Climate change: the role of health service management in leading for change (Funmi Lamidi)

Climate change is an urgent challenge that has significant implications at the community, national and international levels. It affects health directly as seen in the increased intensity and frequency of extreme weather events such as floods, bushfires and prolonged heatwaves. The indirect impact of climate change on health includes risks to food safety and drinking water quality, worsening air quality, effects on mental health and changes in the spread of infectious diseases (DOH, 2021).

In the 2019-20 Australian bushfires, the Australian Parliament (2020) reported at least 52 people died, over 3,000 homes were destroyed and over 17 million hectares of land were burned across New South Wales (NSW), Victoria, Queensland, Australian     Capital     Territory (ACT),  Western  Australia  and South Australia. Conservative estimates based on NSW and Victoria only, projected losses of over one billion mammals, birds and reptiles combined. Insects lost were also estimated to be in hundreds of billions. Various modelling suggests that the fires have had a significant impact on many rare or threatened plants and animals (Richards, Brew and Smith, 2020). Some of these losses are feared to be permanent.

Fig. 1: The blaze at Corryong in Victoria during the 2019-20 summer bushfires (Nguyen et. al, 2020)

The Anthropocene Epoch

The Anthropocene epoch has been described as “a new geological era demarcated as the time when human activities began to have a substantial global effect on the Earth’s systems” (Whitmee et al, 2015). This era is estimated to have begun about 250 years ago (https://vimeo.com/39048998).

In 2015, the Rockefeller foundation and The Lancet Commission on Planetary Health jointly produced a report titled: Safeguarding human health in the Anthropocene Epoch with the aim to promote Planetary health and sustainable development for all. Planetary health is defined by Whitmee et al, 2015 as “the health of human civilisation and the state of the natural systems on which it depends.”

Fig. 2: The human population is healthier than ever before due to advances in science, medicine and technology (World Bank, 2011)

Over the Anthropocene era, advances in science, medicine and technology have led to an increase in life expectancy. Coincidentally, over this period, the planet has also been exploited at an unprecedented rate, leaving a devastating imprint on earth.

This devastating imprint on the environment has led to major ecosystem impairment as well as direct and indirect impact on human health. Examples of these environmental changes include:

• increased atmospheric concentration of Carbon dioxide (CO2).
• ocean acidification.
• global deforestation.
• increased use of fossil fuels and water resources.

The role of health and human services in leading for change

A plenary session on climate change at the ACHSM online congress In October 2021, was a much- needed nudge to further explore how health policies, procurement and programs in the healthcare sector can be used to tackle climate change. The plenary session highlighted a need for long term preparedness and responsiveness of the health sector to climate change.

A whole of systems approach is required in all key operational areas of a health service including asset management, service governance and culture, financing, service delivery and workforce development (Bell, 2011). Internationally, the National Health Service (NHS) in the United Kingdom has launched an initiative called Greener NHS (NHS, 2021). The aim of this program is to reach net carbon zero, save money and share ideas on how to reduce the impact of climate change on public health and the environment.

Health service managers can improve human health and wellbeing by implementing reduction measures and targets to curb carbon emissions (DOH, 2021). Evidence-based actions that health or human services can take on climate change and its impact on health include:

1.   Implement plans, policies and measures to support adaptation to health impacts of climate change. This can be done by implementing health-protective actions.

2.   Increase action to reduce greenhouse gas emissions. This requires the commitment of health service managers to implementing practical steps towards more sustainable healthcare.

3.   Creating an awareness of the link between climate change and health, and  actions that patients and clients can take to stay healthy in a changing climate and reduce their impact. This can be done by supporting innovation and improvements in sustainability and sustainable practices in services. This can also be done by implementing health-promoting and emissions- reducing policies such as programs to encourage sustainable, healthy diets and reduce food waste, as well as promoting a more active lifestyle.

An Australian example of practical steps being taken towards a more sustainable healthcare is the Hunter New England Local Health District (HNELHD) in New South Wales (NSW). The HNELHD has adopted a strategic initiative termed Sustainable Healthcare: Together Towards Zero, with the aim of being carbon and waste neutral by 2030 (HNELHD, 2021). Significant investments have been made in solar power, water sustainability and energy efficient practices to lighten and eventually eliminate the organisation’s carbon footprint. A few examples of its focus programs are:

•   $3.2 million solar panels covering 12,000 square metres, have been installed on the rooftops of all health facilities within the Local Health District, covering about 85 per cent of the hospitals’ roof space.

•   The district is also working to achieve zero general waste to landfill be 2030.

•   The district is aiming to collect 100% of the rainwater that falls on its hospitals’ rooftops, between now and 2030. 50,000 litres of clean water by-product from renal dialysis, previously going down the drain at Tamworth Hospital each week, have been diverted for flushing toilets.

•   The district’s fleet of work vehicles are being transitioned to hybrid. There is a plan to move to pure electric models as soon as e-charging stations are installed on all sites.

In summary, a consciousness of planetary health and impact of climate change must be incorporated into health service management. While advocacy is ongoing for the government to make national and state policies to mitigate the impact of climate change on human health, health services can establish accountability mechanisms and integrate better practices into existing health service planning. In- service and pre-service training could also be done to transform organisational cultures while building the capacity of healthcare professionals to ensure environmentally sustainable practices are used in healthcare delivery.

References

Bell, E. (2011). Readying health services for climate change: A policy framework for regional development. American     Journal      of      Public     Health, 101(5),     804-813.     Retrieved    from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3076409/

Department of Health (DOH). (2021). Tackling climate and its impact on health. Retrieved from https://www.health.vic.gov.au/health-strategies/tackling-climate-change-and-its-impact-on-health

Hunter  New  England  Local  Health  District  (HNELHD).  (2021).  Sustainable  Healthcare: Together Towards Zero. Retrieved from  https://www.hnehealth.nsw.gov.au/about-us/sustainable_healthcare

Nguyen K., Brunero T., Thomas, S., and Mills, N. (2020, January 18). The truth about Australia’s fires — arsonists aren’t responsible for many this season. ABC News. Retrieved from https://www.abc.net.au/news/2020-01-11/australias-fires-reveal-arson-not-a-major-cause/11855022

National Health Service (NHS). (2021). Greener NHS. Retrieved https://www.england.nhs.uk/greenernhs/

Richards, L., Brew, N. & Smith, L. (2020). 2019–20 Australian bushfires—frequently asked questions: a quick  guide. Parliamentary Library. 
Retrieved from https://parlinfo.aph.gov.au/parlInfo/download/library/prspub/7234762/upload_binary/7234762.pdf

Whitmee, S., Haines, A., Beyrer, C., Boltz, F., Capon, A. G., de Souza Dias, B. F., … & Yach, D. (2015). Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health. The lancet, 386(10007), 1973-2028. Retrieved from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60901-1/fulltext?nr_email_referer=1

Views are those of the individual authors and not those of ACHSM or management interns’ host organisations or employers.