Introduction by Croakey: A webinar recently hosted by the NHMRC Partnership Centre for Health System Sustainability (PCHSS) explored ways to improve the healthcare system’s sustainability at a time when a growing number of health systems around the world are working towards net zero targets.
As part of Croakey Conference News Service coverage of the event, our @WePublicHealth Twitter account shared some of the discussions about ways forward, as summarised below, while Alison Barrett live-tweeted the discussions for @CroakeyNews. Collectively, the #HealthClimateSolutions21 tweeters created more than 10 milllion Twitter impressions.
Suggestions included: tackling over-diagnosis and over-treatment, including unnecessary pathology testing; boosting climate health communications; privileging Indigenous knowledges; developing strategic alliances; and investing in more useful and timely data collections and analysis.
From @WePublicHealth and @CroakeyNews tweets:
The webinar kicked off with ABC reporter Sophie Scott as MC, an Acknowledgement of Country by Uncle Chris Tobin from Darug country, and introduction by Professor Jeffrey Braithwaite.
Uncle Chris Tobin said: “Concept of Country extends bigger, extends to our ancestors…All our heath decisions should be aware of that.”
The first session is about the effect of climate change on human health, the increasing demand for healthcare services and ways in which healthcare systems should adapt to the changing climate
Sustainability of our health care system is one of the biggest issues right now, says Sophie Scott. She adds: “This is going to be one of the most important meetings you will attend all year.”
Our future is in our hands
Professor Lesley Hughes, Macquarie University
Professor Lesley Hughes, Pro Vice-Chancellor, Macquarie University, is also a founding Councillor with the Climate Council of Australia.
She discussed the sixth report of IPCC assessment in August 2021 – key message: ‘climate change widespread, rapid and intensifying’ – and therefore we have to do something about it.
Earth temperature and ocean temperature increasing since 1850s. Bushfire seasons are becoming longer and more severe.
Projected changes in extremes are larger in frequency and intensity with every increasing increment.
Catastrophic events cannot be ruled out (for example, melting of permafrost, loss of arctic and glacial sea-ice, loss of coral reefs).
Silver lining from 6th assessment of IPCC = The window for effective action is closing rapidly but the climate future is still in our hands – Professor Hughes.
Bushfire impacts
Claire Sparke, Australian Institute of Health and Welfare
Claire Sparke discusses some of the short-term impacts of the Australian bushfires of 2019 and 2020 – the worst in Australia’s history, both in intensity and longevity.
Assessed data from MBS, PBS and emergency department presentations to explore their short-term health impacts.
The 2019-20 bushfires saw an increase of 125 percent increase in rate of asthma presentations compared to previous year, and an increase in sales of inhalers for shortness of breath in January 2020 compared to previous year.
Bushfire-specific MBS mental health related items at around 500-600 services by week by mid 2020; however, she acknowledges it was hard to calculate with certainty due to COVID-related MBS mental health related items at the same time.
Not a lot of research occurring at present about long-term outcomes of bushfires.
Privilege Indigenous knowledges
Professor Ngaire Brown, Ngaoara
The next presentation is about ‘Social equity and climate change’ by Yuin nation woman, Professor Ngaire Brown, who has spent the past two decades developing extensive national and international networks in Indigenous health and social justice.
She runs Ngaoara, a NFP focused on Aboriginal child and adolescent wellbeing, including issues related to child safety, adolescent development, cultural education and building social capabilities and individual resilience and agency.
Says she thinks often focused on one aspect of climate change, and highlights the importance of the social determinants of health, and climate anxiety, in particular for young people and adolescents.
Climate refugees will be likely in future, especially from the Pacific Region. Will be difficult to move entire populations to other countries.
Professor Brown discusses “Systems Myopia” – short economic cycles, short political cycles, short funding cycles = short sighted planning, especially regarding climate.
We should be far more in-tune with not just impact of decisions made now, but for the next seven generations, she says.
“We have to come together to stop the degradation of the planet.”
Fewer tests
Professor Alexandra Barratt, University of Sydney
Barratt is a lead investigator on Wiser Healthcare, an NHMRC funded research collaboration to reduce over-diagnosis and over-treatment in healthcare, which was the focus of her presentation.
Example of thyroid cancer in South Korea between 1993-2011, where diagnosis of thyroid cancer went through the roof, but thyroid cancer mortality did not increase. Resulted in increased burden on healthcare.
Over-diagnosis tends to happen by overtesting, and is widespread.
Increased patients increases the carbon footprint. Interesting article published in The Medical Journal of Australia about the “carbon footprint of pathology testing”.
Carbon emissions per blood test are small, but because so many blood tests done each year, the combined emissions is huge.
“Jaw-dropping” says Barratt – 4.5 million vitamin D tests were done in 2020 – a 12 percent increase over 2018-2019, for little result.
Between 50 and 200 tonnes of CO2 emissions per year, just from Vitamin D tests in 2020.
Can we do fewer Vitamin D tests?
Preparation matters
Professor Tony Capon, Monash Sustainable Development Institute
He talked about ‘Preparing healthcare services for climate change in Australia’.
You can read some of Capon’s recent work here, ‘The 2021 report of the MJA–Lancet Countdown on health and climate change: Australia increasingly out on a limb’.
In good news though, Northern Sydney Local Health District are the first in Australia to include a planetary focus in their framework.
What should health services do?
Co-benefits of climate action
Professor Lucie Rychetnik
From the University of Sydney and Australian Prevention Partnership Centre, and discussed: ‘The co-benefits of chronic disease prevention in the time of climate change.’
Rychetnik has over thirty years experience translating public health research into practice. Chronic disease is a major issue in Australia, causing eight out of every 10 premature deaths.
Most chronic diseases are preventable but risk factors are complex and related to systems, politics etc. A systems approach will be helpful.
Co-benefits = result in multiple positive outcomes; for example, walking/running is good for individual health, but also reduces carbon emission.
Another example of co-benefits includes increasing provision of urban green space = improved mental health + reduced heat and improved air quality.
When thinking about interventions, think about ‘Triple bottom line: intersection of climate change, health, economy’.
Panel discussion about solutions
Panellists: Professor Lucie Rychetnik, Professor Peter Doherty, Professor Tony Capon, Professor Lesley Hughes, Professor Ngiare Brown, Hisham El-Ansary, CEO Bupa Asia Pacific, Claire Sparke).
Q: What are some of the practical steps that can be taken?
Rychetnik: Adaptation and preparation. Health systems need to be prepared for surges in demand, and have early warning systems.
Doherty: Take adaptive steps. “No way this is going to stop overnight, it’s going ahead.” Sustainable construction and thinking through every aspect of healthcare and systems. Awareness – education of public vital. Improving our whole communication systems is vital. “I think we’re going to have to engage the younger generations to help with this.”
Capon: Supports the points made by others. Waste from healthcare an issue. As health workers, “We’re not protecting the health of people if we’re not protecting the environment.”
Hughes: Doctors/nurses/ all health care workers need to be empowered to communicate with patients and colleagues about climate/health issues. Vote for climate action. Health system needs to be better prepared to anticipate disasters, not just in mopping up after.
Brown: Promote positive Indigenous practices and knowledge. “Those with the least often have the most to offer”- ancient wisdom, willingness to share. Let’s normalise Indigenous practices.
El-Ansary: At health system level- disconnected system and a lot of waste occurs through the journey of a patient through the system. Major corporations play an important role in social issues, and that is part and parcel of contemporary governance in big organisations.
Q: What were the difficulties in tracking the data presented about 2019-20 bush fires?
Sparke: Data is collected with quite a lag. Quicker systems would be beneficial to track data about health impacts of climate events. Health data is collected and analysed at a higher level (due privacy etc), whereas environmental data can be collected and analysed at a micro level. Hard to make associations.
Q: What are the flow-on effects of climate on mental health?
Capon: Mental health is often overlooked. Drought = declined incomes at individual levels (ie farmers) + declined incomes at rural community level = poorer mental health outcomes.
Q: Last thoughts?
Rychetnik: Strategic alliances are important. Evidence needs to address all different outcomes.
Doherty: “Massive challenge, we have to change hearts and minds”
Brown: Place-based and localised response to priorities and engage experts in the community.
Global leadership
Dr Nick Watts, NHS
Participants saw a pre-recorded video by Dr Nick Watts from the Institute for Global Health, at University College London, who spoke about ‘Understanding the environmental impact of healthcare’.
Watts is also NHS England’s first Chief Sustainability Officer. He said he would talk about the problems, stuff that has to become real – we’re already four decades behind.
Three reasons why any health care system should be interested in climate change:
1) It is a big problem. Global average temperature rise, leads to increased volatility = flood, fire etc.
NHS core principle = commitment to universal health care coverage + high quality care for now, and future.
NHS cannot deliver its core purpose without addressing climate change
2) We’ve been responding to this for past decade. Over the past ten years we have learnt that response to climate change is good for health, investing in local infrastructure, food systems.
NHS has reduced its emissions by 30 percent, which is great, but have to act a lot faster to reach net zero by 2040.
3) Healthcare systems are a big part of the problem. Five percent of national emissions.
Job is enhanced by responding to climate change.
Three weeks ago, there was only one healthcare system with a net zero commitment. At COP26, 14 additional healthcare systems committed to net zero.
Address over-treatment
Professor Rachelle Buchbinder, Monash University and Cabrini Health
Her topic: ‘What is over-treatment and why is it a problem?’
Over-diagnosis is when a diagnosis that is technically correct, but won’t benefit them and might cause harm, such as when people with minor symptoms are screened, or new diseases are created.
Over treatment occurs in healthcare (consultations, tests etc) that provide no benefit to the patient. Might occur in healthy people, may treat the risk factor instead of the disease.
How much over-treatment is occurring in Australia? Some estimates say about AUD$30 billion per year that is ineffective.
Reasons why over-treatment occurs = science literacy, uncertainty, want to believe we are helping.
Why is over-treatment hard to fix? Vested interests, media (for example, hype of medical breakthroughs), perverse incentives, difficult to do nothing, routine tests, patient and societal expectations = very complex.
Buchbinder wrote a piece in Croakey last year: ‘Weighing up the potential benefits and harms of comprehensive full body health checks’.
Ecological economics
Associate Professor Martin Hensher, Deakin University
He discussed: ‘Human health and ecological economics’.
“Economics is the study of the allocation of scarce resources among unlimited wants.”
Economic growth driven gains in human health. Standards of health are intimately linked with economic health.
‘Ecological economics’ looks at optimal allocation of resources, just distribution of income and resources, and sustainable scale of economy relative to ecosystem.
Now beginning to live in a period of ‘uneconomic’ growth, where harms from growth are becoming bigger than the benefits.
Health is an important part of the economy + ecosystem.
We are stuck in cycles of poor quality care, overtreatments, overdiagnosis, and all the while, the healthcare system is causing all kinds of environmental demands.
All healthcare causes some harm to the natural environment.
Healthcare cannot grow in the ways we have long been accustomed to.
Many of the worlds’ poor have grossly inadequate access to healthcare.
Practical steps
Dr Forbes McGain, Western Health in Victoria
Topic: ‘Improving hospitals’ environmental sustainability’.
Together with Dr Eugenie Kayak, he wrote in The Medical Journal of Australia earlier this year: “From a quantitative aspect, healthcare’s carbon footprint is important, and this pollution burden conflicts with our efforts to do no harm”.
Forbes wanted to do something within healthcare system itself to make it more sustainable. He gave an example of working in Alice Springs, watching many litres of water in dialysis being wasted.
Ways to improve sustainability in hospitals: renewable electricity; renewables make reusable better, get off gas, work on carbon hotspots.
At macro level: advocate for healthcare sustainability, universities need to help with education, standards really need to be done and improve building infrastructure.
Integrated care
Associate Professor Yvonne Zurynski and Dr K-lynn Smith, @PCHSS_AIHI
Topic: ‘Improving the sustainability of healthcare through integrated care models’.
There is a lot to gain from re-organisation and integration of health systems.
People with chronic conditions need care from many different health professionals, and there is little cohesion between them. Limited shared care planning.
Systems approaches
Dr K-lynn Smith, @PCHSS_AIHI
Topic: ‘Towards a learning health system’
‘Learning health system’ – join up science and technology (remove the silos!), research often sits in journals, co-design and patient-centred care vital, continuous learning, aligned financial and policy incentives.
From elephants to collective action
In final remarks, Professor Jeffrey Braithwaite said: The elephant in the room is the politicians who deny climate change or don’t believe in it for political purposes, and we need to do something about that.
He used to think why is it that humans are smart enough to create the world we have, but not smart enough to solve the problems we created. However, he doesn’t believe that anymore. We can solve the problems and today has emphasised that.
A few takeaways:
- We know what to do, we have to intensively do it. We are big emitters – set an example in healthcare.
- It is completely, rationally in our interest to get this right. Optimistically step forward.
- This is all about ‘we the people, it’s our planet’. None of us individually is as smart as all of us collectively.
Five key takeaways
By Alison Barrett for @CroakeyNews
1) The relationship between climate change, health and healthcare systems is complex. Human activity impacts climate change which impacts human health and then impacts healthcare systems by increasing demand.
2) Healthcare systems also have a negative impact on the environment. Aust’s healthcare system accounts for seven percent of the country’s total carbon footprint. An example…https://www.mja.com.au/journal/2020/212/8/carbon-footprint-pathology-testing
3) Approximately 40 percent of healthcare is unnecessary, providing little to no benefit to the patient, at the same time as adding unnecessarily to the carbon footprint.
4) Solutions for improving sustainability of healthcare system include but not limited to: increased awareness of the issue to politicians, health workers & the public; sustainable building infrastructure; integrate care; telehealth.
5) Work together, use public health-based models, and privilege Indigenous knowledge and expertise in building sustainable health systems.
Twitter analytics
Seventy-three Twitter accounts participated in the #HealthClimateSolutions21 discussions, sending a total of 747 tweets, and creating more than 10 million Twitter impressions for the period, 14 November-13 December.
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