Embedding sustainability in health care – our wellbeing depends on it 

The health sector, whose role is to protect public health, must be front and centre in the battle against climate change, write Dr Eugenie Kayak and Dr Ben Dunne.

Each day as health professionals we are confronted with the ethical dilemma of contributing to the increasing adverse health impacts and threats of climate change and environmental pollution while working to maintain and improve health and wellbeing.

If the global health care sector were a nation, it would be the fifth largest emitter, responsible for over 4% of the global greenhouse gas emissions. Australia’s health care sector is one of the largest per capita emitters (along with the United States, Canada and Switzerland), with an estimated 35.8 million tonnes of carbon dioxide equivalent emissions annually, equivalent to over 7% of Australia’s total emissions.

There is an urgent need for a re-think of the physician’s duties, as Tony Capon (Professor of Planetary Health) presents in his recent article Re-thinking medical ethics as climate change accelerates.

It is time for health professionals to consider our obligation to the health of the planet (planetary health) along with minimising resource wastage (including carbon emissions) while balancing individual patient interests with broader planetary health considerations.

These obligations have numerous synergies and potential “win-win” outcomes, which are simultaneously good for the health of our planetary ecosystems (on which humanity depends on) and for people.

The right policies, such as those promoting low carbon energy, transport and dietary options, alongside health care sector stewardship of practices with a lower environmental footprint (eg, transitioning away from the use of anaesthetic gases with high global warming properties, switching patients from metered dose inhalers to dry powder inhalers, and moving toward reusable rather than single use surgical instruments and products) can benefit planetary health. The reduction of carbon emissions and the judicious use of resources can be achieved while improving population health, individual patient health, and the quality of health care delivery. The most sustainable health care system is one that supports healthy populations, values high quality care by prioritising evidence-based care (delivering the right care, in the right place, at the right time), and minimises the unnecessary use of resources (financial and natural) through its purchasing practices (energy, buildings, vehicles, goods and services).

Fortunately, 2023 offers the Australian health care sector several unique opportunities to address its planetary health responsibility and take a lead in working towards more sustainable, low carbon health care that is both high quality care and climate resilient.

The Australian Commission on Safety and Quality in Health Care (ACSQHC) — responsible for national accreditation in relation to health care safety and quality matters — is developing a Sustainable Healthcare Module, whose Consultation Paper can be found here.

The Module reflects the synergies between the delivery of safe, quality health care and minimising the sector’s adverse environmental footprint. The Module will be considered by the Commission’s Board in June, and the final Module is due to be released later this year.

Although the ACSQHC Draft Sustainable Healthcare Module is to be commended for outlining a framework that can be incorporated into any health care organisation’s existing clinical governance structure, it is imperative that the ACSQHC goes further. As outlined in Doctors for the Environment Australia’s joint submission with the Australian Medical Association, the framework should transition it to a mandatory accreditation standard as soon as possible to reflect the urgency for immediate, meaningful climate action from all high emitting sectors.

Other important high level recommendations for inclusion in the final Module to support the sector transition include, but are not limited to:

• embedding environment, social and governance (ESG) goals into the strategic plans of health care organisations (as a sector, health care is an ESG laggard);
• incorporating sustainability as a core value of all organisational activities and decision making;
• establishing cross-disciplinary environmental and financial sustainability education for all health care staff as per the revised AMC National Framework for Prevocational Medical Training); and
• requiring dedicated environmental sustainability staff to be appointed in each health care organisation — unfortunately, even many large health care facilities still lack such an appointment.

Guidelines on procurement processes are also essential for health care facilities to improve their environmental footprint and cut emissions, as over 60% of health care’s carbon emissions are estimated to stem from goods and services procured (Scope 3 emissions), such as pharmaceuticals, equipment, food etc. By providing high level guidance, the Module would assist facilities to minimise the procurement of carbon-intensive products, including certain consumables, single-use products, pharmaceuticals (eg, the anaesthetic gas desflurane), and catering choices while enabling avenues to low carbon alternatives.

The ACSQHC Sustainable Healthcare Module is also an opportunity to prioritise health care facility infrastructure and health care delivery natural disaster preparedness. This is a rapidly increasing necessity, with climate-fuelled extreme weather events already affecting health services, such as extra hospital admissions attributable to bushfire smoke (> 3000 from the 2019–20 bushfires).

Internationally, 65 nations have come together to form the Alliance for Transformative Action on Climate and Health (ATACH), which is supported by the World Health Organization, after initial meetings at the COP26 in Glasgow. ATACH aims to build climate-resilient and sustainable low carbon health systems. Unfortunately, Australia is missing from ATACH, as it was at the COP26 health talks.

Collaboration and coordination through ATACH and the ACQHS Module are well timed to align with and assist the Department of Health and Aged Care’s National Health Sustainability and Climate Unit as it develops a National Health and Climate Strategy over the course of 2023 and works to reduce health care’s emissions. National coordination and appropriate resources are fundamental for effective change, as England’s Greener NHS program has demonstrated in achieving significant sector emission reductions.

Australia’s health care sector, as a high per capita emitter, has a responsibility to do its share towards addressing climate change — the biggest threat to health. It can do so by being part of the solution (not the problem) and playing its part in the race to net zero (by 2040 with the majority of emission cuts by 2030), contributing to the first ever dedicated health day at COP28, and joining the rapidly growing international action.

Business as usual is not an option, as it means a tripling of the global health care’s carbon footprint by 2050. The health sector, whose role is to protect public health, must be front and centre in the battle against climate change.

Dr Eugenie Kayak is Co-convenor of Doctors for the Environment Australia’s Sustainable Healthcare Special Interest Group, Enterprise Professor of Sustainable Healthcare at the Melbourne Medical School, University of Melbourne, and an Anaesthetist.

Dr Ben Dunne is Co-Convenor for the Doctors for the Environment Australia Sustainable Healthcare Special Interest Group and a Thoracic Surgeon at the Royal Melbourne Hospital. He is a member of the Royal Australasian College of Surgeons Environmental Sustainability in Surgical Practice Working Party, and is the Chair of the University of Melbourne Environmentally Sustainable Surgery Network.

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

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