Introduction by Croakey: As global health leaders vow to keep pushing for stronger climate action in the wake of “shameful” COP26 outcomes, the Glasgow Climate Pact has intensified pressure on the Australian health sector to ramp up climate action.
This follows the Federal Government’s failure to commit at COP26 to developing resilient and low carbon, sustainable health systems, and failure to set a net zero target for Australian healthcare.
Next month, the NHMRC Partnership Centre for Health System Sustainability (PCHSS) will host a webinar exploring ways in which to improve the healthcare system’s sustainability, featuring some positive case studies.
Writing below for the Croakey Conference News Service, Nicole MacKee previews the webinar, which will be held online on 2 December 2021 from 1pm AEDT. Register here and on Twitter, follow the hashtag #HealthClimateSolutions21.
Nicole MacKee writes:
Health leaders and services have been urged to create “an authorising environment” so that staff are empowered to address the climate crisis in their everyday work.
Professor Tony Capon, Director of the Monash Sustainable Development Institute, told Croakey that leadership was needed to support healthcare workers across the system to feel authorised to address climate change in their work.
It was critical to build capacity among healthcare professionals, both pre-service and in-service, Capon noted, adding that it was also important to integrate sustainability considerations into health service planning and development, and existing accreditation systems.
“We can’t have this off to the side as another ‘silo’ of activity,” Capon said, noting that it was also critical to document and share best practice, highlighting the important work of the Climate and Health Alliance in facilitating such practices.
Leaders needed to create “an environment in health services so that staff are empowered to address climate change in the everyday work that they do”.
“As health workers, we urgently need to bring a ‘planetary consciousness’ to our work – bring the planet into health policy and practice. For people to be healthy, we need a healthy planet.”
As well as climate change, Capon said the health sector needed to engage with other environmental concerns.
“There is biodiversity loss, ecosystem degradation, pollution,” he said, noting the need to focus on the “ecological determinants of health”.
“We need an eco-social approach to complement bio-medical.”
Capon will speak at next month’s NHMRC Partnership Centre for Health System Sustainability webinar: ‘Exploring the Nexus of Climate Change, Human Health and Health Care Sustainability’.
Watts has been prominent at the COP26 talks. He told a recent Australian Academy of Health and Medical Sciences webinar that the NHS had long cared about climate change, sustainability and sustainable development, noting its positive response to the 2008 Climate Change Act.
“Last year … things have stepped up; not just a gear shift, but an order of magnitude, in terms of how the NHS is thinking about climate change, how we are building it into the core of everything we do, and how much resources we are throwing into it,” he said.
In October 2020, the NHS adopted two key targets for the health system, a net zero strategy by 2040, and an 80 percent reduction target by 2028.
“That makes me uncomfortable because it’s soon and that’s exactly what it’s designed to do – make people uncomfortable, make sure that we understand that it’s real, tangible and that we should and will be held accountable for it,” Watts said.
Capon said the UK’s long-term commitment to developing a sustainable healthcare system had helped ensure a strong focus on health at the COP26 after momentum has been building successively through the COP process over a number of years.
“The UK Government is out in front on sustainable healthcare because they got started quite a bit earlier than other countries,” Capon said.
While the UK is leading the charge in healthcare sustainability, Monash University’s Tony Capon said that Australia was still “on the starting blocks”.
“Each state and territory jurisdiction is engaging in some way [in sustainability initiatives], but it is regrettable that we are yet to see strong national leadership. I guess this, in essence, reflects the lack of national leadership on climate change more generally,” said Capon, who will address the health system’s preparedness for climate change in Australia in the PCHSS webinar.
Capon said the first critical issue in driving a more sustainable healthcare system was to ensure all health workers understood that climate change had physical and mental health impacts.
Then, he said, there were three key actions needed:
- Preparing health services for the health impacts of climate change. For example, he said, health systems needed to be prepared for peaks in demand caused by extreme weather events like floods, cyclones, bushfires, and heatwaves.
- Get our own house in order. “We have to urgently transition to net zero healthcare in Australia, like they are doing in the UK,” he said.
- Raise awareness of the health co-benefits of climate action. Transitioning to a more sustainable way of living will bring both environmental and health benefits, Capon said. “Less carbon emissions and less pollution will impact health,” he said. “Similarly, active mobility – walking and cycling – results in less carbon emissions and better physical and mental health, and a plant-rich diet is better for individual health as well as for the planet.”
Capon said: “Climate change needs to be part of the core business for health services and, frankly, that is not currently the case in Australia.”
Read more about the net zero ambulance here.
The two-part webinar will hear from a range of eminent speakers, including Professor Lesley Hughes, Distinguished Professor of Biology and Pro Vice-Chancellor (Research Integrity & Development) at Macquarie University, and Laureate Professor Peter Doherty, Patron of the Doherty Institute, who will address ‘The effect of climate change on human health and healthcare system sustainability’.
Other speakers in this session are:
- Professor Ngaire Brown, founding director of Ngaoara
- Hisham El-Ansary, CEO of Bupa Australia
- Claire Sparke, Unit Head, Population Health, Australian Institute of Health and Welfare
- Professor Lucie Rychnetnik of the University of Sydney and the Australian Prevention Centre Partnership
- Professor Tony Capon.
Addressing the second part of the webinar – ‘The impact of healthcare delivery on environmental sustainability’ – are:
- Dr Nick Watts, NHS
- Professor Rachelle Buchbinder, Director of the Monash Department of Epidemiology
- Professor Alexandra Barratt, Professor of Public Health at the University of Sydney
- Associate Professor Martin Henscher, Associate Professor, Health System Financing and Organisation, Deakin University
- Dr Forbes McGain, intensive care physician at Western Health and Clinical Associate Professor at the University of Melbourne
- Professor Yvonne Zurynski, Associate Professor of Health System Sustainability, and Dr K-lynn Smith, research fellow, at the PCHSS
- Associate Professor Stefi Barna of the UK’s Centre for Sustainable Healthcare.
The webinar will also hear from Uncle Chris Tobin, a Darug Elder, who will offer an Acknowledgement of Country. He told Croakey that pollution and destruction of Country was bound to impact upon people’s health.
“It’s crucial to our survival that we change the way we do things,” he said.
A report recently released by the Lowitja Institute also explores the wide-ranging impacts of climate change on Aboriginal and Torres Strait Islander peoples’ health and calls for their voices and knowledges to be privileged in climate responses.
The webinar will profile the complex challenges the climate crisis presents for the health system. Already dealing with escalating demands from the impacts of climate change on physical and mental health, the system itself is also part of the problem.
In Australia, the health system accounts for around seven percent of the nation’s carbon footprint, while globally the system contributed to 4.6 percent of emissions. On top of this, up to 40 percent of care provided in Australia is unnecessary, providing little or no benefit to patients, and harming the planet.
In an interview with Croakey, Professor Peter Doherty said the health impacts of the climate emergency were vast.
“The climate emergency [is a] problem that impacts on just about everything that impacts on health,” said Doherty, who will discuss the impact of climate change on infectious disease spread during the webinar.
As the Earth warms, Doherty said, mosquito-borne infections move away from the Equator and up into higher regions.
“If you think of Kenya for example, you get malaria on the coast, but you don’t get it up around Nairobi, but whether than will continue or not. And that’s a real problem,” he said.
Increasing drought will impact upon water and food security, Doherty added, noting that this could also fuel political instability in some regions.
Even with optimistic climate change scenarios, Doherty said, Australia was likely to see many more 50-degrees Celsius days, which would cause an increase in heat-related deaths.
Professor Lesley Hughes has spoken extensively about the impact of heatwaves, which she said had been dubbed the silent killer.
“Extreme heat and heatwaves kill more Australians than all other weather-related events combined,” she said in an Australian Institute of Health Innovation webinar earlier this year.
“Heatwaves don’t leave the sort of scars on the landscape that a flood or a fire does, but, nonetheless, they are the most important climate-related killer.”
Hughes noted that there was growing engagement of health professionals in climate advocacy, and adaptation. Last month, more than 50 health and medical groups sent an open letter to the Prime Minister urging him to engage with the Climate and Health Alliance’s ‘Healthy, Regenerative and Just’ in developing a national strategy on climate and health.
During the 15 minutes I was interviewing Associate Professor Forbes McGain, five single-use infection control gowns were discarded.
“There goes another one,” said the Melbourne intensive care physician, who was counting the number of gowns disposed as he stood outside the ICU. “The average nurse in ICU will go through about 20 gowns a day in each shift; all thrown away.”
And the impact of COVID-19 on medical waste has been enormous.
“Disposable equipment has gone through the roof,” said McGain, who works at Western Health and is Clinical Associate Professor at the University of Melbourne.
“At Western Health alone, we are talking 3-5,000 gowns a day, every day for 18 months. And that’s just physical waste of one item, there are also gloves, N95 masks, face-shields, and everything else.”
McGain, who has been working to drive more sustainable practices in healthcare for more than 12 years, said: “We live in a very linear economy in medicine – it’s not circular at all – it’s take, make, waste.”
McGain has been working with other researchers from the University of Melbourne on projects to promote greater sustainability in the health care sector, including evaluating the benefits of using reusable anaesthetic breathing circuits, anaesthetic face masks, and laryngoscope blades and handles.
“We used a life-cycle assessment to show the environmental and financial consequences of having reusable equipment – including the labour cost of washing them and sterilising them – is less than buying single-use variants,” he said.
“This was really exciting because everyone assumes that disposable is always better and less expensive, when often that presumption has no foundation at all.”
McGain said the findings were taken on board at his own hospital which elected to use the reusable equipment, but others had failed to follow suit.
“It was a small study and is easily generalisable throughout Australia, New Zealand, the US, Canada, and many other places around the world,” he said.
“But there is enormous inertia. It’s not because those people want to waste, it’s just that it’s easier to chuck and you know there is supposedly no [infection risk to patients].”
McGain has also driven projects to reduce emissions caused by wasted anaesthetic gases and, with colleagues, developed the reusable McMonty ventilation hood to reduce the spread of COVID-19 in hospitals (as previously reported at Croakey).
“Most of our effort, once we had built the hood, was just in keeping the plastic cover reusable.”
McGain said of the many sources of waste in health care, the widespread use of single-use infection control gowns would be a particularly hard habit to break.
“The single-use gown works; it stops people getting infected and it gets chucked away. So, what’s the problem? The problem is money, the problem is environmental destruction, the problem is the nurses hate it, they sweat in it, it’s impermeable, we are dressed in oil – nothing gets in or out,” McGain told Croakey.
“We have some hard yards ahead of us, and I don’t have a solution … yet.”
Integrated care solutions
Associate Professor Yvonne Zurynski, Associate Professor of Health System Sustainability, said health systems were “complex beasts” and their impact on the environment was often not considered.
“That is changing, [but] we need to do a lot more. We need specific co-ordinated policies around reducing the carbon footprint of the health system, and there are really great initiatives underway, particularly in the UK,” said Zurynski, who leads the activities of the Observatory on Health System Sustainability of the NHMRC Partnership Centre in Health Systems Sustainability.
In Australia, Zurynski said her group was focussing on initiatives to better integrate healthcare services, which would reduce waste and duplication of care, as well as improving care quality and patient journeys.
“The health system produces a lot of waste through single-use items, the use of energy – it takes a lot of energy to run large hospitals – plus the way in which the system is organised,” she said. “It requires patients to drive to and from multiple appointments, to drive to get tests in separate facilities, and then come back to their doctor to have the results reviewed.”
Zurynski pointed to several local programs that were paving the way for more sustainable practices, including the HeartConnect program; the Kids Guided Personalised Services (Kids GPS), which is being rolled out in rural NSW; and the Strengthening Care for Children initiative.
Under the HeartConnect model of care, GPs can refer their patients for review with a specialist cardiologist within 48 hours and have all tests completed on the same day, in the same place.
“That saves that wasteful repeating of tests and the run-around patients often have to do to get their different tests done,” Zurynski said.
The Kids GPS model of care, empowers and upskills health care teams in regional and rural NSW to provide care closer to home for children with complex and chronic disease, Zurynski said, while Strengthening Care for Children embeds paediatricians into GP practice, reducing referrals to children’s hospitals and outpatient clinics.
There were other pockets of innovation in Australia, she said, pointing to McGain’s work as well as initiatives such as Choosing Wisely and Evolve. Zurynski also highlighted the work of PCHSS collaborators Professor Paul Glasziou of Bond University and Professor Rachelle Buchbinder of Monash University who are working to reduce low-value care.
Buchbinder told Croakey that, of the Australian healthcare systems’ total carbon footprint, half was from hospitals (including electricity, water, non-recyclable plastics, and medical waste) and another 20 percent was from pharmaceuticals (including production, and delivery).
“The impact of low-value care – unnecessary testing, overdiagnosis and overtreatment – is therefore pretty clear,” said Buchbinder, who will also speak at the PCHSS webinar.
“Low-value treatment harms the health of individuals who receive it, but also indirectly harms the health of everyone through its impact on the environment if we consider that climate change is affecting health of the population.”
Buchbinder said many health professionals – as well as the public – were largely unaware of the environmental harms of “too much medicine”.
Buchbinder applauded the efforts of McGain (who has also recently co-authored a paper with Barratt on environmental impacts of overdiagnosis), medical groups such as the Doctors for the Environment, some professional societies, and states.
However, she said there was much more to do.
“There has not been nearly enough progress,” said Buchbinder, who has recently co-authored a book, ‘Hippocrasy: How doctors are betraying their oath’, which is seeking to raise awareness of the impacts of overtreatment.
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This article is part of the #HealthyCOP26 series, which is being published in partnership with the Climate and Health Alliance. This article is also part of Croakey’s contribution to the Covering Climate Now initiative, an unprecedented global media collaboration launched last year to put the spotlight on the climate crisis. Croakey Health Media is a member of the collaboration, which was co-founded by The Nation and the Columbia Journalism Review (CJR), in partnership with The Guardian.