THE TIME FOR CHANGE IS NOW

By Dr Alice Harpur, ST4 Public Health and Scottish Clinical Leadership Fellow (2022-23)

The climate crisis is the biggest global threat to public health. Dr Marina Romanello reminded us of this at the College’s 2022 President’s Conference: Sustainability in Healthcare. The 2022 Report of the Lancet Countdown shows that life-threatening extreme weather events are becoming increasingly more frequent. Between 2012-2021, 29% more global land area was affected by extreme drought for at least one-month compared to 1951-1960, whilst extreme heatwaves in 2020 were associated with 98 million more people suffering from food insecurity than annually in 1981-20101. These health impacts are echoed across the literature, and as our addiction to fossil fuel continues, it is estimated that 40,000 deaths in the UK are attributable to exposure to outdoor air pollution each year2. Bringing these numbers to life, the media brings our attention to the catastrophic effects of the climate crisis; from the recent devastating floods in Pakistan3, to nine-year-old Ella Adoo-KissiDebrah who was the first person in the UK to have air pollution listed as a cause of death4.

We also know that the climate crisis is widening health inequalities, with those who experience the greatest impacts of the climate crisis, often being those who have contributed least to greenhouse gas emissions. At the President’s conference Professor Tahseen Jafry spoke about her research which has shone a light on women in Malawi who are experiencing worsening gender-based violence and mental health problems as a result of climate change5.

Completing the links between health, healthcare, and the climate crisis, is the understanding that healthcare itself is contributing to the problem. In England, the NHS contributes to 4% of the country’s overall carbon footprint6. Healthcare systems must therefore do three things:

1 Adapt to changing patterns of morbidity.

2 Become resilient to the posed threats of the climate crisis.

3 Reduce the negative contribution that healthcare delivery is making to the climate crisis.

The facts and narrative, however, can be overwhelming, anxietyprovoking and stun us into inaction. But now is a time for action. As the impacts of the climate crisis are unfolding before our eyes we must embrace our opportunities to contribute to the change that is required.

Considering opportunities in our personal lives, at the President’s Conference, Professor Lindsay Jaacks challenged us to reflect upon our dietary choices and attitudes towards food waste. She highlighted the significant impact that reducing our consumption of animal-based products can have on our carbon footprint. In addition to dietary change, Imperial College London have worked with colleagues in the NHS, the Institute of Global Health Innovation, and the UK Health Alliance on Climate Change (UKHACC) to develop a resource which outlines 9 key actions that can be taken to have a positive impact on both your health and the planet (and many have the added benefit of being good for our wallets). These include; using our voice for advocacy, eating more plant-based and balanced diets, switching to active transport, insulating our properties, bringing nature into our homes, enjoying and protecting natural spaces, being more conscious consumers, embracing learning and challenge, and speaking openly to others about the climate crisis.

Considering opportunities in our professional lives, we can adopt greener commuting methods, challenge our affinity to single-use items, avoid over-investigation and treatment, and consider our role in disease prevention. As healthcare professionals, we also have powerful and trusted influence: by taking bold and visible action in this space, we can have a ripple effect that sparks change among our patients, colleagues and wider communities. Looking at examples of healthcare professionals who are already putting change into practice, the College recently hosted a series of webinars that showcased actions to achieve more sustainable practice across medicine, surgery, podiatric medicine, travel medicine, and dentistry.

Figure: Sources of carbon emissions by proportion of NHS Carbon Footprint Plus. Sourced from ‘Delivering a ‘Net Zero’ National Health Service: https://www.england.nhs.uk/greenernhs/wpcontent/uploads/sites/51/2022/07/B1728-delivering-a-net-zero-nhs-july-2022.pdf

These are available to watch via the College’s YouTube channel. Across the UK we’ve also seen changes in practice, from the complete cessation of desflurane use in many hospitals, a move away from metre-dose inhalers, and a growing use of reusable surgical caps. In addition, the Centre for Sustainable Healthcare have produced a wealth of resources to support environmental impacts being considered and incorporated into quality improvement projects and have national specialty networks which share opportunities for change and good practice across a range of disciplines.

Whilst “ground-up” action is essential, there is of course a need for action beyond the individual. We need system-wide changes to make sustainable practice the default option by tackling the carbon footprint associated with activities such as procurement, buildings, and transport. In England the Greener NHS programme is leading work to support NHS England to achieve net zero whilst also improving population health and saving money7. In Scotland, NHS Scotland published its climate emergency and sustainability strategy in August 2022 which outlines five themes and associated actions to reduce the environmental impact of healthcare delivery and adapt the system to climate change8. Also, in Wales, the NHS Wales decarbonisation strategic delivery plan outlines 46 initiatives to achieve net zero9.

Here at the College, change is also underway. We’ve already undertaken a carbon footprint analysis and committed to becoming a net zero organization. Using its voice for advocacy, we have published position statements on sustainable health services and food systems and via UKHACC, have joined with organisations across the world to raise awareness of the health impacts of climate change. We’ve also recently partnered with the Royal College of Surgeons of Edinburgh and The Royal College of Surgeons of England to produce a Green Theatre Checklist. Building upon this momentum, the College is excited to have recently launched a Sustainability Steering Group which will continue to oversee its work to address the climate crisis. With representation from both clinicians and College staff, this group will continue work to reduce the College’s carbon footprint, will use our voice to raise awareness of the links between climate change and health, advocate for sustainable healthcare, and will support fellows and members to develop the knowledge and skills to practice more sustainable healthcare.

To conclude, I am reminded of the phrase I dutifully quoted in my medical school interviews:

“I think a career in medicine provides an exciting opportunity for life-long learning…”

In the midst of evenings and weekends revising for exams, I have of course cursed this concept, but I have no doubt that the ongoing opportunities for learning and development are (and will continue to be) key in making my career stimulating and rewarding. I would therefore encourage you, no matter what stage of the sustainability journey you’re on, to commit to starting or continuing to educate yourself about climate change, and embrace new innovations and approaches to living more sustainable lives and delivering more sustainable healthcare. The co-benefits that accompany many of these changes are also huge, for example, our long and short-term health and wellbeing will definitely benefit from cleaner air, healthier diets, and more active lifestyles. So, let’s not be overwhelmed or complacent about the climate crisis that is upon us, but rather embrace the many opportunities we have to overcome it.

(1) The Lancet Coundown (2022). The 2022 Report of the Lancet Countdown: Health at the Mercy of Fossil Fuels. Available at: Visual summary - Lancet Countdown

(2) Royal College of Physicians (2016). Every breath we take: the lifelong impact of air pollution. Report of a working party. London: RCP.

(3) BBC News (2022). Pakstan floods: ‘It’s like fighting a war with no end’. Available at: https://www.bbc.co.uk/news/world-asia-63080101

(4) BBC News (2020). Ella Adoo-Kissi-Debrah: Air pollution a factor in girl’s death, inquest finds. Available at: https://www.bbc.co.uk/news/uk-england-london-55330945

(5) Glasgow Caledonian University (2022). Climate change makes violence against women in Malawi worse, study finds. Available at: https://www.gcu.ac.uk/aboutgcu/universitynews/climatechange-makes-violence-against-women-in-malawi-worse,-study-finds

(6) NHS England (2022). Delivering a ‘Net Zero’ National Health Service. Available at: https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2022/07/B1728-delivering-a-netzero-nhs-july-2022.pdf

(7) NHS Scotland (2022). Climate Emergency & Sustainability Strategy 2022-2026. Available at: https://www.gov.scot/publications/nhs-scotland-climate-emergency-sustainabilitystrategy-2022-2026/pages/2/

(8) NHS Wales (2021). NHS Wales Decarbonisation Strategic Delivery Plan 2021-2030. Available at: https://gov.wales/sites/default/files/publications/2021-03/nhs-wales-decarbonisationstrategic-delivery-plan-2021-2030-summary.pdf