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SCIENTIFIC reports are becoming increasingly blunt: decarbonise urgently or face catastrophic climate breakdown. The Australian health care sector makes up approximately 7% of the country’s national carbon footprint, while globally, if the health sector were a country, it would be the fifth largest polluter on the planet.
The health sector has a lot of work to do.
For the first time, the Australian Medical Association (AMA) and Doctors for the Environment Australia (DEA) hosted almost all medical Colleges in an interactive webinar: Climate Change and Sustainability: Leadership and Action from Australian Doctors. More than 350 doctors shared ideas and plans about our role in climate action, which is about to dominate the world’s headlines with the United Nations climate conference (COP26) in Glasgow, starting on 31 October.
The leader in delivering net zero: Greener NHS
Dr Nick Watts, the first Chief Sustainability Officer for the UK’s National Health Service (NHS) — and an Australian doctor — spoke about the Greener NHS program. Since 1990, the NHS has reduced its carbon footprint by a third and by 2017 the associated financial savings rose to GBP 90 million annually. Now their plan is for it to be the first net zero health system in the world by 2040.
Watts’ team has rapidly expanded to 150 (with a wider network of approximately 1500 sustainability officers), organised in a series of teams coordinating areas such as net zero ambulances and net zero hospital standards. He noted that the NHS’ 1.3 million staff are overwhelmingly supportive of the sustainability program, and that, in 2020, the NHS Board elected to scale up the Greener NHS program in the midst of a global pandemic, with NHS Chief Executive Sir Simon Stevens saying, “COVID-19 is urgent, climate is important”.
Our colleges set out their plans
Together with the AMA and DEA, the nation’s medical Colleges set out their plans to decarbonise their specialties and advocate for urgent climate action.
In a speed-dating style event, each College (many represented by their presidents) had 4 minutes to present about climate change impacts on their specialty, their current actions and their plans. Three main themes emerged: decarbonising each specialty, advocacy, and collaboration.
Decarbonising your specialty
While energy and hospital design are important, more than 60% of the Australian health sector’s carbon footprint is from clinical care: pharmaceuticals, medical devices, equipment and so on. As Watts noted, every College will have to “rethink and reimagine their specialty with a net zero lens”, so that within 10–15 years, we have carbon neutral anaesthesia, dermatology, respiratory care etc.
Many Colleges are progressing on this path: establishing climate working groups among their fellows. The Royal Australian College of General Practitioners (RACGP), the Australasian College of Dermatologists (ACD), the College of Intensive Care Medicine (CICM) have done so. Trainees are involved; for example, the Trainee-Led Research and Audit in Anaesthesia for Sustainable Healthcare (TRA2SH). Others are reducing low value care – the Australian College of Emergency Medicine (ACEM) and the Royal Australian College of Surgeons (RACS) are promoting Choosing Wisely. Others are designing pathways and procedures so there is less waste produced; for example, the Royal Australian and New Zealand College of Ophthalmologists in cataract surgery and the RACS with their 5R approach of Reduce-Reuse-Recycle-Rethink-Research. The Australian College of Sport and Exercise Physicians is scaling up effective, low cost, zero-carbon interventions such as exercise. The CICM is developing sustainability toolkits, and the Australian and New Zealand College of Anaesthetists (ANZCA) is working with industry to improve sustainability in the health care supply chain.
Many are embedding sustainability into their organisations (the Royal Australian College of Medical Administrators), research programs (ACD) and training (the Australian College of Rural and Remote Medicine), with some setting up sustainable fellowships for trainees (ANZCA) based on successful models in the UK.
Our responsibility and opportunity to advocate on climate
A number of presenters noted that doctors are highly influential and have a responsibility to advocate for broad climate action to protect health, as well as decarbonising our own sector. Many Colleges have position statements, which are important, but just the first step.
Fossil fuel (coal, oil, gas) air pollution was responsible for more than 8 million deaths globally in 2018 – the same as the annual deaths from cigarette smoking. In the UK, the Royal College of General Practitioners and the Royal College of Paediatrics and Child Health have publicly and successfully lobbied for stringent clean air regulations.
A number of Australian Colleges have divested from fossil fuels (eg, the Royal Australian and New Zealand College of Psychiatrists, the Royal Australasian College of Physicians [RACP], ACD, and CICM) but it was noted during the webinar that we also have an important role to publicly call for clean energy.
The RACGP is developing resources for general practice waiting rooms, with climate-health messaging and links to practical health advice for severe heat, extreme weather etc. Given the amount of time people spend in waiting rooms, if displayed widely, these important messages could reach large numbers of people.
Working together
It was also noted that collaboration across the Colleges is powerful. The UK Health Alliance on Climate Change – comprised of most medical Colleges, as well as the British Medical Association and Royal College of Nursing – has been very successful in shifting the British public discourse toward climate as a health issue and articulating the health benefits of climate action.
In Australia, the RACP is currently leading nine Colleges in a large research and advocacy project examining the risks of climate change to Australian health care systems. It aims to unite the Colleges as a collective force for advocacy ahead of COP26.
This is happening on our watch
The climate crisis is affecting the health of our patients, our communities and, indeed, our own families. The AMA and DEA have formally agreed to work together towards mitigating climate change to protect health, and for the medical profession to lead by “getting our own house in order” and striving for health care sector emission reductions in line with the Paris Agreement goal to “limit global warming to well below 2, preferably to 1.5 degrees Celsius, compared to pre-industrial levels”. That is net zero emissions from the Australian health care sector by 2040 and a 2030 interim target of 80% emission reductions.
Working together with the Colleges, we can raise the bar and take action commensurate with the catastrophic risks we face, and reap the benefits of transforming the health care sector towards net zero.
Dr Kate Charlesworth is a public health physician, and a member of the AMA and Doctors for the Environment Australia.
Dr Omar Khorshid is President of the Federal Australian Medical Association.
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.
Ah, Prof Tim Florin, the famous climate denialist. at it again. http://www.readfearn.com/tag/tim-florin/
We can walk and chew gum at the same time, dear professor. We need to reduce emissions and focus on all the other issues you’ve described, and we can.
Great article, thank you!!
It makes good sense to urgently address air pollution derived from fossil fuel to improve air quality, thereby helping to reduce worldwide morbidity and mortality.
This will then hopefully help mitigate climate changes.
Very proud of the good work by the medical profession-the AMA, RACGP, DEA, and other peak medical bodies taking leadership in this area!
Excited as you may be by presenting numbers ‘we should be alarmed by’ it is important to keep a scientific mind in the process. The authors of the paper you reference actually model extremely broad confidence intervals which include negative numbers (i.e lives saved by fossil fuel emissions). “We estimate a global total of 10.2 (95% CI: −47.1 to 17.0) million premature deaths annually attributable to the fossil-fuel component of PM2.5.” “The estimate for China predates substantial decline in fossil fuel emissions and decreases to 2.4 million premature deaths due to 43.7% reduction in fossil fuel PM2.5 from 2012 to 2018 bringing the global total to 8.7 (95% CI: −1.8 to 14.0) million premature deaths.”
As you should be aware confidence intervals tell us the range for which this model could give any answer by chance and in this case at the very crude level of 5% statistical significance which as most scientists know is not actually very significant. The number they have plucked for increased deaths ’caused by emissions’ is no more valid than the minus numbers that determine fossil fuels actually save lives. In fact ‘tuning’ the model to obtain a ‘desired outcome’ of double the predicted premature deaths actually reduces the reliability of the model in predicting anything.
Basically this model tells us nothing in the way of climate science and our impact.
That does not mean we shouldn’t look to reduce our impact but keep it real and evidence-based please.
Climate science is well understood, the current changes were forecast and the scientific consensus is similar the theory of microbe caused disease.
Read the explanations of science at The Royal Society and NASA websites (or any other science websites)
http://www.royalsociety.org
http://www.nasa.gov/subject/3127/climate/
It is therefore extraordinary that a) some Doctors still spout this climate denial nonsense and b) that these comments are published in reputable journals
Interesting that the UK NHS is “the leader in delivering net zero”.
Last year my cousin’s 37 year old wife in Bolton was stuck in bed, being cared for by her 8 year old, while my cousin was in hospital for 2 weeks on steroids and oxygen for Covid. The wife didn’t even get a Covid test, and had no medical care (both sets of parents were too at-risk to help her).
This year my daughter in Sheffield got online midwifery, no blood pressure checks or diagnosis of a transverse lie. Fortunately, a flight to Australia and professional obstetric care solved things.
The 71 year old friend of my daughter, with an aortic dissection for a few months, has been told it’s not appropriate care to repair it. Just go home and take it easy.
Last week my cousin’s husband (father of the other cousin) died in Bolton, aged 67. An insulin dependent diabetic, he had not seen a GP for nearly 2 years. As he got sicker, over a few days he called the GP repeatedly to no avail (too busy), then eventually called an ambulance, which arrived too late.
Maybe I’ll let the grieving widow know that the net zero ambulance care, and the net zero GP care, has helped fund 150 drones and 1500 sustainability officers. They are certainly less carbon burning than GPs who order tests and treatments. Or a hydrocarbon endoluminal aortic graft in a 71 year old.
“Now their plan is for it to be the first net zero health system in the world by 2040.” Yeah, right. Zero care gives zero emissions.
Excellent article. As medical professionals we have both a Hippocratic obligation and a clear opportunity to support rapid decarbonization. With increasing evidence available on the health impacts of climate change that we are already seeing, acting immediately is really the only thing to do. Great to see the AMA leading with DEA and medical colleges on this.
Best to read “Unsettled?” by Steve Koonin, an eminent physicist and senior science adviser in the Obama administration. The science doesn’t actually say what most activists and journalists say it does.
Mainly absolute tosh. The groupthink of these commentators and The Journal leaves me gobsmacked. It would be great if it were all that simple.
The almost exclusive focus on CO2 is making our dire environmental situation worse. The main focus should be on reducing our massive human made biomass (concrete, steel, roads, buildings, medical waste etc). It is this which is destroying the habitats of our fellow fauna and flora and the enjoyment of the Earth.
*Rather than reducing the human footprint on our Earth, we are building (low energy density) solar and wind farms which are a blot on our land, and this is in addition to the problem of how to recycle every 20 years, where to mine the cobalt for them and the inadequate battery storage that currently involves slave labour in DRC, slave labour manufacture in Uigher China, and none of which satisfactorily solves the problem of intermittency, which is currently causing havoc in the northern hemisphere..
*And the focus on CO2 means that we dont dispose of plastic properly by incineration, but rather pretend to recycle in landfill and the sea.
*We are exporting our CO2 emissions and manufacturing to ‘developing countries like CCP China, so degrading our standard of living, and damaging world democracies.
There is a massive problem. But for god sakes don’t make it worse with glib simplicity and zealotry. The problem is complicated and deserves cool analyses, and real cost benefit modelling as best we can.
Great article, thanks.
This is the health challenge of our generation (generations).
It’s so important that we move together and lead as a profession and implement action across the healthcare sector.