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Value-based healthcare: how can it help address the climate crisis?

Introduction by Croakey: Almost 40 percent of all heat-related deaths between 1991 and 2018 were due to anthropogenic climate change, according to a new study involving 43 countries.

The findings, published in the journal Nature Climate Change, found that climate change was responsible for 37 percent of all warm season heart-related deaths (with a range of 20.5-76.3 percent), based on empirical data from 732 locations in 43 countries.

The largest climate change-induced contributions (more than 50 percent) were in southern and western Asia (Iran and Kuwait), south-east Asia (the Philippines and Thailand) and Central and South America.

“Our findings support the urgent need for more ambitious mitigation and adaptation strategies to minimize the public health impacts of climate change,” reported the researchers. The World Health Organization estimates that more than 166,000 people died due to heatwaves between 1998 and 2017.

The findings come as a new publication from the Deeble Institute for Health Policy Research argues that value-based healthcare is a useful framework for addressing climate health hazards, reports Croakey journalist Linda Doherty below.

(And follow #ValueBasedCare on Twitter on 3 June for news from an online summit convened by the NHMRC-funded Partnership Centre for Health System Sustainability).


Linda Doherty writes:

Australia must commit to a green and resilient health system with strategies that recognise the impact of climate change on the health of current and future generations, according to a new report from the Deeble Institute for Health Policy Research.

Value-based healthcare provides the framework for systemic and sustainable transformation to understand the climate-related health needs of patients and to design solutions to improve health outcomes and costs, says the report.

But climate change needed to be fundamentally recognised as a determinant of health so that new strategies could address its impact on the health of the population, particularly vulnerable communities in rural and remote areas, on workforce shortages and carbon emissions.

“The complexity of climate change and related health issues and systems challenges must be considered as an essential component of Australia’s climate change strategy,” said the report, Transforming the health system for sustainability: environmental leadership through a value-based health care strategy.

“This will require strong leadership within the health sector, supported by innovative, evidence-based and practice informed strategies that support the sustainability of a healthy Australia.”

A value-based approach to healthcare was being used to some extent in Australia and in other countries facing sustainability challenges, including ageing populations, the growing burden of disease, changing community expectations and rising healthcare costs.

“Yet health systems and services appear to be considering environmental sustainability independently of value-based health care, with limited evidence of initiatives or entities purposefully aligning the two concepts in practice,” the report said.

The often-misunderstood concept of values-based healthcare was “the measured improvement in a patient’s health outcomes for the cost of achieving that improvement” and encouraged the participation of patients in the design and delivery of their care, which was “an important principle in supporting access and contributing to sustainability from a social perspective”.

Younger Australian patients were increasingly concerned about climate change and were demanding stronger action from governments and business leaders.

The changing preferences of Millennials (those born between 1979 and 1995) and Generation Z (1996 – 2010) could influence healthcare models and products as they transition into healthcare markets and make decisions based on pro-climate values. The younger generation could, for example, demand more telehealth services to reduce transport emissions.

Health costs of climate events

The Deeble Institute report summarised the impacts on health of Australian climate-related natural disasters and extreme weather events, concluding that these events were “contributing to significant short-term direct health impacts including physical injury, respiratory illness and cardiovascular issues as well as long-term and indirect outcomes such as eco-anxiety and mental health trauma”.

COVID-19 pandemic: The coronavirus causing COVID-19 has been attributed in part to altered climate conditions. The social, economic and health conditions created by COVID-19 have increased the prevalence of mental ill health in Australians, with a 30 per cent increase in demand for mental health telephone support services.

Catastrophic bushfires: 33 people died in the 2019-20 bushfire season, estimated to have cost the health system $1.95 billion in hospital admissions and premature loss of life. Additionally, bushfire smoke is estimated to be responsible for 417 excess deaths, 1,124 hospitalisations for cardiovascular problems, 2,027 for respiratory problems and 1,305 asthma presentations.

Air quality: Thick black smoke covered large parts of the country for weeks during the 2019-2020 bushfire season. The Australian Capital Territory recorded the worst air quality in the world in early January 2020 and 11 million people (across the ACT, New South Wales, South Australia and Victoria) reported exposure to bushfire smoke. Hospital emergency department presentations spiked on days when air quality was poor.

Heatwaves: Identified as Australia’s deadliest natural hazard by the Department of Infrastructure and Transport. Between 2007 and 2017 mortality increased by two percent during heatwaves.

Air pollution: In 2015 an estimated 2,500 deaths in Australia were attributed to air pollution linked to climate change (including bushfire smoke and carbon emissions).

Thunderstorm asthma: The 2016 Victorian thunderstorm asthma event, triggered by high pollen levels and a severe thunderstorm occurring simultaneously, caused a high level of acute respiratory distress in people with pre-existing allergies and asthma. Within a 30-hour period, public hospital presentations in affected areas (Melbourne and Geelong) increased by 58% (9,909 presentations), with a 672% increase in respiratory-related presentations.

Trauma to physical and cultural health

Aboriginal and Torres Strait Islander people living in rural, remote and northern communities are expected to experience the health impacts of climate change most severely, causing trauma to physical and cultural health.

The Deeble Institute report said this impact was intensified by existing socioeconomic disadvantage such as inadequate or hard to access health and educational services, insufficient housing and water supply, limited employment opportunities and health risk factors.

“Within this context, climate change has the potential to exacerbate not just individual physical health, but also the social, emotional and cultural wellbeing of the whole community,” the report said.

Reducing the carbon footprint

The Transforming the health system for sustainability report calls for action to reduce the carbon footprint of the healthcare system, which contributes 7.2 percent of Australia’s total CO2 emissions. Australia is the 10th largest total healthcare carbon emitter globally.

Value-based healthcare could guide the introduction of virtual healthcare solutions to reduce the carbon footprint and health technology should be more widely used to address sustainability issues.

Preventative health and primary care should be strengthened to keep people out of hospitals and reduce the carbon footprint since hospitals accounted for almost 45 per cent of Australia’s healthcare carbon contribution.

Workforce shortages

In some parts of Australia, particularly rural and remote areas, climate change-related increases in temperatures were already causing healthcare workforce shortages, which disproportionately affect at-risk populations and people with complex health and social needs.

These shortages also meant people had to travel further to access care. The report calls for more integrated care that is patient-centred, holistic and cost-effective and facilitates local and systems’ sustainability through “consideration of, and accountability to the environment”

“The increasing health burden attributable to climate change is compounding health system sustainability issues and placing additional pressure on the healthcare workforce,” the report said.

Transforming the health system for sustainability: environmental leadership through a value-based health care strategy was written by Emma Hoban, Policy Analyst, Australian Healthcare and Hospitals Association; Rebecca Haddock, Director, Deeble Institute for Health Policy Research, Australian Healthcare and Hospitals Association; and Kylie Woolcock, Policy Director, Australian Healthcare and Hospitals Association.


This article is published as part of our contribution to the global Covering Climate Now initiative, an unprecedented collaboration involving hundreds of media outlets around the world. It is co-founded by The Nation and the Columbia Journalism Review (CJR), in partnership with The Guardian.

Support public interest journalism on climate and health

If you value our coverage of climate and health, please consider supporting our Patreon fundraising campaign.

This fundraising is so we can provide regular, in-depth coverage of the health impacts of the climate crisis, taking a local, national and global approach. All funds raised go to a dedicated fund to pay writers and editors to put a sustained focus on the health impacts of climate change. Please help us to produce stories that will inform the health sector, policy makers, communities, families and others about how best to respond to this public health crisis.

See Croakey’s archive of climate and health coverage.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Summer reading 2020-2021
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Testing Croakey News category 1
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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
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Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
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Population Health Congress 2015
2016 conferences
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#cphce2016
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2017 conferences
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#BTH20
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#ClimateHealthStrategy
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