Emergency room for the health and climate nexus

Climate change is the leading threat to global health. Developing countries, which have contributed the least to climate change, are not only the most vulnerable to extreme events (from heatwaves wildfires, floods, tropical storms and hurricanes all making the headlines this year) but have very few resources to adapt and protect their people. Research from the World Economic Forum shows that 3.6?billion people already live in areas highly susceptible to climate change. Climate-induced impacts have ripple effects on healthcare systems, creating a significant burden on already strained infrastructure and medical and human resources, with costs for healthcare systems exceeding USD1 trillion.

The vital signs show health and climate are inextricably linked: for good health outcomes, we need good climate outcomes. ?

There is growing awareness of extreme heat's detrimental effects on health and livelihoods. ?According to the WHO 37% of heat-related deaths are caused by human-induced climate change. Those over 65 have risen by 70% in two decades. According to the Red Cross Red Crescent Climate Centre extreme heat impacts can be even starker among the young, old, poor and outdoor workers. However, heat is one aspect of the myriad effects of climate change that impact disease spread and health infrastructure.

Due to the expansion of mosquito habitats, the increase in pollution-related illnesses and vector-borne diseases such as dengue, malaria and Zika necessitate different health care services. According to the World Economic Forum by 2050, climate change is projected to cause 14.5 million deaths and $12.5 trillion in economic losses, with low- and middle-income countries disproportionately affected, having already incurred 91% of deaths from climate-related events in the past 20 years. There is also the direct costs to health from sectors such as agriculture, disruption to food systems affecting more than 100 million, water and sanitation) estimated to be between US$?2–4?billion per year by 2030. We are also seeing the rise of antibiotic- resistant ‘superbugs’ due to climate change. Getting to accurate data and modelling challenges persist, especially around capturing risks like drought and migration pressures with the number of people displaced from many uninhabitable regions.

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Care is at the centre of the healthcare community. The general public cares more about the environment and nature when it has a direct impact on health. But as a busy A&E doctor on night shifts or a GP seeing a nappy rash for the hundredth time unless your hospital is being evacuated because of extreme heat or there is a power outage you might well ask “Is this a burning platform for me today?” “What can I even do about this?”

Let’s look at some immediate triage solutions and some areas where greater awareness and more active listening skills could be transformational. The primary fix is a one health mentality. The appreciation that planet, nature and people’s health are inextricably linked. Tick.

The role of the private sector:

We need the most influential companies that make up our world to be accountable and own their supply chains. We can have a direct influence over this in where we purchase, invest and advocate.

According to the World Benchmarking Alliance which ranks the 2000 most influential companies in the world against the UN SDG’s 95% do not assess the impact of their operations on nature. According to its latest Nature Benchmark it also found that less than 1% of the major companies analysed assessed their dependencies on nature. While some companies are helping to halt and reverse biodiversity loss, the majority do not yet fully understand how they impact and depend on nature. Indigenous Peoples and Local Communities (IPLC) often live in critical ecosystems and coexist with threatened species. They manage about 40% of all terrestrial protected areas and their ecological knowledge enables a sustainable existence worldwide. Yet less than 13% of companies assessed express a clear commitment to respect Indigenous Peoples’ rights.?

Nearly three quarters (72%) of the world’s population is water insecure.?Less than a third of companies report water use reductions or disclose water usage from water-stressed areas. Water quality is also an issue with only 15% of companies reporting metrics on discharged pollutants and just 4% have set targets to reduce them. Overall performance of the pharmaceutical industry is good according to the benchmark with Novartis, Sanofi, Merck, Johnson&Johnson and Pfizer ranked highest although none of these companies score more than half marks on governance and strategy, ecosystems and biodiversity or social inclusion and community. https://www.worldbenchmarkingalliance.org/publication/nature/rankings/segment/pharmaceuticals-and-biotechnology/

Action: As a healthcare provider you might be asking what does this have to do with me? If you do have a pension or investments in these companies then you can decide how you invest ethically and responsibly by researching and owning the investment decisions you make. Be part of the decision-making process or lobby for change in your own work environment to ensure companies you are using through your supply chain are reporting and disclosing their environmental and sustainability metrics and performing strongly in this area.

In the UK the NHS is responsible for around?4% of England's total carbon footprint and?40% of public sector emissions. Like healthcare systems around the world it has an important role in mitigating as well as adapting to the impacts of climate change. The NHS has set a target to reach net zero by 2040 for direct emissions and through its supply chain by 2045. This has been legislated for and is supported by the public and staff.

Action: Be the change you want to see in the world. Look at your direct environment and believe you can be the influence and changemaker. Look at your own place of work – hospital or practice and think about how the carbon footprint, plastics or water use can be reduced.

Eliminate avoidable waste

Waste is important because of the emissions associated with the production, use and disposal of equipment and products. For example, a recent review identified?quality improvement interventions in surgery?with the potential to improve both environmental and financial sustainability. Great Ormond Street Hospital NHS Foundation Trust’s celebrated?‘The gloves are off’ campaign?led to the use of 36,600 fewer disposable gloves every week. Key to this success was the role the Lead Nurse for Infection Prevention and Control and Lead Practice Educators played in engaging colleagues through awareness and education campaigns. By developing decision-making tools, using prompts and engaging nursing and phlebotomy staff, Charing Cross Hospital achieved a?25% decrease in cannulation during emergency attendances?in one year. This equated to a reduction in the percentage of cannulae that go unused from 40% to 27%, financial savings of ￡95,000 and a carbon reduction of 19 tonnes CO2e.

Lower-carbon alternatives

Can be sought for unpreventable care with a high carbon footprint. University Hospitals Bristol NHS Foundation Trust saved 360 tonnes CO2e per year?using alternatives to the highly polluting anaesthetic gas desflurane.?Low carbon care is becoming an important talent driver as healthcare professionals want to work in places prioritising the environment and sustainability. By asking for change in the work environment from food suppliers in the canteen, to electric ambulance fleets, walk to work schemes and improving efficiency and harnessing technology (including AI and online appointments) hospitals and practices can meet their net zero targets. This requires a strategic approach backed by purposeful, intentional action.

Building capacity: Decarbonising care requires dedicated time and resources for staff at all levels. As within the private sector sustainability goals, performance and where applicable incentives should be aligned. Newcastle Hospitals NHS Foundation Trust has employed junior doctors in paediatrics, oncology and anaesthetics with half or more of their time dedicated to quality improvement related to environmental sustainability.?South-East London ICS has committed to?identifying, educating and resourcing clinical staff to work on sustainability in primary care.

Building capability Environmental sustainability needs to be embedded consistently across professional groups through undergraduate and workplace education and training. This should be routinely endorsed by medical schools, councils and global health organisations. There is an opportunity to make sustainability part of everyone’s job and ongoing training and patient care delivery and improvement. These frontline staff are the closest to understanding their own environment and are best placed to reimagine what changes and process improvements are possible. There should be an open line from these front-line staff into the centralised decision-making function to ensure more empowerment for transformational change. These improvements should also be shared through a global database of case study examples to provide best practice and learnings across diverse regions to drive innovation.

Action:

Ask the question - Does your hospital have a net zero strategy?

How are you and your department aligning and delivering on it?

The need for partnerships Collaboration will support faster decarbonisation and better healthcare outcomes. As we have seen standardised reporting for companies, we could look at this for hospitals and practices so they can be benchmarked and encourage a race to the top. More funding is required and incentives to change. This is where philanthropy can step in as a catalyst, especially in data, research into sustainable care models and pollution hot spots to move at the pace and scale needed to address planetary and nature risks impacting health.

We are seeing philanthropy and business looking at intersections across climate change, food, health, and livelihoods to build resilience, especially in the global south. One health is about the interdependence of the health of people, animals and ecology. This is a global systemic complex problem which needs unification. This is undoubtedly where Public-Private-Philanthropic Partnerships (PPPPs) can add value, through building consistency and oversight in a fragmented environment towards strong and effective collaboration. This is an opportunity we need to capitalize on.

The collaborative State of Global Air report, 2024, shows that 8.1 million people died from air pollution in 2021. As an example charities in the air pollution space are looking at big data to identify potential pollution hot spots to monitor air pollution in big cities, especially in Asia. The monitoring system is linked to transport and taxis to report back in real time on current levels impacting citizens. This allows for more monitoring and remedial action at these hotspots to address the root cause and improve air quality as supported by local businesses and Government. ?These pilot schemes enabled by partnership models are enabling faster progress by putting data and people at the heart of improving lives in some of the most polluted cities and should be rolled out universally.

Other examples include access to sustainable energy in remote areas to ensure consistent healthcare in hard-to-reach areas. The lack of reliable energy affects basic and crucial healthcare service delivery, including deliveries, maternal and childcare, immunization and accident and emergency injuries. Energy-driven healthcare interventions are being delivered through partnering with NGOs, local government officials and District Health Officers, who have been critical in championing these solutions, as well as ensuring their sustainability.

Need for urgent action

To avert catastrophic health impacts and prevent millions of climate change-related deaths, the world must limit temperature rise to 1.5°C and fast.

At the macro level we need better access to knowledge and data, more global and regional capacity and capability building, more shared best practice and case study examples. There is great opportunity to drive partnerships in this space to move faster together target more financial investment into critical infrastructure, technology and data projects. A central knowledge hub would be a game-changer to avoid silos and leverage best practice models that are already working in other regions to bring partners together and support countries in achieving their commitments to climate-resilient and low carbon health systems.

Mobilizing the strength of the global health community is critical as we build better, cleaner, more climate-resilient and environmentally sustainable health systems. This is within your sphere of influence today.

Be an Enabler today:

·????? Be curious

·????? Understand your environment and the impact it has

·????? Stay accountable

·????? Join the climate change's health implications movement and push for change towards sustainable healthcare systems for all

·????? The WHO is engaging directly with the healthcare community to develop a global action plan on climate and health. Have your say: https://extranet.who.int/dataformv3/index.php/984572?lang=en