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This article was first published on Friday, December 6, 2024
The importance of prevention, primary healthcare, cultural safety and learning from exemplar services are among nine key takeways from the recent Greening the Healthcare Sector Forum, Marie McInerney reports for the Croakey Conference News Service.
Marie McInerney writes:
From reusing renal dialysis unit water for flushing toilets, to plugging nitrous oxide leaks, providing e-bikes for staff, and the development of a regional climate health framework, health services are stepping up for climate action.
This year’s Greening the Healthcare Sector Forum, hosted online over two weeks by the Climate and Health Alliance (CAHA), provided a road map for action during nine sessions under the theme ‘Accelerating collective action for sustainable and climate-resilient healthcare’.
Here are nine key takeaways from the featured case studies, high-level discussions and calls to action.
1. Tackle toxic interests and extreme capitalism
In the opening panel plenary, Australian health leader Professor Fiona Stanley did not pull her punches, urging that we scrap the gross domestic product (GDP) as a measure of success and warning of the direct impact on health and climate of extreme capitalism and toxic vested interests.
The fossil fuel, tobacco, alcohol, fast food, and sugar industries, as well as the media, are “influencing our children and young people and family’s health more than any of the research we’re doing”, Stanley said.
“That anguishes me,” she said.
Stanley referred to the numbers of mostly Aboriginal children with foetal alcohol syndrome and intellectual disability going into the Banksia youth detention centre in her home state of Western Australia, “even though the evidence is overwhelming that this is the most disastrous thing to do”.
Stanley said she was sick of wonderful reports and strategies like the National Health and Climate Strategy being undermined by vested interests.
Asked what a healthy, regenerative and just future looks like, she urged a civil society focused on equity, diversity, trust, care, the collective good, and prevention versus cure.
“If we’d done [prevention] better in the last 20, 30, 40 years, we wouldn’t have the climate change we have,” she said, because we would understand the role of capitalism and greed that are “driving the health problems for the whole world”.
Royal Darwin Hospital emergency physician Dr Mark de Souza, who has worked closely with Larrakia Elder Dr Aunty Bilawara Lee on the hospital’s campus greening project, also called on the health sector to “step up” and put policy settings and legislation under scrutiny from health perspectives.
He spoke of the “courage that is now required of us all” to speak out against Australia’s continued investment in oil and gas, for the sake of human and planetary health, which are so critically linked.
2. Solid foundations accelerate action
“Health is the argument for climate action,” said CAHA CEO Michelle Isles, quoting the world Health Organization, as speakers at the conference laid out the policy and campaign context for greening the health care sector.
Assistant Health Minister Ged Kearney, who as head of the Australian Nursing and Midwifery Foundation (ANMF) was a founding member of CAHA, told the Forum:
- The latest State of the Climate report shows “alarmingly” that Australia’s climate has already warmed by an average of 1.51 degrees Celsius since national records began.
- Australia’s health system is currently responsible for around 5.3 percent of national greenhouse gas emissions.
- The Federal Government is making good progress on its National Health and Climate Strategy. Work has now begun on 31 of 49 planned actions over five years (from December 2023), with 11 completed or in final stages.
- It has just published first in a series of reports: Systematic Mapping Review of Australian Research on Climate Change and Health Interventions
While there are deep concerns about health and climate action in Aotearoa New Zealand under the National-led Government, Isles welcomed two recent publications:
- Its Health National Adaptation Plan 2024-2027 which seeks to put health at the forefront of its climate response.
- The Our Atmosphere Our Climate 2023 report which warns of the higher risk “of multiple severe weather events that overlap in time and/or space” and where gradual changes can cause “cascading effects”.
3. Learn from exemplar services
At the Hunter New England Local Health District in regional New South Wales, health services are on track to be carbon and waste neutral by 2030 under its award-winning Sustainable Healthcare – Together Towards Zero strategy.
Its innovations include re-using clean water from rental dialysis units for flushing toilets at Tamworth Hospital, recycling old staff uniforms into bathroom tiles, and supporting clinicians to swap their fleet car for an e-bike.
The health service, the largest in NSW, won CAHA’s 2024 Health Care Climate Champion Pacific award at the #GreenHealthForum24 for the work launched three years ago.
Ramsey Awad, Executive Director of Infrastructure, Planning and Sustainability for Hunter New England Health, said the service’s approach is founded on genuine Aboriginal stewardship values, the engagement of staff and community, and a pledge to never put sustainability into competition with quality care.
“We never wanted the tension of solar panels versus employing a frontline clinician,” he said.
Rather the program last year delivered $3 million in savings that is invested back into frontline care, Awad told the conference.
The Hunter New England LHD, which includes Newcastle Hospital (Australia’s second busiest Emergency facility), covers a huge geographical area, around the size of the United Kingdom.
Under the strategy, it has installed “solar panels on every roof, LED lights in every building”, and is now looking at ground-mounted solar on large sites and batteries in smaller facilities, he said.
Awad said LED lighting is a “no brainer” for health services wanting to cut emissions: paying back investment in less than 18 months and delivering recurrent savings to Hunter New England of $1 million a year.
In transport, the service is moving its fleet to hybrid electric, and installing “a raft” of electric vehicle charging stations in regional areas.
In what’s believed to be a first in Australia, clinical staff are trading fleet vehicles for e-bikes and can salary sacrifice to buy their own.
The service has just finished a successful ‘Gloves Off’ campaign to reduce the 30 million rubber gloves that go into landfill each year, has redirected plastics for hospital roads and furniture, and is partnering with the private sector and universities on other reuses.
“This is the stuff Treasury is interested in,” he said, showing the savings.
In another session, Jenny Rutherford, virtual care manager at Hunter New England Local Health District, talked about a concerted effort by the service to boost virtual consultations, given that getting patients to travel six hours for a 15-minute consultation “is not the best care for them”.
The LHD now does 6-700 video consultations a week, amounting to 38,000 patients over the past 12 months. These are done in patients’ homes or in one of 44 telehealth rooms across the region if they need support or better connectivity.
This had saved them 5.5 million kilometres of travel, 1,300 tonnes of carbon emissions, and nearly 9,000 nights away from home.
It’s helped attendance figures, allowed other members of a care team, such as a GP, to be involved in treatment planning and benefits clinicians by reducing their costs and travel time and allowing more time with patients, she said.
4. Cultural safety matters
“We know the answers but we lack the power.” That was the verdict on Indigenous knowledges and health in the opening plenary from Aunty Dr Doseena Fergie, a nursing and midwifery leader who is from Wuthathi, Mabiauag Island and Ambonese ancestry.
Fergie, a founding member of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM), said she takes courage from the balanced ecosystems that existed in Australia before colonisation, but lamented that Aboriginal and Torres Strait Islander people “have become invisible” in health systems.
“We can’t go back to the past but we can learn [from it],” she said, urging allies to recognise the need for self-determination and to keep the Uluru Statement from the Heart “high on our agenda” despite the defeat of the Voice referendum.
Asked about values in care, Fergie said Aboriginal and Torres Strait Islander people are communal and preference relationships “with the environment and with each other”.
Her father always told her “don’t take more than you need and, what you have, share it around with everybody”.
Speaking about Aboriginal and Torres Strait Islander health, Fergie said health systems are still “not culturally safe for our mob”, and this remains the critical barrier to addressing preventable chronic conditions.
Donna Burns, a Wiradjuri woman and CEO of the Australian Indigenous Doctors Association (AIDA), had a similar message, saying it was not possible to “decouple” quality or high value care from cultural safety.
Racism and lack of cultural safety were “counter to a sustainable healthcare system”, she said.
In a powerful panel session on Caring for Country, she gave the example of an Indigenous person avoiding early healthcare because they felt unsafe in the system, and the costs to their health and to the climate from later interventions, including acute care and air or road transfers from remote areas.
“This can be avoided or at least minimised if we can create a healthcare system that is culturally safe because people will come to us earlier. That is key not only to the individual and family but to environmental impacts,” she said.
The session also heard about the award-winning Kabi Kabi Indigenous Employment Initiative involving Kabi Kabi Traditional Owners and Elders, UnitingCare, a UCQ property team, young Kabi Kabi and Wakka Wakka peoples and the Ny Ku Byun Elders Village in Queensland.
Trainees are learning to integrate cultural practices at Ny Ku Byun including smoking ceremonies, native planting and caring for land, which has led to deep-rooted relationships with Elders and residents.
“They’re experiencing better health outcomes because they feel culturally safe and respected,” said Jessica Abernethy, Acting Team Leader of Uniting Care Queensland’s RAP Program.
The project “is helping to pave the way for a broader cultural shift in the healthcare sector” and one that UnitingCare intends to replicate elsewhere, she said.
The session also heard from Abernathy’s colleague Nikki Burns, a Yorta Yorta, Wemba Wemba, Dharug woman, about her work on embedding cultural safety in care, and about Gold Coast Health’s Banyahrmabah healing space at the Tugun Satellite Hospital, which promotes traditional healing practices (see this video).
Moderator Francis Nona, a Torres Strait Islander academic, said the session was a call to action to the health sector to reflect deeply on stewardship, sustainability and holistic wellbeing. He echoed many other presenters in saying Country is not just physical landscape, but a way of life “that has sustained First Nations communities for generations and has the potential to enrich our healthcare systems today profoundly”.
Further reading: Health: Spirit, Country and Culture, the latest of the National Museum’s art of the First Knowledges series, by Shawana Andrews, Sandra Eades and Fiona Stanley.
Further listening: The Health Report: The Voice is a health issue – hearing again the reasons why.
5. Prevention is climate action and social justice
Dr Kate Charlesworth, a Sydney public health physician who leads the Climate Risk and Net Zero Unit at New South Wales Health, had three key messages:
- Keep people healthy and well – preventative and public health measures like vaccinations, health promotion, tobacco control, obesity policies “are actually sustainability measures”.
- Reduce low value care – on the risks and costs of over-diagnosis and over-treatment, research shows about 10 percent of global healthcare is harmful and another 30 percent is low value.
- Where we do offer effective quality healthcare, focus on decarbonising it, starting with reducing use of plastics, anaesthetic gas etc.
Charlesworth talked about having been a junior hospital doctor who became frustrated with clinical health. She did a Master of Public Health, worked with leading tobacco control advocates, and remembers thinking that “they had saved many more lives than any cardiothoracic surgeon that I know”.
That style and level of advocacy, which also led to mandatory seatbelts, is what we now need to bring to the climate debate, she said, “that professionalism, that influence, and that making it tangible for people that this is actually about the health of their families”.
In a session on resilience, Bendigo Health’s Dr Kate White also urged greater investment in prevention.
White helped lead the development of the Loddon Mallee Climate Change and Health Framework – the first such regional framework in Victoria which benefited from significant internal champions and a shared view of the need for urgent action in a region hit hard in recent years by flooding and bushfires.
“When you are funding prevention properly, you’re addressing the issue of community health and social justice – we’re embedding our communities with more resilience, because they’re stronger, they’re healthier, they’re preventing chronic disease, they’re more socially connected,” she said.
“So I start upstream, and I hope that in the future, we might see a waking up to that knowledge of ‘let’s prevent chronic disease so we’re not putting so much pressure on the healthcare system to make us well’”, she said. Communities are then empowered, “because they’re taking more control of their own health and wellbeing from the beginning.”
6. Primary healthcare is critical for disaster recovery
The scale of the Northern Rivers floods in 2022, which hit the New South Wales regional centre of Lismore twice in two weeks, is a cautionary climate tale for every region in Australia and beyond, says Aimee McNeill, Director of Integrated Wellbeing at Healthy North Coast.
“Think of the worst-case scenario disaster your region could experience, and then double it when you consider what’s occurred [here],” said McNeill.
Her organisation led the delivery of over $40 million in disaster programs in response to the floods, across prevention, preparedness, response and recovery.
The 23 initiatives that were rolled out highlighted the critical role of primary healthcare coordination during disasters, she told a session on resilience.
Place-based primary healthcare innovation strengthens the health response in disasters, while community health system resilience reduces the impact of disasters as well as reliance on acute and out of region resources, she said.
Primary Health Networks and primary healthcare offer unique skills that need to be embedded in national and state disaster management plans, she added.
McNeill laid out the impact of the Northern Rivers flooding, “one of the most devastating in the nation’s history”, which saw 10,000 people evacuated, and 4,000 homes made uninhabitable. As well as hitting essential services and infrastructure across the region, it also shut down many general practices, which lost clinical data and were not held as priorities for having power restored.
Her team’s responses included having medics touring the region in vans, supporting aged care, setting up pop-up mental health centres and introducing flood recovery navigators to step people through complex health systems.
They also established Resilient Kids, a mental health service for young people affected by extreme weather, a first for Australia.
There were many lessons, but overall they confirmed the findings of the Royal Commission into Victoria’s 2009 bushfires that “the most resilient communities are those that are most connected,” and that “resilience is built alongside communities, not for them”.
Nearly three years on, “the community is still in recovery”, she said, echoing other presentations about the long tail of disasters.
7. Reducing nitrous oxide emissions is a priority
For specialist anaesthetist Dr Cas Woinarski, it was a lightbulb moment when he calculated excessive nitrous oxide (N2O) emissions at Barwon Health in regional Victoria.
“I realised that if we could solve this issue, we could make a big difference for no change in patient outcomes,” he told the conference in a presentation on identifying and detecting N2O leaks in Australia’s healthcare facilities.
As detailed in a government report he has co-authored, N2O is a potent greenhouse gas with a global warming potential 265 times that of carbon dioxide (CO2).
Leaks in N2O infrastructure have been identified as a significant contributor to the emissions footprint of anaesthetic gas use in healthcare and are financially wasteful.
“Nitrous oxide in healthcare represents some 70,000 tonnes of CO2 emissions per annum across Australia,” Woinarski said, warning that an astounding 50-100 percent of these emissions may not contribute to patient care.
It can take years to address the issues via three main phases – assessment, establishing a portable supply system, and decommissioning, with only four Australian hospitals (Broome, Charles Gardner, Prince Charles, Modbury) having yet got there.
But he said there is good work underway:
His key tip: “Collaborate with people who are further down the line than you. We now have answers to the questions that we were asking 12-24 months ago.”
8. Reduce low value care
Dr Christopher Leung, from Melbourne’s Austin Health, told the session on high-value low-carbon care about a Victorian Choosing Wisely scaling collaborative to reduce unnecessary tests, treatments and procedures in 11 metropolitan and regional health services in Victoria.
It identified 27 low value care practices across imaging, pathology and prescribing, particularly in emergency, intensive care, and outpatients.
“The great news is that in just over four months, there was a 33 percent decrease in low value care practices,” he said.
Key lessons are to focus on the triple bottom line, integrate changes into ‘business as usual’ and quality improvement processes, ensure there is at least modest funding for the roles involved, and to measure success.
“If there is an opportunity for low hanging fruit and rapid decarbonisation of a health service, then this is it,” Leung said.
Ophthalmologist Dr Alex Buller from Hastings in New Zealand talked about efforts in his award-winning practice to introduce reusable cannulas.
Sketching a fascinating journey of innovation that was “anything but a straightforward easy pathway”, he said “our superpower is being small”.
“We can make changes, fail, try again, fail, try again and move forwards because we’re a small team making our own choices,” he said.
Other takeaways from the session included the need for strategic coordination and executive buy-in, having clinical champions, the need for funding/resourcing sustainability roles/work, and the importance of data to measure problem and change.
9. Work for hope
Finally, if you read the ‘hothouse world’ high-warming scenario developed by Te Whatu Ora Health New Zealand (see page 26 in this report), and aren’t incredibly alarmed, then you haven’t read it properly – because that’s the trajectory we’re on at the moment.
That was the bleak observation by New Zealand presenter Vicktoria Blake, commenting on the report, Climate Change Scenarios for the Health Sector.
But, the conference heard that there is also great hope for change, not least from the health sector.
See the full conference program and this link for the Croakey Conference News Service coverage.
