Tomorrow.”
Editor’s note, 3 December: This article was amended after publication to delete some comments by Dunne.
See Cate Carrigan’s preview of the Forum, ‘To achieve a net zero health system, what will it take?
And see Croakey’s extensive archive of climate and health stories.