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On the pathway to greener healthcare: from the Hunter Valley to Darwin and beyond

Introduction by Croakey: The knowledge and values of the Awabakal people are being embedded into the development of the John Hunter Health and Innovation Precinct in Newcastle, reports Dr Sarah Simons.

This work will feature at the Greening the Healthcare Sector Forum 2022, to be co-hosted on 7 October by the Climate and Health Alliance, the Global Green and Healthy Hospitals Network, and the Hunter New England Local Health District (HNE Health).

Simons will also live-tweet the event for the Croakey Conference News Service. It will be held at the Hunter Medical Research Institute in Newcastle and online. On Twitter follow #GreenHealthForum22 and this Twitter list of presenters and participants.


Sarah Simons writes:

“It’s working with us, not for us,” stresses Sheryn Barrack, who is Manager in Aboriginal Engagement on the traditional lands of the Awabakal and Worimi people at the John Hunter Health and Innovation Precinct.

Barrack’s is a new role focused on embedding Aboriginal knowledge and values into the new hospital campus from the ground up in a pioneering project on the lands of the Awabakal people.

One of her main priorities with the new build is ensuring that local Aboriginal communities and leaders are involved with the site design and construction from the outset; she describes how designing with Country ensures authenticity.

This includes organising site walks through the construction sites with local Aboriginal communities to safeguard any artefacts and identify and protect any items of historical or cultural significance as early as possible, which ensures that any building plans are “culturally inclusive and responsive”.

It also includes identifying valuable plants and trees; these site walks have collected over 750 seeds from five different plant species thus far. Additionally, the site walks promote ecological and cultural safety by educating site designers, engineers and workers on the new build.

Barrack says that due to learned Cultural knowledge, the site engineers can now identify different types of trees and tell the difference between various plant types to the point where construction workers are able to use their newly learned knowledge of Country to identify which plants can be used for bush medicine.

Kentan Proctor from Bahtabah Local Aboriginal Land Council providing a plant identification session. Photo by Sheryn Barrack.

Chain of knowledge

Another valuable aspect of Caring for Country includes the regeneration and recycling of the wood felled to make way for the hospital.

Barrack describes how the wood is reused and repurposed with three local community partner organisations, including a local youth group where young people learn woodwork skills to craft cultural items such as boomerangs and didgeridoos from the felled wood, giving these young people professional skills and valuable work experiences.

“By replanting these seeds and sharing skills,” Barrack explains, “we continue that chain of knowledge. That’s how we close the gap.”

This year’s Greening the Healthcare Sector Forum places First Nations expertise in environmental justice and sustainability front and centre, drawing on thousands of years of experience and innovation in Caring for Country.

Local Elder and John Hunter Hospital gardener Uncle Frank Wallace. Photo by Sheryn Barrack.

Barrack and her team’s work will be profiled at the Climate and Health Alliance’s (CAHA) annual forum alongside presenters and delegates from all over Australia. This year’s event is co-hosted by CAHA, The Global Green and Healthy Hospitals Network and the Hunter New England Local Health District.

Driving systems change

Hosted at the Hunter Medical Research Institute in Newcastle on Awabakal Country, the forum’s theme of “Driving systems change for sustainable healthcare” takes an approach prioritising First Nations peoples’ expertise. The forum aims to to consider the existing evidence base, review existing sustainability efforts and takes a step back to more broadly discuss sustainable healthcare at a policy level.

The forum is especially timely given recent efforts to re-invoke the urgent and dangerous impact of climate change on health and redress the significant carbon footprint of the Australian healthcare system; the Deeble Institute for Health Policy Research’s most recent brief on Decarbonising Clinical Care highlighted that carbon emissions from the healthcare sector comprise seven percent of national emissions.

A third of healthcare emissions are from public hospitals, 19 percent from pharmaceuticals and 10 percent from private hospitals. General practice, community and public health services together make up a further 10 percent of all Australian healthcare emissions.

However, whilst both climate policy and public healthcare remain key topics of political interest, the Australian Government still lags behind other nations, including the UK, in formally committing to decarbonising healthcare.

Two years ago the NHS was the first health system to formally commit to a net-zero sustainable health system by 2040. The NHS’ Sustainable Development Unit was founded in 2008 by Dr David Pencheon and Sonia Roschnik, both of whom are presenting the keynote address at this year’s Forum on their leadership experiences of developing a sustainable public health system

In Federal Parliament on 3 August, Health and Aged Care Minister Mark Butler confirmed his commitment to developing a National Health and Climate Strategy in consultation with state and territories and peak stakeholders. Reducing the carbon footprint of the health sector is one of the strategy’s three identified areas of focus.

In a comment provided to Croakey, he said it has long been Labor Party policy to put in place at the national level, a focused climate and health strategy.

“The Minister for Climate Change and Energy, Chris Bowen, and I will be outlining our views about good climate and health policy at a federal level,” he said.

“We need to make sure that the health system is able to deal with the climate impacts that we know are already baked into the system, and the challenge of reducing the carbon footprint of the health sector itself.”

Challenging juxtapositions

The location of the forum in the Hunter region of NSW also illustrates a challenging juxtaposition experienced by many climate advocates across the world.

Whilst environment justice efforts to mitigate carbon emissions are often enacted on a local scale with cumulative impact (for example, recycling programs and food waste reduction efforts), energy sources such as coal powered power stations propagate a significantly larger carbon footprint with direct detriment to population health.

This is the case in The Hunter, where pioneering local sustainability efforts are overshadowed by ongoing controversial plans to reopen the Upper Hunter coal mine amidst longstanding concerns about already dangerously high and worsening levels of air pollution from existing coal power stations and coal mines.

Air pollution levels in the Hunter Valley have consistently exceeded the World Health Organization’s recommended safety limit since 2015 with marked detriment to the physical and mental health of local communities.

Dr Mark de Souza is an Emergency Physician in Darwin and the Chair of the Sustainable Healthcare Committee NT Health. He recognises the challenging juxtaposition of implementing sustainability efforts whilst the NT Government continues to support climate damaging projects such as fracking on the door step of the health service, especially when the hospital is already treating people experiencing the adverse health effects of rising temperatures and climate change in the Northern Territory.

The climate challenges faced by communities in Darwin are markedly different from the rest of Australia whereby the humidity and land surface temperature of the wet tropics have a marked sociological impact on local communities. As part of their climate adaptation and mitigation efforts, de Souza heads up a project at the Royal Darwin Hospital restoring greenery and plants to the hospital campus.

Despite the rich and tropical surroundings of the Northern Territory, the people of Darwin are served by a “concrete jungle built for the snowscapes of the northern hemisphere”, according to de Souza.

The hospital campus lacks covered walkways and wheelchair access and is long overdue an adapted, fit for purpose and culturally safe facility. De Souza and his team of colleagues have been working on restoring greenery to the Royal Darwin Hospital, creating “cool and restorative green spaces” onsite by planting over 450 trees and counting since December last year.

Greening the hospital landscape. Photo provided by Dr Mark de Souza

De Souza describes a multitude of benefits to creating these green spaces and in particular prioritises the “immediate psychological first aid” inferred from the foliage for staff, patients and visitors to the hospital.

The trees cool the land surface temperature from up to 60 degrees Celsius in the unplanted area to more than 20 degrees Celsius cooler in the planted areas, providing shelter and respite in the heat for those wanting to spend time outside.

Furthermore, the act of planting itself has had a marked social and psychological benefit for the hospital’s workforce, worn down and challenged by ongoing staff shortages, the pressures of the pandemic and hospital overcrowding.

The trees also encourage and protect a number of non-human species including bats and insects which in turn promotes cross-pollination for fresh food and fruit production, a vital income stream in the NT.

Importantly, de Souza continues, 70 percent of the Royal Darwin Hospital’s inpatients are First Nations people, many of whom choose to discharge themselves early from hospital against medical advice. De Souza attributes this in part to the culturally unsafe environment in which First Nations people are forced to receive healthcare.

The design and composition of the green spaces has been created in close consultation with the Larrakia community, the Traditional Owners of the land, to ensure that the gardens are planted for the First Nations communities using the hospital.

Aunty Bilawara Lee is a respected Larrakia elder who will speak at the forum on this project and share how she has guided and advised on the gardens from the outset to ensure that plants and trees with specific cultural value to First Nations people are planted in order to foster cultural safety and provide a welcoming environment.

More recently, de Souza describes their efforts to label and curate Larrakia knowledge on the plants with multilingual signposting and QR codes linking directly to the hospital intranet.

Dr Mark de Souza at work. Photo supplied.

A recycling ecosystem

Another example of a successful effort involving frontline health workers as well as hospital management will be showcased at the Forum by Susan Farlow and her team at St Andrew’s War Memorial Hospital in Queensland.

Farlow works as the Hotel Services Manager at the hospital and was shocked at the huge volumes of waste produced by the hospital across every sector: “all the disposable single use plastic, the wrapping around the clean linen and the food plastic wrap!”.

They reviewed the plastic waste generated over a twelve-month period and found that the hospital produces 1,976 bins worth of plastic; equivalent to 38 bins a week.

As part of St Andrew’s War Memorial Hospital’s commitment to diverting 30 percent of their waste from landfill by 2025, Farlow and her team work with CircMed to educate their colleagues and champion upcycling of products such as disposable curtains, IV fluid bottles, soft and pressed plastics and packaging materials that would have previously been disposed of without thinking twice.

Their approach to creating a closed-loop hospital recycling ecosystem is straightforward: “keep it simple”, says Farlow.

The project is a partnership with CircMed, a Brisbane based organisation propagating closed loop recycling solutions in healthcare.

CircMed’s Director of Clinical Innovation Danielle Munro says that whilst there is an undeniable benefit of single use plastic in healthcare, they want their colleagues to re-frame their understanding of plastic “from single-use to just the first use [in their hands]” and to think about how the products they’re used to disposing of can be upcycled within the hospital, whether as part of the new curtains or as food wrap in the kitchen.

One of the most important elements of their program is teaching staff at every level how to properly sort waste and how products can be recycled.

Since the program was launched as a trial in October 2021, more than 7.5 tonnes of plastic have been upcycled.

From L: Susan Farlow St Andrew’s War Memorial Hospital, and Danielle Munro, CircMed.

The practical advice and community focus prioritised at the Greening the Healthcare Sector Forum will share climate mitigation efforts that are feasible for anyone working in any aspect of the healthcare sector to implement; this, perhaps, is one of the most important messages the Forum hopes to relay.

The Australian healthcare sector will continue to work under duress but the impact of increasingly dangerous carbon emissions on both population health and the health system itself cannot be ignored; utilising thousands of years of experience in Caring for Country is the most valuable way to mitigate and adapt to the dangers of climate change.

• Dr Sarah Simons is an Emergency Department registrar working in a busy inner city public hospital in Melbourne. She is British trained with postgraduate study in global public health at UCL and an academic interest in the determinants of health, incorporating social justice perspectives and advocacy into emergency clinical practice for socially vulnerable people. She reports for the Croakey Conference News Service. Follow on Twitter: @SarahNSimons


From Twitter

On Twitter follow #GreenHealthForum22 and this Twitter list of presenters and participants.


 

 

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