Reducing waste and improving your environmental footprint: in the clinic or hospital (Canberra Doctor - August 2017)

Doctors have a proud history of standing against threats to human health: The medical profession played a key role in highlighting the risks to health posed by smoking and, at the height of the cold war, doctors advocated strongly against nuclear war.

The Lancet has identified climate change as both the greatest threat and greatest opportunity for public health in the 21st century.

The challenge now is to act for the planet.

A few facts

Global average temperature records are broken every year, and our atmospheric carbon dioxide concentration is higher than at any time in the past 15 million years. In fact, when CO2 levels were last this high during the Middle Miocene period, the Earth was approximately 3–5°C warmer, and average sea levels were 40–70 metres higher.

In the face of such dire potential outcomes, it is easy to become disheartened and disengaged. However, due to the very long geological time scale that our planet operates on, it is likely that we still have time to act to reduce our carbon emissions and prevent these dire consequences.

What can doctors do?

As doctors, we play an important role in reducing the environmental footprints of health services and in educating the public about the links between climate change and human health.

At an individual level

- Rational investigation, prescribing and intervention can significantly reduce emissions. Every test, procedure and medication has an inherent carbon footprint. Rational practice is already being embraced by proponents of healthcare sustainability, and the additional environmental sustainability is a great bonus.

- Reduce waste associated with procedures. In some situations it makes sense to take only the items that you need rather than a large ‘pack’ that may contain extras that will not be used, and cannot be reused.

- Think about whether a reusable option exists. This is of particular relevance for items that can be sterilised rather than discarded. There is often a huge carbon footprint associated with procedural equipment, and if it can be safely sterilised again, choose it over the single-use only option.

- Consider active or public transport options to get to work. If you can get your daily exercise by riding a bicycle or walking, not only do you free up the time you may have spent at the gym, increasingly studies suggest there is a substantial boost to cognition and wellbeing! Many workplaces have good shower and bicycle lockup facilities, especially here in the ACT.

- Consider whether you can utilise substitutes for in-person appointments, where appropriate. Telehealth is playing an increasing role in healthcare, and we may be able to utilise these capabilities to improve convenience for our patients and reduce carbon emissions associated with their travel.

- Turn off lights in rooms that are not in use and change lights to low-energy options

- Recycle where possible

When providing lifestyle-related health advice for patients:

- Educate patients about the impact of exposure to negative environmental health determinants, such as air pollution and heatwaves. Aside from its role as the main driver of climate change, fossil fuel usage is also associated with poor air quality. Air pollution is considered to contribute 3000 excess deaths in Australia per year.

- Encourage prioritising active transport where appropriate. The wealth of literature on the physical and mental effects of exercise may be the motivator your patients need to begin an exercise program. The Australian Physical Activity Guidelines (2014) recommend at least 30 min of moderate physical activity on most days for adults. If your patients can integrate this into their days as incidental exercise to and from work or other engagements, thereby reducing transport emissions and improving urban air quality, even better!

- Maintain a healthy, broad and balanced diet. Red meat is a particularly carbon-intensive food source, and current evidence suggests Australians eat more than what is required for a healthy diet. In fact, the NHMRC Australian Dietary Guidelines (2013) suggest that Australian men would benefit by eating less red meat per week, recommending a weekly maximum of 455g of lean, cooked red meat. Nuts, seeds, legumes, beans, tofu, poultry, eggs and fish are all good alternative protein sources and are generally less carbon intensive.

At an organisational level

- We need to continue to advocate for improving healthcare sustainability. Organisations can undertake quality improvement cycles to reduce waste, which are often informed by waste audits performed within operating theatres, emergency departments and wards. You may be amazed by how a single letter to or conversation with managers can lead to change. The WHO has created a framework to assist with effective engagement.2

- Individual practices can engage private environmental auditors for expert advice in how to improve their sustainability; this can also lead to financial benefits over time for the practice.

- We must ensure our organisations make it easy for us to take the environmentally-friendly option. For example, co-location of recycling bins with other waste bins and providing secure cycling facilities and showers are two simple ideas.

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The suggestions above represent a starting point. There are many excellent resources available online that provide advice on reducing your carbon footprint within your personal life. If you wish to become involved with an organisation for environmentally-minded health professionals, consider joining Doctors for the Environment Australia (www.dea.org.au). Below is a link to DEA’s climate change and health policy.3 DEA meets on a second-monthly basis here in Canberra, and there are excellent opportunities for becoming involved at local and national levels.

*Dr Angus Finlay is Chair of the ACT Branch of Doctors for the Environment Australia, and is a Registrar at The Canberra Hospital and Calvary Hospital.

Further reading

1. WHO: Healthy hospitals, healthy planet, healthy people: Addressing climate change in healthcare settings: http://www.who.int/globalchange/publications/healthcare_settings/en/
2. DEA Position Statement on Climate Change and Human Health: https://www.dea.org.au/revised-climate-change-and-health-policy-and-position-statement-healthy-planet-healthy-people-dea/