World Health Day feels particularly poignant this year and our responsibility as health clinicians and researchers to lead becomes ever more pressing.
World Health Day 2022 asks us:
‘Are we able to reimagine a world where clean air, water and food are available to all?
Where economies are focused on health and well-being?
Where cities are liveable and people have control over their health and the health of the planet?’
So let’s reimagine… How could we live, teach, provide healthcare and develop research in a more sustainable or even a regenerative way?
The recent Intergovernmental Panel on Climate Change (IPCC) report, the findings of which were described by the UN Secretary-General António Guterres as ‘a damning indictment of failed climate leadership’, makes it clearer than ever that we have this decade to pivot and rapidly decarbonise our systems to limit global warming to closer to 1.5 degrees. Based on current policies and commitments, the majority of IPCC scientists surveyed think we’ll hit 3 degrees and catastrophic warming within their lifetime.
Hope is not a method. The investment required to limit climate change is just a few percent of the global GDP by mid-century. But it will require coordinated leadership at a scale never seen before; leadership that will need to come from all sectors.
Much has been written about how to bounce back well as we emerge from the worst of the global pandemic with a new understanding our interconnectedness, our responsibilities as citizens and states, and the level of global co-operation that we can achieve when required.
The floods in NSW and Queensland and increasingly frequent fires and other extreme weather events around the world demonstrate that the predicted effects of anthropogenic global warming are galloping ahead. At the same time, the tragic war in the Ukraine has further highlighted systemic fragility and strained supply chains particularly related to our ongoing dependence on fossil fuel-based energy.
In Australia we have a federal election looming and for the 1.63 million young people aged 18 to 24 enrolled to vote, climate change is one of the most important issues that will determine how they will vote on election day. A nation-wide study funded by Deakin University’s Institute for Health Transformation (IHT) showed Australians were 3 times more worried about climate change than COVID-19 and approximately 1 in 5 young people are experiencing significant mental health impacts because of anxiety related to climate change, with tangible impacts on cognitive and functional impairment affecting their work, family, and social life.
Overwhelmingly we care, but how do we respond? Delay may be the new denial but for many of us, the challenge is how to manage our emotional response and transform our fear into action. As a hospital colleague recently confided, ‘I have struggled with the step of moving into advocacy because that feels harder, I don’t know what I’m doing and everything I read gives me such unpleasant feelings of alarm and dread that it’s easier to go into avoidance mode… and tell my kids off for putting the soft plastics in the wrong bin… then feel guilty about watching Netflix as our ecosystem collapses… but the antidote to this is connection and action.’
The Lancet Climate Commission suggests that health professionals must be leaders in responding to the health threat of climate change and that tackling climate change could be the greatest health opportunity of the 21st century.
In Australia representational health bodies are already responding to this call for advocacy by demanding comprehensive and effective policy. For example, the Climate and Health Alliance’s Healthy, Regenerative and Just Framework for a national strategy on climate, health and wellbeing for Australia, Doctors for the Environment Australia’s Policy; Action on Climate Change and Health and the call for a National Healthcare Sustainability Unit.
Beyond advocacy for policy, health professionals and researchers also need to lead in the decarbonisation of our own sector. The surge in use of plastic fossil fuel-based personal protective equipment globally during the pandemic has drawn public and professional attention to the scale of environmental impacts of medical waste in healthcare as well as our broader footprint.
In healthcare we have been slow to reduce our own carbon footprint, which is the source of approximately 7% of our annual national emissions. Research has found that in one year of healthcare, Australia produced 35772 Kilotonnes of CO2e, which is the third highest emissions in the world per capita.
Globally we can look to the Healthcare Without Harm and the Global Green & Health Hospitals network for leadership, and the UK’s NHS as a first mover on this issue with a government-funded, ambitious roadmap to 80% reduction in carbon footprint across direct and indirect emission sources by 2028 (see scopes 1,2 and 3 in the figure below) and carbon zero health service by 2040. This is a truly extraordinary ambition, backed by policy, investment, research, and implementation science.
Figures 1&2 -Quick explainer: Scope 1&2 are mostly Gas burned onsite and purchased electricity while Scope 3 emissions include everything from consumables and waste, food, transport, pharmaceuticals, etc. is estimated internationally to constitute around 70%
Images: Healthcare without Harm
In Australia, we are yet to declare health sector decarbonisation goals beyond federal and state targets. In Victoria, the State plan is to be carbon zero by 2050 but only across Scopes 1 and 2 of Healthcare Without Harm. We must advocate and lead in this space. One important Victorian initiative is the Victorian Renewable Energy Target (VRET2), which will include all hospitals being supplied by 100% renewable electricity by 2025. This leads to significant infrastructure electrification opportunities. Fossil gas consumption contributes almost half of Victorian hospital energy. Several Victorian hospitals including University Hospital Geelong still need to plan for how to retire their gas co-generation plants and transition to renewable electricity supply for space and water heating.
Deakin University has a comprehensive renewable energy plan. Barwon Health has a strategic priority regarding environmental sustainability and the implementation plan and targets are in development. We welcome Kylie McIntyre to the team as the new Sustainability Manager for the Barwon South West Region. Deakin and Barwon Health are partnering via the Deakin Sustainable Health Network and Institute for Health Transformation (IHT) to inform Barwon Health and Barwon South West regional sustainable health plans .
IHT has funded an interdisciplinary team including members of IHT and Deakin University’s Institute for Frontier Materials (IFM) to work with Barwon Health to map the drivers and challenges of medical waste (namely single use PPE), with the aim of identifying priorities and actions (e.g. circular economy-based initiatives) aligned with Barwon Health’s sustainability priorities for Scope 3 of Healthcare without Harm. The study will use successful systems dynamic-based Group Model Building using STiCKE software, developed by IHT’s Global Obesity Centre, to understand the supply, use, disposal and recycling chain, allowing a unique whole system view of the problem of medical waste management. This will reveal opportunities for reduction, reuse, recycling etc and material development and experimentation with IFM.
Linked to this study are a series of post-graduate projects including a practicum project to understand Barwon Health’s footprint across Scopes 1-3 using the new GGHH CheckUp tool, a PhD project and scholarship on leading and managing environmental sustainability in healthcare, and an Executive Dean-Health strategic fellowship on medical waste and circular economy with IHT and IFM.
Decarbonise your day
This suite of sustainable healthcare initiatives operationalises IHT’s identified complex challenge of Improving sustainability of our health system and multiple pillars of IHT’s Strategic Refresh 2025. This includes multidisciplinary and participatory designed research and advancing strategic, high value partnerships. This body of planetary health work demonstrates a significant collaboration between IHT and the newly formed Sustainable Health Network. Together the Sustainable Health Network and IHT will deliver concrete benefits for health services partner .
It’s obvious that our planet impacts our health, and the way we look after our health and healthcare services impacts the planet. On World Health Day, we encourage all to decarbonise your day by opting for active travel to work, trying a planetary health diet, sharing this blog post on social media, becoming an advocate by joining Doctors for the Environment Australia or the Climate and Health Alliance, and calling on government to implement a national strategy on climate, health and wellbeing.
If you are interested in contributing to the next steps in this project or championing sustainability issues in your healthcare setting, please contact Dr Mike Forrester and Dr Rebecca Patrick at firstname.lastname@example.org
- Climate Change is a Health Crisis: Health Messages from the IPCC Sixth Assessment Report on Climate Impacts, Adaptation and Vulnerability, Climate and Health Alliance
- The IPCC report
- Healthcare Without Harm roadmap and 7 Interventions, Healthcare without Harm
- Is there such a thing as ‘too much medicine’?, Healing Health podcast, IHT
- Australia in 2030: what is our path to health for all?, IHT