Speaker 1: ♪♪ My name is Amarantha. I'm the first Welsh Leadership Fellow in Sustainable Healthcare. In this session, I'll be discussing what sustainable healthcare means within the context of national and global health. An international survey reveals that climate change is taught in only 15% of medical schools worldwide. But if the global healthcare sector were a country, it would be the fifth largest greenhouse gas emitter on the planet, ranking just behind Japan. The human population is healthier than ever before, but to achieve this, we've exploited the planet at an unprecedented rate. A growing body of evidence shows that the health of humanity is intrinsically linked to the health of the environment. But by its actions, humanity now threatens to destabilise the Earth's key life support systems. Human beings have converted about a third of ice-free and desert-free land surface of the planet to cropland or pasture. Half of all accessible freshwater is appropriated for human use. 2.3 million kilometres squared of primary forest has been cut down by humans since 2000. 90% of monitored fisheries are harvested at or beyond maximum sustainable yield limits. And concentrations of greenhouse gases are at their highest level for the past 800,000 years. The modern world system, beginning with colonisation and industrialisation, set off a series of social transformations that have increasingly destabilised the function of the natural systems that support us. Geologists have called for a new name to mark a new epoch in which human activities and exploitation of the planet are physically detectable in the geologic record itself. They've called it the Anthropocene. The concept of planetary health considers both the health of human civilisation and the state of the natural systems on which it depends. It is the recognition that human and natural systems are fundamentally interconnected at all scales and reflects the concerns of other health movements. The planetary health movement aims to enable just, equitable and sustainable modes of living on our planet. Through recognising the socio-ecological drivers of illness, through appreciating and protecting biological and cultural diversity, by calculating threats to human health and ecosystem integrity to improve accountability and decision-making, by redefining growth and prosperity away from GDP toward measures that permit better quality of life for all, and funding interdisciplinary research and developing governance structures and processes to respond to environmental threats to life and health. Climate change has the potential to undermine the last 50 years of global gains in public health and this illustration from the US CDC shows how. The human symptoms of climate change are unequivocal and potentially irreversible, disproportionately affecting communities least responsible for climate change and those who are most vulnerable in society. The WHO has found already that 150,000 people are dying as a direct result of the issues shown here and this will only increase to 250,000 by 2050 if we do not act now. Closer to home, I found this image really shocking. Ice caps melting causing a rise in sea levels at the current pace means this image shows the landscape of our current homes in south-east Wales within 80 years, how it might look for our children and grandchildren. The red denotes flooding areas and thus the new beachfront homes of Llandaff and Pen-y-Lan, the top floor of the prospective UHW2 would have a sea view of underwater Pont Cana. Cardiff is the sixth most susceptible city in the world to the impacts of climate change, 16 places above London. Flooding will become an annual occurrence and coastal flood defences cannot protect us from the three rivers which run through Cardiff. You can check out your home via the web address at the bottom left of the screen if you're interested. But how does healthcare fit in? First, a definition. The goal of sustainable healthcare is to meet the needs of patients and populations of the present without compromising the ability of future generations to meet their own needs. Keep this definition at the forefront of your mind while we understand how the healthcare sector can lead to the transformation to a sustainable society. This is why we, the healthcare sector, need to look at our own shortcomings. The NHS is the UK's biggest public greenhouse gas emitter, responsible for approximately 5% of all UK environmental emissions. The carbon footprint for NHS Wales for 2018-19 exceeded 1 million tonnes of carbon dioxide emissions. But what does a tonne of carbon dioxide look like anyway? This is a three-storey tall cube representing one tonne of carbon dioxide in volume. You can see the equivalent building size next to it and the little person for reference. A million of these stacked together, like the row of buildings in the background, would represent the Welsh NHS. Can you see the item held by this person in the medical wasteland? It's actually a used blood bag dangling at their feet. 2% of global plastic production is medical plastic, which increases by 6.3% per year. Except now that we're in the midst of a global pandemic, this number likely falls short of what we expect for the next year. Antibiotic presence has been found at 65% of 711 river sites worldwide. Supply chain workers, many of whom are children, are paid less than $1 per day without the protection of health and safety regulations. The medical waste you see here harbours germs that are easily spread through water bodies, eventually contaminating the global food chain, of which everybody is a part. Health services the world over are under significant pressure. There's a rising demand for healthcare, growing concerns about safety and quality, staffing shortages in the face of chronic underfunding, and the constraints of international trade agreements. Perversely, healthcare activity can undermine a society's capacity to build health itself, as it's often able to commandeer funding at the cost of health protection and illness prevention. To this, we now add the constraints of finite natural resources, the need for investment in adaptation and resilience measures, and the additional load of morbidity and mortality that the climate crisis brings. The future of healthcare will depend, in part, on the adaptive capacity of hospital infrastructure to respond to the physical and health-related impacts of climate change. This includes sudden and non-linear changes in the volume and patterns of healthcare demand, from floods, pandemics and migration, as well as the disruption to buildings, travel, energy infrastructure and supply chains caused by extreme weather events. The COVID-19 pandemic has provided a taste of these demands and constraints, as have extreme weather disruptions to healthcare, such as the evacuation of hospitals during Hurricane Sandy and medical equipment shortages caused by hurricane damage in Puerto Rico. The Climate Change Act 2008 sets the UK's emissions target for six specific greenhouse gases by the year 2050. Levels should be 80% lower than the 1990 baseline. The Paris Agreement, agreed upon by the end of 2015, is a legally binding commitment to limit global temperature rise to no more than two degrees above pre-industrial levels. Signatories currently represent more than 97% of global greenhouse gas emissions. This does include the USA, whose withdrawal is not effective until 4th November 2020. The Wellbeing of Future Generations Act is a ground-breaking, world-first piece of legislation securing the future generations of Wales. This Act requires public bodies to do things in pursuit of the economic, social, environmental and cultural wellbeing of Wales, in a way that accords with sustainable development principles, and to require public bodies to report on such action. No other country on the planet has a piece of legislation like this one. In the Environment Wales Act 2016, Welsh Ministers must ensure that the net Welsh emissions account for the year 2050 is at least 80% lower than the baseline, so nation-specific compared to the UK-wide Climate Change Act. It also promotes sustainable management of natural Welsh resources. A policy commitment in 2017 from the Welsh Government Cabinet Secretary for Environment and Rural Affairs called for the whole public sector, that is government and its government-controlled enterprises, to be carbon neutral by 2030. This year, NHS England, in October 2020, moved the goalposts considerably closer for its net emissions. The NHS England carbon footprint, the emissions they control directly, will be net zero by 2040, with its PLUS scope, the emissions they can influence, to be net zero by 2045. Wales has recognised this and has been working on an NHS Wales Net Zero 2030 strategic delivery plan with the Carbon Trust, aligning with previous Welsh Government commitments. We expect this to be published by January 2021, setting out smart targets for specific healthcare issues. The UN Climate Change Conference of the Parties, also known as COP26, postponed from this year, is where participants meet to discuss and review the commitments they made to international climate change conventions. Now back to you guys. The Royal College of Physicians has identified sustainability as a domain of quality within healthcare, which must run through and moderate other domains, as shown here. Point number 25 of the GMC Outcomes for Graduates states that newly qualified doctors must be able to apply the principles, methods and knowledge of sustainable healthcare to medical practice. Within this key outcome, many of the sub-points reference wellness, the environment, ecology and medical practice from a global perspective. You must be able to explain the impact that global changes may have on local health and wellbeing. The graph shown here charts the pathway to net zero for the NHS England Carbon Footprint Plus scope. The green box highlights the large proportion of issues that are directly influenced by healthcare professionals in clinical practice, where people working on the frontline can identify inefficient patient pathways and suggest innovative methods of change. The blue box highlights supplier alignment to net zero commitments. The companies and bodies with whom we choose to work matter more than we currently appreciate. So how do we go about making these changes? Four principles, developed by the Centre for Sustainable Healthcare, provide a framework. First, we should prevent the need for healthcare. Then, make better use of patients as partners in managing their own health and illness. Following this, we should make our clinical services as high value and efficient as possible. And finally, we should factor in the environmental impact when making decisions about treatments and technologies. These principles can inspire and motivate project ideas that directly link back to each principle, but they can also influence the way you approach existing projects. Don't be afraid to address just one principle when reviewing and reflecting on your current practices, research methods and quality improvement projects. Once you recognise one principle within your work, the rest are easily identified. How can we demonstrate the value in our work? Sustainable value explicitly considers the environmental, social and financial impacts in relation to health outcomes for both patients and populations. Resources are often used as a shorthand for financial costs when in reality we are equally reliant on social assets such as staff, carers and patients themselves and environmental resources. Considering these three criteria together denotes the triple bottom line and should be integral to calculating value within a service. In summary, sustainable health care encourages a more holistic perspective. We need to make sure that we're considering the needs of the entire population, not just the individual patient. We need to think about preventing illness and building health and resilience. We need to make best possible use of finite resources, but most importantly, it can no longer only be about the financials. We need to account for the environmental and social aspects. It's not all doom and gloom. Healthcare Without Harm is an international, non-government organisation seeking to transform the health sector worldwide so that it becomes ecologically sustainable. For 23 years it has advocated for environmental health and justice, reducing toxic chemicals and generation of waste in healthcare, while transforming the supply chain and fostering climate action. Here are some other bodies who are doing amazing work and I encourage you to look them up, especially if you're interested in pledging your help and connecting with other like-minded medics. The COVID-19 pandemic has thrown a spotlight on many aspects of the link between human health and the environment. Local green spaces have never been more valued. Evidence on the benefits of nature for health points to the importance of green spaces where people live. These health benefits arise partly because green space promotes physical activity, but also appear to be linked to other factors. Urban green spaces such as parks provide opportunities for social interaction and social inclusion, which are likely to be especially important for more marginalised groups. Natural environments have relaxing and restorative effects and have also been linked with improved immunity. Access to green space is related to lower mortality from cardiovascular disease, lower rates of obesity and lower levels of type 2 diabetes. People moving to greener areas go on to have better mental health and higher levels of wellbeing. Only when the last tree has died and the last river been poisoned and the last fish been caught will we realise that we cannot eat money. The 2015 Lancet Commission's conclusion that tackling climate change could be the greatest global health opportunity of the 21st century highlighted the need for a global monitoring system with the ability to engage policy makers and support health professionals. In 2016, the Lancet Countdown tracking progress on health and climate change was formed to address this gap, beginning with a public consultation to identify key areas of health and climate change to track and monitor. Their reports are published annually. The collaboration recognises that the voice of the health profession is essential in driving forward progress on climate change and realising the health benefits of a robust response. How can you use your voice, and most importantly, take action? Thank you for listening. www.lancet.gov.uk