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Identifying the environmental costs of health-related travel

Wider use of telehealth services and better coordination of health care might help to reduce carbon emissions related to healthcare, a recent study suggests.

Researchers from the University of Tasmania surveyed residents on King Island in Bass Strait in an attempt to establish the carbon emissions from their healthcare-related travel.

Isabelle Ellis, Professor of Nursing: Rural and Regional Practice Development, University of Tasmania, writes below that in one year, the islanders surveyed travelled more than 350,000 km for their health care generating more than 130 tonnes of carbon emissions.

These data only include the patient travelling and not their accompanying carers or support people; and only represent 40 per cent of the residents.

This is the equivalent in offsets of growing 20 trees for 30 years.

****

Isabelle Ellis writes:

Health care in Australia has increasingly turned to business thinking to drive improvements, such as process mapping to reduce waiting times in our emergency departments, systems thinking to improve adverse events like reducing medication errors; and lean thinking to reduce waste.

The quadruple bottom line for business refers to the financial bottom line plus the social, economic and environmental measures used to assess whether a business is profitable and that profitability is sustainable.

It is no longer enough to produce a product and sell it for a profit without any thought to the impact that activity has on the producers, society, and the environment.

Applied to the health system, a well-run system would result in patients receiving the best quality care, close to home, at a cost they, the country and the environment can afford.

In reality, healthcare systems have been contributing to the impact of climate change by the energy they consume and the waste they generate.

Current estimates published in an article by Chung and Meltzer in the prestigious Journal of the American Medical Association in 2009, put the health care sector’s contribution to total emissions in the United States’ at 8% and in the United Kingdom, 18%.  In Australia emissions associated with health care have not yet been calculated but are expected to be similar to the US and UK.

The National Health Service has estimated travel represents 16% of its health emissions, with patient travel estimated at 7%. According to a former Australian Government Department of Climate Change and Energy Efficiency report published in 2012, transport is responsible for 16% of Australia’s total emissions.

With a more widely distributed rural and remote population than the UK, it would be anticipated patient travel would make a substantially greater contribution to carbon emissions associated with health care in Australia.

On 1 July 2012 Australia commenced carbon pricing; although the current government is trying to push through a Carbon Tax Repeal Bill, the commitment to reduce our carbon emissions by 5% by 2029 remains.

In addition to the time and cost of travel, in the developing carbon economy, emissions from transportation and the need to reduce our carbon footprint will become an increasingly important factor in decisions about the economics of health care delivery.

The Australian government as part of its National Digital Economy Strategy has committed $460M for the national telehealth initiative. One of the primary aims or this investment is to increase access to health services for people living in regional, rural and remote areas.

Telehealth services are expected to reduce the amount of travel required for people in living in rural areas and their health care providers.

To try and quantify health care travel and the carbon emissions this generates we invited the clean green island of King Island in the Bass Strait to be involved in a population survey about their health related travel.

An impressive 43% of the island’s 677 households responded to the survey covering the health related travel for the year June 2011-2012 for 625 of the island’s 1553 residents.

Over the year these islanders travelled in excess of 350,000 km for their health care generating more than 130 tonnes of carbon emissions; the equivalent in offsets of growing 20 trees for 30 years. These data only include the patient travelling and not their accompanying carers or support people; and only represent 40% of the residents.

When calculating the carbon emissions with the validated Carbon Neutral calculators, we found using a medium car, or 4WD vehicle powered by petrol or diesel, for road travel released emissions comparable with air travel per km travelled for a single person flying on a scheduled flight.  If all remote Australians accessed healthcare similarly to our King Island sample, this could equate to 109,560 tonnes CO2 emissions per year.

Rural and remote communities support important mining, agriculture, fishing and tourism industries in Australia. People currently have to travel to access many health care services including diagnostics and specialist care as well as for follow up services.

Investment in telehealth service development by the Australian government is intended to meet the goal of reducing healthcare related travel. However, the King Islanders reported that they were often referred by their GP to specialists who do not provide teleconsultations.  Stories of poorly coordinated care were common with diagnostic investigations not ordered before specialist appointments requiring two trips instead of one.

Getting care for serious illnesses or from many specialists was funded by the Tasmania government for King Islanders to attend in Hobart via Melbourne. Many King Islanders, being dairy farmers, found it very difficult to be away for any length of time resulting in delays seeking treatment, or not returning for follow up care if travel was involved, or choosing to go to a destination that allowed them to complete all of the requirements for care in a single day trip.

Taking a quadruple bottom line approach to health care planning and incorporating the carbon cost of travel will help to improve effectiveness, efficiency and sustainability for our overstretched health system.

 

 

 

 

 

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