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If the planet was a patient, it would be morally wrong not to treat her urgently

In the first section of this comprehensive post wrapping the latest climate and health news, Croakey covers recent publications putting a global focus on children’s rights and responses to the growing problem of extreme heat.

In the second section, Remy Shergill from the Climate and Health Alliance reports from the recent Better Futures Forum Australia, including important discussions on Aboriginal and Torres Strait Islander people’s health, reducing the carbon footprint of medical research and healthcare, and calls for a National Healthcare Sustainability Unit.

The headline above is a modified quote from one of the presenters to the forum, Professor Tarun Weeramanthri, president of the Public Health Association of Australia.


Melissa Sweet writes:

Nearly half of the world’s children live in countries that are at “extremely high risk” from the impacts of climate change, according to a new initiative developed by UNICEF: the Children’s Climate Risk Index.

Outlined in a new report, ‘The Climate Crisis Is a Child Rights Crisis: Introducing the Children’s Climate Risk Index’, the index finds that young people from Central African Republic, Chad, Nigeria, Guinea, and Guinea-Bissau are the most at risk from climate change, which threatens their health, education, and protection, and exposes them to deadly diseases.

The index ranks countries based on children’s exposure to climate and environmental shocks, such as cyclones and heatwaves, as well as their vulnerability to those shocks, based on their access to essential services.

Launched in collaboration with Fridays for Future on the third anniversary of the youth-led global climate strike movement, the report finds approximately one billion children – nearly half of the world’s 2.2 billion children – live in one of the 33 countries classified as “extremely high-risk”.

“For the first time, we have a complete picture of where and how children are vulnerable to climate change, and that picture is almost unimaginably dire,” said Henrietta Fore, UNICEF Executive Director.

“Climate and environmental shocks are undermining the complete spectrum of children’s rights, from access to clean air, food and safe water; to education, housing, freedom from exploitation, and even their right to survive. Virtually no child’s life will be unaffected.”

The report also reveals a disconnect between where greenhouse gas emissions are generated and where children are hardest hit by climate change. The 33 ‘extremely high-risk’ countries collectively emit just nine percent of global CO2 emissions. Conversely, the 10 highest emitting countries collectively account for nearly 70 percent of global emissions. Only one of these countries is ranked as ‘extremely high-risk’ in the index.

“Climate change is deeply inequitable. While no child is responsible for rising global temperatures, they will pay the highest costs,” says Fore.

Heat inequities

Concerns about the inequitable impacts of the climate crisis are also highlighted in a new series from The Lancet on heat and health.

Authors warn that heat extremes are already lasting longer and becoming more frequent and intense, while extremely hot weather that is currently considered rare will be increasingly commonplace.

In an accompanying editorial, The Lancet says more sustainable and affordable cooling interventions are needed that do not further increase greenhouse gas emissions or exacerbate existing inequalities.

For example, despite the immediate health benefits of air conditioning and its increasing prevalence worldwide, it is an unsustainable solution to extreme heat, contributing to air pollution, greenhouse gas emissions, and an increased urban heat island effect.

Moreover, air conditioning is often unaffordable for those people most at risk from extreme heat, which widens inequality and punishes those who often contribute the least to climate change.”

The editorial says that putting health at the centre of multisectoral policy and planning can deliver co-benefits; for example, green spaces in cities are not only crucial for cooling but also reduce exposure to air and noise pollution, relieve stress, provide a setting for social interaction and physical activity, and sequester carbon.

The editorial says that while some governments have adopted national or local heat health action plans, these are highly variable, and implementation is uneven. Many health-care facilities are unprepared to deal with heat.

Meanwhile, a new study published in The Lancet Planetary Health has used supervised machine learning and related methods to systematically identify and map the scientific literature on climate change and health, estimating that 15,963 such studies were published between 2013 and 2019.

However, the climate health literature is dominated by impact studies, with mitigation and adaptation responses and their co-benefits and co-risks remaining niche topics.

“We found major gaps in evidence on climate health research for mental health, undernutrition, and maternal and child health,” the researchers reported.

“Geographically, the evidence base is dominated by studies from high-income countries and China, with scant evidence from low-income counties, which often suffer most from the health consequences of climate change.”

The publications come amid a push for a strengthened focus on health at the upcoming COP26 meeting in Glasgow, reports Health Policy Watch.


Remy Shergill writes:

The Better Futures Forum Australia was held from 17-19 August. This summary is compiled from tweeted coverage of the discussions.

See this Twitter thread from a session “The path to a healthy and resilient Australia”, with:

  • Professor Kathryn Bowen, Deputy Director, Melbourne Climate Futures, Lead Author of IPCC Sixth Assessment Report
  • Fiona Armstrong, Founder & Executive Director of the Climate and Health Alliance
  • Meaghan Scanlon MP, QLD Minister for Environment and the Great Barrier Reef and Minister for Science and Youth Affairs.
  • Dr Omar Khorshid, Australian Medical Association President.

Bowen cited evidence that Australians are three times more worried about climate change than COVID, and discussed Samuel Wells’ sermon:

Think of a person living in two generations’ time potentially facing the extreme consequences of climate change, and imagine what they’d be saying what they wish you had done differently.

I’m going to set out what they might say in five concentric circles: Humility, accountability, example, hope, solidarity.”

Khorshid said the AMA’s policy was released in 2015 and makes a strong argument for climate action on health grounds. “We make clear recommendations to Government: an active transition to renewables, urgently implementing a climate and health strategy, and communicating cclimate health to the public.”

He said:

It’s hard to call for government action when healthcare’s footprint is growing. We want to see a National Sustainable Development Unit, a centralised unit which coordinates sustainable healthcare action across the country, similar to the NHS in the UK.

We’ve also joined the @Green_Hospitals network. We have declared a climate emergency. Many people may not expect this from this sector.

The IPCC report is filled with words we now expect, “unprecedented”, “extinction” etc. As a doctor, this is a terrifying message. Hope is crucial. There is plenty we can do. We can prepare for risks we can’t avoid, and mitigate what we can. We need politicians and decision makers to listen to science, as they have during COVID.”

Armstrong talked about how collaboration is crucial for the health sector to tackle the climate crisis. “We are proud to have 70-plus groups working together to guide climate health policy and advocate for strong climate action.”

A question was raised: how to convince a government obsessed with economic growth that we can’t have a strong economy without a healthy population, which we can’t have with climate change?

Minister Scanlon: We need to speak about this as an economic problem. Jobs and climate action go hand in hand.

A question: How can the medical community align with other actors to help accelerate action?

Khorshid said: This is something the medical/health sector believes in deeply. It’s clear our membership has moved a long way down this pathway. Let’s consider, “What can I do as a doctor/a hospital?”; “What can I say to the leaders of my hospital?”.

The AMA is aware of its responsibility to make people feel “activated” rather than emphasise learned hopelessness.

Zero emissions healthcare

See this Twitter thread from a session, “Creating a Zero Emissions Healthcare Sector for Australia”, with:

  • Dr Jason Wu, @georgeinstitute
  • Peter Thomas, @AAMRI_Aus
  • Dr Janine Mohamed, @LowitjaInstitut
  • Sally Mangan, @AmbulanceVic
  • Josh Karliner, @HCWHGlobal
  • Dr Eugenie Kayak, @DocsEnvAus

Dr Janine Mohamed, CEO of the Lowitja Institute said:

“Aboriginal and Torres Strait Islanders are the most affected by climate change, including our health.

I’m advocating for a collective vision. I would like to see less hierarchical leadership. My vision for this future for Aboriginal and Torres Strait Islanders is that we’re not in a blind spot, we’re at the table. I’m very proud of the leadership Indigenous peoples have shown in the legal system, during COVID, during bushfires and in climate change.

As Aboriginal people, we leave strong legacies. This issue is not just about us. I want us to be good Elders.

By privileging the voices of Indigenous peoples, transformative change happens.”

Peter Thomas, Exec Director of @AAMRI_Aus: The job of medical research is to improve people’s lives. To reduce emissions, we’re looking to change our approach to operations, investment, research design, and more focus on Climate Change Adaptation Research.

“Our staff has really been pushing senior management and our board. Which brings me to investments. Some medical research institutes have large investments in activities which work against good health. In the 70s we divested quickly from tobacco. But we’ve been a bit slower to divest from things which affect planetary health. This is slowly changing, though it’s hard to do because we don’t have total oversight. Thanks to @AAMRI_Aus staff for driving this.

We’re starting to focus on research design. To date, we haven’t as a sector been considering how to have a low carbon footprint. How do we build carbon assessment into our grant applications? Balancing the health benefit of the research vs the huge amount of CO2 it can cause. Research today is much more intensive today than the research we did 30 years ago, e.g. supercomputers. In Australia, lots of this energy still comes from brown coal.”

Dr Eugenie Kayak from Doctors for the Environment Australia said: “It’s beholden on us to follow the best possible scientific evidence. Under a business-as-usual scenario, a child born today will experience a world 3-4C warmer than pre-industrial times. We have lots to do, but we have the knowledge and tech to do it. We need the will & leadership.

Healthcare sector is responsible for seven percent of our national emissions. We need to get our own house in order. Climate change is a health emergency and we shouldn’t be contributing to the problem. It’s fair to say that emissions from the health sector are rising.

First recommendation: Australia needs a clear roadmap to reach its emission reduction targets, with federal leadership. We need a sustainable development unit, similar to the @GreenerNHS.

Second recommendation: 100% renewable power for all our hospitals by 2025. It might seem pie in the sky, but Victoria govt has announced that all govt ops will be renewably-powered by 2025, including public hospitals. NO new gas infrastructure in hospitals. We need net zero buildings. Hospitals in Adelaide and Canberra are being planned like this.

We need higher priority on primary and preventative care. We need people out of hospitals, which are the highest emitting buildings.

We need to fix procurement and supply chains. The healthcare sector is responsible for 10 percent of GDP. If we lead, we can influence other sectors.”

Full report from DEA here.

Viewer: “Totally agree with Dr Kayak that healthcare business as usual cannot continue if as health professionals we wish to meet our ethical responsibilities to the community including future generations.”

Sally Mangan, the Sustainability Director at @AmbulanceVic, which now pledges to the following reduction targets for our Scope 1 and 2 emissions on our path towards zero net carbon emissions from our 2015 baseline:

2025: 39% emissions reduction

2030: 60% emissions reduction

2045: Net zero emissions.

“AV is starting to frame carbon impact as “carbon per patient” to give a more human-focused lens when communicating.

“We’re the first ambulance service in Australia to lead on sustainability in this way. We see a role to learn and share knowledge as we transition to low-carbon healthcare.”

Josh Karliner for @HCWHGlobal talked about their Global Roadmap: http://healthcareclimateaction.org/roadmap/

He said: “If we continue business as usual, healthcare emissions will triple. The Road Map is not just an academic exercise, it’s based on action happening around the world.

The Road Map demonstrates how healthcare can implement seven high-impact actions to further reduce sector emissions by 44 gigatons over 36 years, equivalent to keeping more than 2.7 billion barrels of oil in the ground each year.”

Healthcare could save 4.8 million lives by doing this reduction. If we can’t decarbonise, we can save those 4.8 million lives. We need a broader societal decarbonisation and a transition to more equitable lives.”

Loads of detail here.

Q: The healthcare system also still relies a lot on paper documentation, still FAXING documents, still printing out referrals? Why is the healthcare system the slowest in transitioning from archaic practices? Who’s keeping providers accountable?

Kayak: The system is very siloed and it’s hard to transition to a smooth system in which we can easily transfer information.

@JanineMilera: It’s a values statement. It needs to be hard-wired in, planned for and measured. We need the data to change it.

@Dr_WuJ: We keep coming back to this idea that we need better data and better evidence to make these changes.

Q: In 10 seconds, what would you like to see change in Australia’s health sector?

Kayak: A National Healthcare Sustainability Unit, new report coming out very shortly.

Thomas: More money for medical research to make long term investments into emissions reduction

@JanineMilera: Indigenous Knowledges. Historical truth telling offers us an opportunity to acknowledge what we’ve done wrong, what we can do better. Indigenous Knowledges offers a way forward.

Mangan: Have agency for change in your organisation. We started at zero two years ago, now we’re here.

@JoshKarliner: I hope the health sector in Australia builds on its great work to become a leader and model for healthcare decarbonisation, for greater equity, learning from Indigenous Knowledges, and builds a 21st century health system which helps to save us all.

Part of the solution

See this Twitter thread for a session on “Healthcare Workers as part of the Climate Solution”, with:

Kate Charlesworth: “Not enough people in the healthcare sector are aware of how much we are contributing to the problem. The health system, which is supposed to look after people, is a major source of carbon, plastic and air pollution, making people sick. We need net zero health. @NHSuk is a leader in this space. Here is their path to net zero healthcare.

There is no silver bullet. Getting to a net zero health system is going to require action right across the health system.

We know some hotspots, like anaesthetic gases (2% of emissions) and meter dose inhalers (4-5% of emissions).

Good stuff is happening already. The new Women’s and Children’s hospital in Adelaide will be 100% renewable, no gas installation. Telehealth is a huge reduction in health carbon footprint. Many hospitals are switching to less impactful anaesthetic gases.

“Climate action is a win-win-win – we just need to get on with it.”

Martin Nguyen: Excess medical supplies are an opportunity. Rather than going to landfill, we want to redistribute them.

Alexandra Barratt looks at making healthcare more efficient and carbon-friendly. She looks at implementing best practice and avoiding overuse: “We always think about reducing goods, but what about services?”

What about imaging? In one year, 29,000 were overdiagnosed with several cancers which would never have harmed them.

“This low value and harmful care has a solid body of evidence. It’s widespread. Around 30% of care is low value. 10% of care is harmful. This contributes to healthcare’s high footprint.

But the other 60% is very important! We need to find low-carbon ways to do this. We need green hospitals, low carbon ways to deliver, and models of care and patterns to reduce instances of low value care to improve care quality, save money and enviro co-benefits.”

Q: I’m a clinician. How can I reduce my footprint now?

Barratt: @wiserhealthcare had loads of resources on their website. More prudent testing requests, imaging requests.

Q: How does research get into our guidelines at work?

Barratt: We need to make sure our research is useful to clinicians. We know this is getting more important. It will be something we need to consider alongside time and cost.

Q: What are the biggest carbon hotspots in healthcare?

Charlesworth: Surgery, anaesthetic gases, nitrous oxides, respiratory tests and MDIs. Dry powder inhalers are more friendly than MDIs. Switching anaesthetic gases, using scavenging machines. Then you get into water use in kidney units and so on.

“Reduce, reuse, recycle. So, as Alex has said, do we need this test? There’s a lot of talk now about the circular economy. They’re very keen to work in healthcare, where high quality plastic is being used. St Vincent’s Hospital has looked at recycling plastics into building materials. There’s a private project in Tamworth, which uses reverse osmosis of dialysis water so it can be used for gardens. Good ideas are happening everywhere but need broader coordination to make them widespread.”

Q: @MedicalPantry what’s the deal with expired goods? Why should developing countries use products which aren’t deemed good enough for us?

Nguyen: 20% of what we get is expired, but 80% are brand new supplies. Mostly to do with excess supply. We don’t just give supplies, we ask communities on the ground what do you want / need? It’s their choice what they want to use. They are given the expiration information upfront, they make an informed decision when choosing their products.

Q: As a GP, I see lots of overtesting and overdiagnosis. How do we educate people on this, and focus on lifestyle medicine too?

Barratt: It’s very hard to do! We know there’s lots of waste from overtesting, yet efforts to curb it are limited.

What can we do differently? Let people know about the carbon footprint of all this unnecessary care. Response has been positive when talking to clinicians. They know it would save money and would be good for the environment.

It won’t be motivating for everyone, but if we target opinion leaders, guideline leaders, policymakers, it will build the momentum for change.

Again, having a national unit to coordinate that would be a great way of scaling that up (like @NHSuk)

Viewer: “It would be great to add in a piece of data in the MiMs database of the carbon cost of the medication so that when this is plugged into the practice mgmt software and a clinician chooses to prescribe, they can see this and make an informed choice.”

Q: Is there scope to move away from single plastics, or does sterilisation mean that’s not feasible? How does this fit in with COVID?

Charlesworth: @RACSurgeons want to move back to old fashioned stainless steel instruments, with onsite repair and sterilisation.

Barratt: @ForbesMcGain has done some work looking at reusable anaesthetic equipment. It makes sense to have reusable, UNLESS your electricity is from coal. If you’re sterilising with electricity, it needs to be renewable.

Q: What is your call to action or opportunity for engagement for attendees?

Nguyen: Reach out to @MedicalPantry, we’d love to work with your hospital, or volunteer. Once you see the amount of surplus healthcare produces, you won’t be able to turn away.

Barratt: Important to remember that change comes from lots of little small steps. “Little steps, big effect”. Keep on taking those little steps for big change.

Charlesworth: Do something. Action feels much better than anxiety. Find what you can do in your patch. There are so many opportunities to improve health, save money and save carbon.

Prioritising health

See this Twitter thread from a session, “Prioritising health in the national climate response”, with:

Zhang, the Co-Chair of the MJA-Lancet Countdown on Health and Climate Change for Australia, said: “The aim of @LancetCountdown is to track indicators and national progress of #ClimateHealth in Australia. We look at health impacts, adaptation, mitigation, finance and political engagement.

Despite positive action at local and state levels, there is no national climate health adaptation plan in Australia, whereas 50 percent of countries surveyed in the 2021 report have these plans. Australia is lagging far behind other countries when it comes to the renewable transition. We have many opportunities to take #ClimateAction to protect Australians’ health, esp in a green recovery from the pandemic.

Over the last few days of the Better Future Forum I’ve been excited to hear strong passionate voices from the health sector for climate action.

The 2021 Lancet Countdown report was accepted by @theMJA last week. Watch this space and share with your network!

Viewer: “So interesting that WHO considers climate change the greatest health threat, even in the context of COVID … our Australian government is just not reflecting this concern at all…”

@DiarmidCL is discussing WHO’s Manifesto for a Healthy Recovery from COVID-19, which gives six “prescriptions” from WHO, as well as a comprehensive set of key actionables, for achieving healthier environments.

@DiarmidCL: “Governments around the world spend more on subsidising the fossil fuel industry than they spend on health.”

Professor Tarun Weeramanthri said:

If the planet was a patient, we’d know she was deteriorating. It would be morally wrong to not treat her urgently.

Treating her with known solutions would have numerous co-benefits. For health professionals, pragmatic people, there is no question about climate action. Statistics are people with the tears wiped off.” (Wow).

He said:

“We urge the federal government to take strong action. CAHA’s National Strategy for Climate, Health and Wellbeing is long overdue.

Climate action is everyone’s responsibility. Climate action without climate justice is not ethical from a public health perspective.

If the planet was a patient, we’d answer yes to three questions:

  1. Is the patient sick?
  2. Do we know what to do?
  3. Is there more we can do, and quickly?”

Very powerful speech. You can read it in full here.

Q: How can WHO engage with Australian health professionals?

@DiarmidCL: Thanks for the question on @WHO engagement with Australian health professionals. We are really pleased to work with CAHA, @GCHAlliance  and others as umbrella groups. The more we raise our voices together, the better.

@DiarmidCL: There’s a direct link between countries’ pandemic recoveries and their NDCs. It indicates how ambitious countries are on climate change. They need to be ambitious and serious. We need 2050 commitments, but we also need short term targets.

“Health should be central, it’s always high on peoples’ list of concerns. It’s also economically rational to make decisions on health.

@tarunw: We need to stop doing “silly stuff” as Barack Obama said.

$5trillion more in public money for fossil fuel subsidies than health is silly stuff. Australia’s “gas-led recovery” is silly stuff.

We now need a positive concept of what we should do in our post-pandemic recovery.

@yzhang01: We need a more resilient health system, whether to a pandemic or a disaster. There are more disasters coming. Any recovery plan from COVID without thinking of the long term health risks from climate is shortsighted.

Q: We have good public health campaigns in schools / community organisations (eg. smoking/alcohol). Would the @_PHAA_ look at integrating climate and health education in schools and across sectors?

@tarunw: It’s a great idea, we need partnerships and support from the education system. Need evidence based messages.

@DiarmidCL: It’s a great idea, and similar things are happening internationally. A big push to have climate integrated into curricula, including medical/health.

@yzhang01: I’m in the @WHO working group. We have a subcommittee on capacity building / education programs on #ClimateHealth. We’re very keen to put this in the curricula of med schools, current health profs and younger generations. It’s an intergenerational issue.

Q: What is the effect of climate on mental health?

@yzhang01: Our first @LancetCountdown report in 2018, we looked at suicide rate and increasing temps in Australian cities, found a relationship. Prolonged heatwaves, drought all poorly linked with poor mental health.

Q: How can the health sector push the federal government ahead of @COP26 ?

Behrens: It’s interesting the government responds to health messages on COVID but not climate. What can we do differently?

@tarunw: In WA, we say “we’re with you, we won’t sit back.” If you act, we’ll be right here supporting you, it’s all of our jobs. Turn it into a positive for them. Use the health co-benefits argument, the economic savings argument, all good for governments.

@DiarmidCL: The evidence is that positive framing around health is more convincing to people. Politicians are used to people shouting at them.

Health is 10% of the economy, 4.4% of global emissions. It’s a big player in climate policy. Leadership in health makes a big difference.

@yzhang01: There are frustrations, but we need to continue our efforts to push this forward.


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