Health care must be part of climate change solution

PRESENTLY, the world is on track for a 3.2°C temperature rise with current emission pledges – a temperature incompatible with human civilisation, let alone healthy populations. The stark reality is that to meet the 1.5°C Paris Agreement target, global human-caused greenhouse gas emissions must reduce by 7.6% every year from 2020.

Every country and every sector must play its part to reduce emissions. Health care is a major polluter. If the global health care sector were a nation, it would be the 5th largest emitter in the world, contributing about 4–6% of global greenhouse gas emissions. The Australian health care sector makes up approximately 7% of Australia’s national carbon footprint – a larger contributor to climate change than all the activities (flying, eating, driving, working and consuming) of a population size equivalent to South Australia’s.

The health care sector has an added responsibility to not only be part of the solution but to “first, do no harm” and urgently work to ensure it does not remain part of the problem.

Doctors for the Environment Australia (DEA) has today released a report highlighting why Australia’s health care sector needs to reduce its greenhouse gas emissions urgently – to 80% by 2030 and net zero emissions by 2040 – to play its part in meeting the 1.5°C Paris Agreement goal.

Last summer’s catastrophic bushfires demonstrated the devastating health impacts of our changing climate on our health and health services, with over 3000 cardiovascular and respiratory hospital admissions, 1305 asthma presentations to emergency departments and 417 deaths attributable to smoke in Queensland, New South Wales, the Australian Capital Territory and Victoria.

Numerous global and national medical organisations, including the Australian Medical Association (AMA), have declared climate change a health emergency. The specific health threats to the Australian public have been highlighted once again in the recent MJA–Lancet Countdown report and the Grattan Institute’s climate change and health report.

Economically, increasing damages from climate change over the next 30 years are predicted to cost the Australian economy at least $1.89 trillion, assuming current emissions policies are maintained. These costs are projected to be borne primarily by the health care sector and community.

DEA’s report highlights why it is critical for the health care sector to begin actively leading on greenhouse gas emission reductions in accordance with the sector’s core remit to “protect and promote health”. The recommendations seek to enable the health care sector to reach the necessary targets:

• establishment of a national Sustainable Healthcare Unit (SHU);
• 100% renewable electricity and no new gas installations in Australian hospitals;
• prioritisation of preventive and primary care and sustainable models of care;
• procurement of medical equipment, pharmaceuticals and goods with low carbon footprints, and reduction in travel emissions through telemedicine and electric vehicle fleets; and
• establishment of a National Net Zero Expert Panel to assist in guiding interim emission reduction targets and pathways for the health care sector.

A staggered timeline offers a sensible and realistic plan to achieve an 80% reduction in health care’s carbon dioxide (CO₂) emissions by 2030 and net zero by 2040, which would be consistent with the emission reductions needed to protect health and sufficient to instigate widespread transformational changes within the sector.

In the UK, the National Health Service (NHS) Sustainable Development Unit (SDU) has shown both what can be achieved and aspired to. The NHS has not only established a net zero emissions target by 2040 but have developed a detailed health sector road map to ensure this target is reached.

Through SDU initiatives, the NHS reduced the health sector’s CO₂ emissions by 11% between 2007 and 2015 despite an 18% increase in inpatient admissions over the same period. SDU initiatives continue to save the NHS over £90 million per annum. The NHS is now a national leader on emission reductions, with flow-on advantages to the broader economic transition to net zero through its large purchasing power and as the largest employer in the UK.

Similarly, the Australian health sector has large and influential purchasing power and can drive positive economic, social and environmental outcomes through how it purchases energy and procures goods, services and travels. There are also additional health co-benefits from low carbon energy, transport and dietary choices which decrease air pollution and increase physical activity and plant-based diets.

Despite this, responding to and mitigating climate change has, until recently, been seen as distant from core business within Australian health care. Small changes have been achieved by individuals and institutions, such as the planned Canberra Hospital extension, which will be powered entirely by renewable electricity. However, there is an absence of a coordinated road map with consistent benchmarking of emissions to track changes from our health care system as a whole. The AMA, the Royal Australasian College of Physicians, the Climate and Health Alliance and DEA have all proposed an Australian national SHU.

A national SHU would lead and coordinate metrics, innovation, improvement initiatives and collaboration nationwide in order to achieve pragmatic outcomes. The details of a national SHU have been previously outlined by DEA.

DEA’s requisite for net zero emissions health care recognises that health and the environment are inextricably linked. It is now incumbent on the health care sector to lead in enabling a healthier future. Health care must contribute, through measures within its own domain, to avoiding the unnecessary and unmanageable health implications of greenhouse gas emissions. Providing high quality care for all patients – without jeopardising the health of current and future generations – is at the core of health care.

Dr Hayden Burch is a junior medical doctor working in Melbourne. He is also Victorian Chair of the Sustainable Healthcare committee for Doctors for the Environment Australia.

Dr Eugenie Kayak is national convenor of Doctors for the Environment Australia’s Sustainable Healthcare Special Interest Group and has been actively working to raise awareness of and address health care’s environmental footprint for over a decade.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.