Introduction by Croakey: For healthcare to become more sustainable, we must stop providing low value interventions, where the harms or costs outweigh the benefits, according to Dr Fiona Godlee, editor in chief of the BMJ.
And it is also critical to press political leaders to increase investment in public health, she writes in the journal’s latest edition.
These and other calls for transformational action are expected from the Greening the HealthCare Sector Forum, to be convened next week by the Climate and Health Alliance (CAHA), Global Green and Healthy Hospitals and UnitingCare Queensland.
Journalist Cate Carrigan previews the forum below, for the Croakey Conference News Service.
Cate Carrigan writes:
Creating a low-carbon healthcare system will require transformational change, including not only green design and the use of renewables, but a move to better preventative health, reducing over-diagnosis and cutting back on low-value care, according to a health sustainability expert.
Dr Kate Charlesworth, Climate Risk Lead, Sydney North Health Network and North Sydney Local Health District, told Croakey the healthcare system needs to get rid of over-treatment and then decarbonise effective care.
Giving the example of respiratory care, Charlesworth said inhalers used for asthma and CODP (chronic obstructive pulmonary disease) often have potent hydrofluorocarbon propellants – which create greenhouse gases.
“Where appropriate, we need to switch to dry powder and other types of inhalers that are much less environmentally damaging – and we need to do that across the system, in every specialty,” she said.
“The great thing is, in so many cases, that will mean better value and more accessible care. Less harms, risks and costs, and more appropriate and environmentally sustainable care.”
Energy – which makes up 20-30 percent of the health system’s carbon footprint – is another major part of the picture, with Charlesworth saying it would be “a quick win” to switch to renewables.
Charlesworth said using renewables was also about better health, pointing to a recent global study on the health hazards of fossil fuel pollution.
“We wouldn’t allow smoking in our hospital, and we wouldn’t use asbestos, so we shouldn’t be using fossil fuels.”
Other initiatives she identified were transitioning to clean green transport, and rethinking models of care to address the use of pharmaceuticals, medical devices and equipment that make up 60 percent of healthcare’s carbon footprint.
Charlesworth is among the speakers at next week’s Greening the HealthCare Forum.
Ensuring the best use of landscaping to counter climate impact at aged care facilities, phasing out carbon intensive anaesthetic gases, and moving to plant-based diets are among the innovative approaches to be presented at the forum, to be held on-line and onsite at the Royal Brisbane and Women’s Hospital Education Centre, on Turrbal and Jagera/Yuggara Country.
A roadmap for action
Carol Behne, CAHA’s Sustainable Healthcare Program Manager and GGHH Pacific Coordinator, told Croakey the forum program is based around most of the seven action areas identified in a Health Care Without Harm (HCWH) roadmap for healthcare decarbonisation:
- Power health care with 100 percent clean, renewable electricity
- Invest in zero emissions buildings and infrastructure
- Transition to zero emissions, sustainable travel, and transport
- Provide healthy, sustainably grown food and support climateresilient agriculture
- Incentivise and produce low-carbon pharmaceuticals
- Implement circular health care and sustainable health care waste management
- Establish greater health system effectiveness.
Behne said the aim was to facilitate connection, share knowledge on new approaches to sustainable healthcare and inspire action.
“We want to showcase the positive work underway and encourage further action, particularly from government and health sector leaders,” she said.
Behne said healthcare is on the frontline of the climate emergency – having to deal with the impacts of heatwaves, fires, floods and pollution – and is also a big contributor to the problem: creating seven percent of Australian greenhouse gas emissions and 4.6 percent of global net emissions.
“This is at odds with the health sector’s moral imperative to ‘first do no harm’,” she said.
“There are many opportunities for the health sector to reduce emissions and improve sustainability, and at the same time prepare for climate change related impacts on health service delivery and improve health outcomes.”
National leadership needed
With the Federal Government failing to implement longstanding recommendations to implement a national climate and health strategy, the momentum is coming from states and territories and individual health services.
Victoria is implementing sustainability reporting requirements for carbon emissions, water usage and waste across health services; Queensland Health has an office of environmental sustainability; WA Health has just appointed Dr Sarah Joyce as Lead Sustainable Development Officer in a new sustainable development unit; SA is working on carbon foot printing and planning Australia’s first all-electric hospital, NSW has a sustainability lead, and the ACT is building a 100 percent electric wing at one of its hospitals.
“What we really need is a commitment from the Federal Government to ensure our health system is climate resilient and low carbon,” Behne said.
Australia did not join more than 50 countries that made a commitment at COP26 to develop low-carbon climate resilient health systems, and Behne is now calling for a much stronger stance.
“We need a national sustainability unit within health to coordinate action between states, territories and health services, and provide resources to make this happen,” she said.
Since 2017, health organisations have been urging the Federal Government to establish a national sustainable healthcare unit within the Commonwealth Department of Health “to provide leadership and direction to the health sector, support state and territory initiatives to implement sustainability initiatives through the provision of tools, resources and guidance, and collect and report data on health sector sustainability performance across Australia”.
Charlesworth agrees that national leadership is needed to scale up the work being done on the ground to green the healthcare system.
“There are passionate doctors, nurses and others, who are reducing waste, recycling, looking at procurement and different models of care such as telehealth – things that we know are important for a net zero health system,” she said.
“But we are yet to get the leadership and coordination that’s required to really scale things up to the pace that we need,” she said.
Judene Andrews, the Manager Environmental Sustainability at UnitingCare, said the organisation was supporting the forum as it saw collaboration as key to accelerating progress towards a healthier, fairer, and greener future for all.
UnitingCare recognised that “the health and wellbeing of our clients, residents, patients and staff is inextricably linked to the health of our planet”.
Andrews said UnitingCare’s own sustainability strategy had set ambitious targets across its organisation, including 70 percent reduction in emissions, achieving 100 percent renewable energy, and a 100 percent hybrid and electric passenger fleet, and that it had a $3.8m solar PV rollout underway at 22 residential aged care facilities and one regional hospital.
CEO of the Lowitja Institute and proud Narrunga Kaurna woman Dr Janine Mohamed will address the forum’s opening session. She told Croakey the event was important in bringing together people committed to working towards net zero emissions, climate resilience and an equitable and environmentally sustainable healthcare sector for all.
Mohamed said the forum showed a commitment to doing the hard work needed to address inequity, challenges she knew well through her work to embed cultural safety across the health system and to impact racism.
Aboriginal and Torres Strait Islander peoples have known for thousands of years that our health is directly linked to the health of Country, and the Greening the Healthcare Forum brought together people who also understood the importance of holistic understandings of health, she said.
Mohamed said she would outline research on climate change and Aboriginal and Torres Strait Islander health undertaken for the Lowitja Institute, with the backing of the Climate and Health Alliance, which highlighted the disproportionate effects of the climate crisis upon Indigenous people.
She would also discuss how extreme heat is affecting health and wellbeing, especially of those with chronic conditions, and how climate change is compounding historical injustices and disrupting cultural and spiritual connections to Country.
Mohamed called for collaboration between health services and for transformational change so that health systems are equitable, climate resilient, sustainable and net zero, with cultural safety embedded.
Greening aged care
Forum participants will be told about research findings that identified keys to improving the way aged care facilities can maximise landscaping to counter climate impacts.
In a joint project, researchers from Sunshine Coast and Griffith universities worked with UnitingCare Queensland to review two of its aged care facilities, assessing the potential of green infrastructure to improve health and sustainability outcomes in residential aged care.
The team looked at environmental design, the impact on atmospheric heat (using sensors placed around the grounds), and how strategic design could reduce heat and improve other indicators such as sociability and sustainability.
Data was logged over several months to gauge the temperature and humidity range, assess headload, check surfaces – such as bitumen paths – for radiated heat, and identify maximum shade.
Researcher Dr Tony Matthews, a senior lecturer in urban and environmental planning at Griffith University, told Croakey while both facilities had quite generous green space, plantings were for aesthetic rather than strategic purpose, such as shade provision.
“It became clear that the design priorities for landscaping weren’t taking account of benefits that would flow from strategic plantings of other types of greenery.“
Once the researchers had conducted the monitoring and interviewed residents and staff, they formulated strategic landscape designs to maximise benefit from the greenery: heat reduction, and better outdoor space for socialising and relaxing.
The draft plans incorporate more natural shade – additional shade trees – but also more shade cloths in certain areas, and the building of cooling rain gardens (depressed areas designed to collect rain water and often planted with grasses and flowering perennials) to replace the large grassy areas with central drains common in such facilities.
Matthews, who will present the findings at the forum, said the plans are currently being refined before being taken to UnitingCare senior management.
As modification can be expensive, Matthews said the plans were drawn up in stages to allow for gradual implementation.
Matthews told Croakey residents were very enthusiastic about the plans, telling researchers they would use the gardens more for socialising and exercise if there was additional shade and enjoyable places to sit.
While residents are the priority, the changes are also about families. ”If you are going to be putting your elderly relative in aged care, the better the facility the less anxious you will be about the decision“.
“We want to create a place where the whole family goes to visit grandma. Where you can take your small children and there’s a good outdoor space they can run around in, and they are not just sitting in a room.“
“Having decent greenspace and outdoor space where elderly people can go and have social engagements and activities is a way to do this.”
Matthews added that better landscaping would also lead to happier staff and less turnover – a major issue in thje aged care sector.
Underlying all of this is the fact that heat is a major health hazard for elderly people.
“Very hot days are particularly hazardous to elderly people, and with ten percent of the national population of seniors living in residential aged care facilities, it makes sense to try and address heat as a major health concern within the sector.“
Wake up call on anaesthesia
Medical trainees are driving change in environmental sustainability in anaesthesia, encouraging the sector to rethink the use of certain gases, reduce the use of ‘blueys’ – medical gowns, reuse drug trays, and recycle paper and cardboard.
Dr Rose Cameron, from the Trainee-led Research and Audit in Anaesthesia for Sustainability in Healthcare (TRA2SH) group and a New Zealand anaesthetic trainee, told Croakey the organisation’s mission is to reduce the environmental impact of theatre waste, whilst maintaining high standards of patient care.
Cameron, who will present a paper on ‘Positive change in sustainable practices in anaesthesia’, said operating theatres produce around 20-33 percent of all hospital waste, and anaesthesia makes up 25 percent of that.
A major initiative of TRA2SH is the ‘Ditch the Des’ campaign targeting the volatile anaesthetic desflurane, one of the most common and harmful, which emits much more greenhouse gas then alternatives such as sevoflurane.
Cameron said TRA2SH’s ‘Annual Operation Clean Up’ (OCU) Day promotes a bundle of sustainable changes focussing on Refusing, Reducing, Reusing and Recycling.
“We are working to stimulate positive culture change in sustainable practices in anaesthesia, through trainees.
“Trainees are great as we move around hospitals frequently and are therefore uniquely positioned to raise awareness, educate and advocate eco-leadership in our departments,” she said.
Cameron said TRA2SH is also hoping to collaborate in future with other departments (surgeons and ICUs) and is passionate about sustainable practice and creating a circular economy.
“Trainees involved are able to use education and audit to promote awareness of practice and self-reflection to others for a more sustainable future in healthcare,” she said.
Transforming a health service
One of Australia’s largest health services, Brisbane’s Metro North Hospital and Health Service (MNHHS), is on the frontline of change, adopting a 2021-26 sustainability strategy that embeds sustainability initiatives into the planning, design, construction, operations and maintenance of MNHHS projects.
MNHHS Executive Director Assets and Infrastructure, Kate Copeland, will outline the strategy at the forum, saying it incorporates Sustainability Design Guidelines to be applied to all stages of future projects, including planning, construction, water usage, waste, maintenance, urban greening and disposal.
The guidelines lay the path to carbon neutral buildings, more electric hospitals (where all power comes from renewables), improving hospital air quality, and empowering patients to control elements of their environment such as lighting and air conditioning.
As part of its strategy, MNHHS is moving to electric vehicles, both its 300-strong passenger car fleet – to be fully changed over by 2026 if not before, the diesel-powered maintenance buggies, trucks, and security staff motor bikes, in addition to the battery-powered gardening tools already brought in to the replace petrol-run equipment.
Not wanting to wait until 2026, the MNHHS is ensuring that – at a minimum – hybrid vehicles are being used by 2022, phasing out all fossil-fuelled passenger vehicles.
The importance of eating our way to a cleaner planet is the key message from Dr Angela Genoni, Nutrition and Research Development Lead, Doctors for Nutrition, who will tell the forum that plant-based foods are not only “exceptionally important from a climate perspective but also from a health perspective”.
Genoni’s presentation ‘Delivering cost savings through plant-based catering in healthcare settings’ will highlight that plant-based foods create substantially less carbon emissions than animal-based foods and are much cheaper to provide.
“In a healthcare setting, dietary provisions are centred around the Australian dietary guidelines which includes meats and dairy products which are actually quite expensive compared to plant-based alternatives, such as legumes, fruits and vegetables,” she said.
A project undertaken by Genoni found that plant-based food could meet all the dietary requirements of a standard patient in a hospital setting.
“What we’ve found is that nutrient composition and dietary fibre intake is greater with increased plant food consumption,” she said.
“The take home message is that food production and consumption is a large contributor to greenhouse gas emissions, and animal-based produce contributes to over half of these.
“Therefore, if we can reduce that by swapping to plant-based foods, then we are really starting to make a difference and it benefits peoples’ health at the same time.”
Genoni said one of the spin-offs of better nutrient content and higher dietary fibre is improved health to keep people out of hospital and speed recovery, so they can get home sooner.
There are also the benefits of reducing the risk of food poisoning, and storage and preparation costs, with less refrigeration required for plant-based foods.