The recent Cambridge University Leadership Programme looked at sustainable development in health services worldwide. It was an opportunity to hear the evidence and arguments which were both persuasive and alarming. The link between population growth and our reliance on a carbon-based economy, leading to rising levels of CO2 in the atmosphere, and the consequent changes in climate was compelling. This is relevant to healthcare systems, and the professionals that work within it, not only because climate change itself is having significant consequences on the health of populations, but because healthcare systems themselves have a significant carbon footprint. more…

When I used to teach public health to medical students and other health professionals, I tried to set myself the challenge of helping people learn about populations, prevention, screening, social determinants of health, quality of healthcare, and such things without mentioning the words public health at all. You may know why.

A great paper by Dror Etzion, assistant professor, Desautels Faculty of Management, McGill University (Sustainability by Stealth: four ways to make sustainability more attractive) addresses the same approach with sustainable development, another area that elicits various emotional responses. With his permission, I have taken this excellent paper and expanded it to help us engage others in issues like sustainable development and climate change: areas that make us question our values and beliefs as well as our actions, areas where we should use the precautionary principle: where action is needed when the evidence is sufficient but neither perfect nor complete. more…

On my way to Spur Road this morning I walked past a group of children scooping murky water out of the gutter into some buckets. These buckets were then lifted to their heads and carried home. Further down the road there was another group of people, huddled around a standpipe. 45 yellow five-gallon containers were lined on either side, ready to be filled. This is daily life in Freetown. more…

“There’s a 50% chance that humans will be extinct by the end of the century because of climate change,” said Hugh Montgomery, director of the UCL Institute for Human Health, at last week’s conference on environmental sustainability. I’d heard that before, but it made me think of my daughter, who can expect to live for most of this century. And what about any children she might have? And then I wondered if the apocalyptic vision, true as it might be, is the best way to spur people to act on climate change. more…

What contrary creatures we humans are. I begin the year convinced that our civilisation will collapse soon but at the same time enjoying the continuous Mozart on Radio 3, abandoning alcohol for the month with enthusiasm, and committing myself to three runs and 70 000 steps a week. As my wife, who also thinks that our civilisation is approaching its end, says: “Nothing matters, but everything matters.” I didn’t know I’d married a mystic. more…

It’s easy to say that the NHS should do better, not more – but what does that actually mean? Well, it means investing resources (money, people, buildings…) in healthcare which delivers outcomes that people both want and need. Unlike many private organisations whose objectives may be a little simpler (e.g. maximising shareholder value, obeying the law, and promoting reputation), the NHS has mutiple (and often conflicting) objectives, whilst it is constantly exhorted to improve quality and minimise cost. Cost is easier to measure, but there are just a few challenges with “quality.” First, there is not a widespread agreement on what it means and secondly, we rarely have the information systems (or even the culture) to know exactly how money and other resources translate into high quality outcomes (valued by both patient and professional). more…

As UK participants returned from last week’s European Health Forum in Gastein (read more), Austria, newspaper headlines calling for “Cuts in wasteful NHS bureaucracy” and “Pay freezes for high earners” will have reinforced the messages they heard. Debate focused on the impact of the financial crisis on health and what governments should do about it. While saving money by reducing waste in Europe’s” inefficient health systems” was one message, the central one was that health is largely determined by factors outside the health system, and that the rallying cry’s should be “social justice” and “jobs for health.” more…

We have no right to steal from future generations. At the end of this month, the consultation will close on the proposed carbon reduction strategy for the NHS in England. This country is the first in the world to start legislating on climate change, the most serious and urgent health threat to current and future generations. Doctors, scientists, and other health professionals have a special responsibility to urge our colleagues, communities, policy makers, and politicians to take this threat seriously now by concerted action. more…