COP26: opportunities missed for Australian health care

AT the United Nations Climate Change Conference in Glasgow (COP26) over 50 countries participated in the COP26 Health Programme and committed to strengthen the climate resilience and sustainability of their health systems. Among them are some of the most vulnerable nations, such as Fiji, and some of the biggest health care carbon emitters, such as the United States.

The COP26 Health Programme was supported by the UK government as the Presidency of COP26, and the World Health Organization, Health Care Without Harm and the UN Framework Convention on Climate Change (UNFCC) Climate Champions.

Such commitment from the global health care sector at COP26 affirms recognition by the sector of the urgent need to act on climate change. The health of populations across the globe is already being affected by increasing extreme weather events, and if the global health care sector were a nation, it would be the fifth largest emitter (4.4% of global greenhouse gas emissions).

This commitment also aims both to protect health and health services from further climate-related events (increased resilience) and to mitigate its contribution to the problem by undertaking to be net zero emissions, ideally by 2050 or earlier.

Yet while health care contributes to over 7% of Australia’s total carbon emissions – Australia was missing from this foundational initiative.

By not participating in the COP26 Health Programme, or related commitments, the Australian government has once again failed to recognise the inextricable link between health and climate change and missed an opportunity to support a sector that is well placed to lead in reducing carbon emissions and environmental impacts to protect health. Leadership that could result in environmental, health and financial positive outcomes (triple bottom line benefits), as outlined in Doctors for the Environment Australia’s Net Zero Emissions report.

In September 2021, the Australian Medical Association (AMA), ten specialist medical colleges and Doctors for the Environment Australia (DEA) called on the Australian government to commit to cut Australia’s greenhouse gas emissions, aligned with science-based targets, this decade to limit global warming to 1.5°C; develop a national climate change and health strategy to facilitate planning for future health impacts; and reduce the health care sector’s own significant emissions.

A recently released report lead by the Royal Australasian College of Physicians warns that in Australia greater exposure to climate impacts will see hospitals struggle to cope with the growing burden.

The UK’s National Health Service (NHS) has demonstrated what the health care sector can achieve with its Greener NHS Programme. Over the past year, even with the impacts of COVID-19, the NHS has beaten its annualised reduction target of 1260 ktCO₂, equivalent to the electric supply of 1.1 million UK homes. The NHS was the first national health service to commit to net zero (by 2040) and now 14 more nations have joined it. The AMA, DEA and others have called for similar net zero commitments from Australia’s health care sector.

Fortunately, many in the Australian health care sector are independently committing to significant emission reductions this decade (such as Hunter New England Local Health District, UnitingCare) and working to address the sector’s climate resilience. However, without national coordination across jurisdictions to decrease health care sector’s emissions, the development of the most efficient and effective pathways to net zero will be limited.

DEA’s recently released Proposal for a national Sustainability Healthcare Unit (nSHU) highlights the need for a national unit to work with state-based units and the private health care sector (including industry) to effectively reduce emissions across state, regional, health organisation, hospital and practice levels.

The funding and control of Australia’s health care presents unique regulation challenges and as such the effectiveness of a nSHU several years ago would have been insurmountable. Today, though, there is an appreciation and desire across the sector (board members, executives, doctors, nurses, support staff, supply industries) to act with health care governing boards increasingly looking to incorporate climate risk and mitigation into their decision making and environmental, social and governance strategies. A national unit providing evidence-based roadmaps, guidance and advice would be expected to result in significant outcomes even in the absence of extensive regulatory policies.

A national Sustainable Health Care Unit could be accommodated in the Commonwealth Department of Health or hosted by another health care entity or university. It may begin with only six to 12 staff (as the NHS’s Sustainable Development Unit did for over a decade) with the capacity and skill set to establish guidelines and roadmaps to enable:

• mechanisms for standardised measurement of health care’s emissions across states and health care entities, including Scope 3 emissions;
• effective mapping and implementation advice for emission reductions, sustainability best practices and sustainable models of care; and
• decreasing the carbon and environmental footprint of health care’s goods and services (equipment, catering etc).

As the 2019 Lancet Countdown on health and climate change highlighted, business as usual is not an option – this would result in a child born today experiencing a world 4°C warmer. The most recent MJA–Lancet Countdown 2021 report reminded us, once again, how vulnerable Australians and their health and way of life is to excess heat and extreme weather.

COVID-19 was urgent but the climate is important (and urgent). The global response to COVID-19 demonstrated how nations across the world can act to protect health. It is estimated that if only one-fifth of the funds spent on COVID-19 were spent on climate change action per annum, the Paris goals would be achievable – changing the course of humanity.

The benefits of climate action are many, including the unexpected. Worldwide each year, double the number of premature deaths are attributed to air pollution (predominantly fossil fuel derived) than from COVID-19 in 2020 – deaths that could be avoided by phasing out fossil fuel combustion.

As every nation and every sector looks to play their part in limiting the global temperature increase to 1.5°C, not only does Australian health care have no time to lose, it could lead by getting its own house in order.

Dr Eugenie Kayak is an anaesthetist. She is a member of Doctors for the Environment Australia and the Convenor of its Sustainable Health Care group.

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.