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.
The question then arises what has this got to do with clinicians and third sector organisations such as the British Heart Foundation (BHF)? The BHF, like many organisations and clinicians, has already debated this and has realised that there is a particularly convenient truth: a virtuous cycle of health and other co-benefits. For example, a lower carbon-based economy will have higher levels of physical activity, less reliance on a red processed meat diet, and more reliance on a higher fruit and vegetable based diet. This all leads to decreased carbon emissions, better global land use, and higher levels of health in the population—notably better cardiovascular health.
The obvious next step is to identify and implement the most effective interventions and actions that health professionals and health organisations might take to transform this situation. This is particularly true in the NHS when the service is struggling to contain costs (like many healthcare systems globally) to the tune of £20 billion whilst undergoing considerable structural reform following the passage of the Health and Social Care Bill in England.
The sustainability agenda provides a great opportunity for progressive organisations to deliver on the “triple bottom line”—simultaneous financial, social, and environmental returns on investment (e.g. saving money, health improvement, and mitigating climate change). The NHS contributes about 25% of public sector carbon emissions in the UK, two thirds of which are due to the procurement arrangements that the NHS currently has in place, so inaction is not an option: hence the need for specific and practical examples that doctors and other health professionals can make a reality.
Impressive case studies were presented, including a world beating hospital and community food system from Nottingham NHS University Hospitals Trust using the “quiet” leadership of a focussed, competent, and visionary catering manager, and a transformational approach by UCL in London towards energy, procurement, and staff engagement. UCL is a Trust where even the Departments of Surgery and Oncology are actively researching what their disciplines look like in a more sustainable world. Other health organisations ranging from BUPA to Glaxosmithkline also showed how sustainability is becoming core to their successful and future proof business models. Clearly, it is feasible to implement sustainable development business plans in both public and private sector organisations.
Amartya Sen contributes to the debate in his book “The Idea of Justice.” Currently a widely used definition of sustainable development comes from the Brundtland Report 1987 which defines sustainable development as “development that meets the needs of the present without compromising the ability of future generations to meet their own needs.” This definition has been reformulated by Robert Solow (1992) defining sustainability development as “whatever it takes to achieve a standard of living at least as good as our own and to look after their next generation similarly.” Amartya Sen draws on the work of Gautama Buddha and suggests that sustainable development should be re-characterised as “that which does not compromise the capability of future generations to have similar or more freedom.” Given the shift of the locus of economic power to the BRIC countries, I think it is a cause of optimism that Indian philosophy might provide the philosophical basis for future developments here.
The BMJ recently published its second Spotlight series introduced with “Will doctors now take a lead on climate change?” at the same time as the King’s Fund published its report “Sustainable health and social care; Connecting environmental and financial performance.” Both publications are able to make plausible and persuasive arguments for linking health, financial performance, and environmental development—“the triple bottom line.”
Doctors have an important opportunity to address what Muir Gray aptly calls the “cholera of our time” with many practical ideas that are already widely publicised by this journal. This meeting crystallised for me what others (notably Peter Cawston, a GP from Glasgow) have neatly summarised as the key 5 areas for action:
- Helping people eat better and move better
- Enabling women to have control over their fertility
- Targeting prescribing on those most likely to benefit
- Promoting a greater sense of belonging
- Helping people manage a better death
So, while enjoying an unseasonably early warm spring, and the prospect of a rather dry summer, I will be looking to integrating sustainable development into my day to day work.
Mike Knapton is the associate medical director (Prevention & Care), British Heart Foundation. The views expressed are not BHF policy and are the personal views of Mike Knapton. Tom Pierce is a cardiac anaesthetist working at the University Hospital Southampton.