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27 Jun 2018

BY DR TESSA KENNEDY, CHAIR, AMA COUNCIL OF DOCTORS IN TRAINING

When we talk about sustainability in health we are usually talking about spending and workforce. But what of the physical environment?

Existing AMA policy acknowledges that: “Human health is ultimately dependent on the health of the planet and its ecosystem. Climate policies can have public health benefits beyond their intended impact on the climate. These health benefits should be promoted as a public health opportunity, with significant potential to offset some costs associated with addressing climate change.”

Yet the health sector itself contributes around seven per cent of all greenhouse gas emissions. Our own resource rich settings create an enormous amount of plastic and other waste which take a direct toll on patient health and our environment. The way we run our hospitals is also increasingly unsustainable from an environmental perspective.

Health facilities and workers should promote a holistic approach to health, including its social and environmental determinants. We are increasingly acknowledging this: hospitals are non-smoking areas, because tobacco is a significant risk to health. There have been efforts to improve food options and exclude sugar sweetened beverages from hospital canteens because obesity is a significant risk to health.

Yet every time I place a cannula, suture a chest drain, resuscitate a baby, I generate a large amount of disposable, non biodegradeable waste, including plastics and instruments that have barely touched a patient. When I wash my hands tens of times a day, paper towels are co-mingled with nonrecyclable rubbish. Many of us will drive to work because of lack of public transport options to suburban hospitals, especially when working shifts, and a lack of showering and changing facilities required to encourage active self-transport options like cycling or jogging.

Disposable coffee cups, choice of volatile anaesthetic gases, computers and lights left on overnight - there are many environment degrading and wasteful practices that would take little effort to change.

Nonetheless, I’m sure like me, many of you have felt like the threat of climate change is more of an existential one than of direct relevance to your every day. Even with good intentions it just feels too big, too far beyond our reach to change. Like any efforts we make are just a drop in a warming ocean.

But what if we could see the impact of our actions in the community we treat? To measure the impact of our efforts to change in terms of patient outcomes and cost savings that could be reinvested in our insatiable health budget? It would be a lot easier to stay motivated.

Luckily, we not only have a fantastic opportunity of many low hanging fruit to improve sustainability due to the current lack of priority it is afforded, but a proven model of how to go about achieving change from the UK NHS Sustainable Development Unit. This dedicated unit has coordinated research, policy and action to improve the sustainability of health care. They succeeded in cutting NHS greenhouse gas emissions by 11 per cent between 2007 and 2017, despite an 18 per cent increase in health service activity.

If we are sincere in acknowledging climate change and environmental degradation as one of the most significant threats to human health in our time, we must acknowledge our part in addressing it in how we work. As Associate Professor Forbes McGain of the University of Sydney and Doctors for the Environment Australia has said: “The [Australian] health-care system can’t become low carbon and low waste without leadership, incentives and direction.”

Being aware of the environmental impact of our work practices and changing our individual actions are a great way to bring the issue front of mind and help start a conversation with others. But to achieve sizeable change we need to issue a triage category upgrade for environmental sustainability, and we need the whole system to respond.

So, bring your Keep Cup. But also ask the coffee shop whether they would give discounts to everyone who brings one. Choose the instruments that go back to the sterilizer, not into the sharps bin. But also question whether the marginal cost saving of procuring single use plastic items offsets the clinical waste disposal and other environmental costs. Factor environmental impact into your choices and practices at work every day, and write to your chief executive to ask them to do the same. Improve patient outcomes locally, globally, and save money doing so – it’s a no-brainer.

The science is clear – we’ve been issued a Code Green. And if we are serious about safeguarding human health, we must respond.


Published: 27 Jun 2018