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Sarah Walpole: It only takes health professionals to do nothing for bad things to happen

10 May, 11 | by BMJ Group

Sarah WalpoleThe key strategic challenges facing health services across the globe are to meet changing needs and expectations, improve quality of care, and work within financial, resource related, and environmental limits. Environmental health threats include pollution, adverse weather events, and changing climatic conditions (posing challenges to infectious disease control and food security). Resource shortages for healthcare systems pose moral dilemmas about distributive justice. How should the need for resources to care for a patient be weighed in the balance against the harm caused by extracting and using these resources? Oil is a good example of a resource that is now being used at a faster rate than conventional oil supplies are being discovered.

The challenge is for us to provide health services that protect health and provide care, and that are resilient to current and future environmental health threats. We must share resources in a just way between populations, both current and future – we borrow (or steal) too much from each other and from the future.  Are we able to understand, retain, and weigh up the complex challenges of protecting both current and future generations?

Understand the information
“Put your hand up if you know what your carbon footprint is!” I’ve often heard this question asked and been dismayed, if not surprised, that I’m among two or three of the 30, 50, or even 100 person audience of health professionals to put up my hand. Either the audience have indeed visited a personal carbon counter and are not admitting it (embarrassed? lazy?), or most health professionals simply don’t know (or don’t want to know) how much of the world’s energy reserves we use every day. Both possibilities concern me, but talking to friends and colleagues after such lectures combined with research makes me strongly suspect the latter.

So how energy literate and numerate are we? Most of us don’t even know how much energy we use at home, never mind how much energy our hospital or GP practice uses, and how much energy we could save using more efficient technologies or models of care.

There are excellent examples, however, of health professionals and units within the UK health service who are working to create an understanding of energy use in the health service. While the NHS Sustainable Development Unit (SDU) has calculated how much energy is used by the UK health service each year, many hospital departments and GP practices across the country are taking similar measurements.

Health professionals have a profound responsibility to understand and take action on the biggest strategic health threat we face. To measure the energy use of our hospital, we can use the SDU’s tool as a starting point; and to find out the footprint of our GP practice, we can sign up for the Royal College of General Practitioners’ carbon footprinting tool. Measuring our personal energy use can also be an insightful exercise and help us to make sense of some of the figures – to do this try an online footprinting tool and a smartmeter for your home.

Retain and weigh up
Once we’ve understood what we’re using, we can consider the options to save money, improve care, save carbon, and promote immediate and long term health. David Mackay, of the Department for Energy and Climate Change (DECC), has taken on the even larger scale challenge of modelling options for future energy supply and usage of the whole of the UK.

We are committed by law and science to reduce emissions by 80% by 2050, a commitment that extends to the health service and is mirrored in the commitment of the SDU to help the NHS achieve 80% reduction of emissions by 2050.  What the DECC Pathways Analysis highlighted to me is that, even with the most conservative predictions of energy demand in 2050, finding a comfortable solution on the supply side isn’t easy. You can choose to focus on renewable energy sources but you may have to cover an area half the size of Wales with wind turbines, or you can focus on burning biomass or oil, but you’ll have to rely on imports from other people’s countries (and what will they do?). David Mackay has said that he hopes this tool will bring a degree of reality to the debate about energy supply.

We, as health professionals, should accept and address this responsibility, just as we did with cholera, tobacco, and HIV/AIDS.  Although difficult decisions have to be made, there are very few trade offs. Nearly everything that helps mitigate climate change, helps improve health now, especially eating better and moving more.

Communicate
In the health service we need to measure the current situation and the impact of taking forward (and not taking forward) possible solutions to inform the debate and take action.  While the SDU progresses at a national level, we can all measure our impact and look at options to meet targets for reducing emissions at a local level.

Communication and engagement are essential to sharing best practice, making the best decisions, and taking the best action, even in the face of imperfect evidence (which we are well used to acting on). Communicating with those who aren’t yet motivated to reduce emissions challenges us to articulate the important linkages between health, resource use, and the environment and reaffirm our own motivations. Learning to communicate these issues more effectively will be a rewarding challenge, and a crucial step to work with others to protect and promote health without compromising the needs of the future.

Sarah Walpole is a junior doctor and web editor www.climateandhealth.org

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