A guide to reducing the footprint of the health sector

On June 30th I attended this meeting, jointly organised by the BMJ, Royal College of Paediatrics & Child Health, and the Faculty of Public Health. There were at least 200 delegates, many either doctors or senior managers in public health roles in the NHS whose jobs include taking these issues seriously and having the clout to do something about them in their workplaces. This is just a brief summary of the main presentations in a rich and inspiring day.

Professor Alan Maryon-Davis, president of the Faculty of Public Health introduced key aspects of why it is imperative to consider the public health implications of carbon emissions and climate change. These included:
- displacement of populations as areas become uninhabitable, and increased ethno-cultural conflicts as people compete for resources
- more extreme climatic events such as hurricanes (which disproportionately affect sick and frail people)
- changing patterns of vector-borne diseases (e.g. malaria used to be endemic in Europe and is likely to return)
- water-borne diseases due to flooding
- cancers due to increased UV radiation
- food and fuel poverty

He explored the health implications of the two basic responses: mitigation (reducing emissions to slow down climate change) and adaptation (dealing with climate change that is already happening or inevitable). From a public health point of view, some aspects of these responses can have ‘co-benefits’ in terms of both the health benefits of more active lifestyles and the financial benefits for individuals and health services of increased energy efficiency.

Dr David Pencheon, from the NHS Sustainable Development Unit gave some more specific information on the carbon footprint of the health sector. The NHS, with 1.3 million employees and £17bn procurement budget, has both a huge responsibility (it has a larger carbon footprint than any other single organization) and a lot of potential muscle to effect change. 20% of the NHS’s carbon emissions are due to energy (currently just under half of this comes from renewable sources); 20% comes from transportation of patients, staff and visitors; and 60% comes from goods used e.g. pharmaceuticals, plastics, disposables, etc. The health costs and benefits of any changes in these areas need to be carefully balanced.

He gave some examples of what individual health Trusts have done, for example, Treliske Hospital in Cornwall takes food miles into consideration and as far as possible purchases local food. He also mentioned ‘co-benefits’ – what we do today can save the NHS money in the future. Indeed he argued that the long-term sustainability of the NHS depends on it seriously reducing its carbon footprint.

There followed a discussion with the audience which included the following points of interest:

- because of cost pressures, oil vulnerability can be a bigger motivator to senior managers; we therefore need to link NHS energy strategy to peak oil as well as climate change. (However some national policies – e.g. Lord Darzi’s proposed polyclinics – are likely to involve more centralization of services and hence more transportation.)

- behaviour change (at either individual or corporate level) is difficult to bring about, but can be supported by technology. E.g. thousands of computers in hospitals get left on standby all night despite campaigns to encourage staff to turn them off; so Whittington Hospital in London installed computers that automatically switch off at 8 pm unless still in use.

- it was suggested that every NHS Trust should have a carbon reduction plan, and this should also involve individual employees. Every NHS job description includes equality and diversity, and this has to be included at interviews; sustainability and carbon reduction should have the same status, and should be included within clinical governance.

Tom Cumberledge from The Carbon Trust was the next speaker. They offer a 10 month Carbon Management Programme through which NHS Trusts can develop an organization-wide strategy to embed emissions reduction into their day-to-day operations. This requires commitment by the board of management, who need to put up the funding for a project leader as well as seconding influential staff from every department. The Carbon Trust is working in this way with many Local Authorities and NHS Trusts; on average, NHS organizations who have undertaken the programme have each reduced annual C02 by 4,100 tonnes and have also therefore saved £450,000 per annum (a key aspect in motivating management).

There was then a panel of speakers from various NHS Trusts and organizations which have worked to reduce their carbon footprint, including the Royal College of Paediatrics who were hosting the conference - one important point from their experience was that carbon reduction strategies need to involve everyone in the organization, and may be resisted and ineffective if imposed from above. There was also a GP from a practice in Wales who made some challenging points about health advice and carbon – for example, people are advised to eat 5 portions of fruit & veg a day, but this advice does not mention taking food miles into account. This practice, in Rhayader, had made some significant changes (including requiring pharmaceutical reps to offset their carbon emissions for visits to the surgery!) and had also made links with their local Transition Town group.

The afternoon speakers included a senior anaesthetist on the carbon footprint of international conferences (a perk of the job in senior academic medical circles) with an interesting demonstration of video-conferencing technology, including a short lecture by video-link on the health perils of climate change which contained some sobering facts: the CO2 that is stored in fossil fuels was laid down over 350 million years, but is now being very rapidly released into the Earth’s very thin atmosphere. Natural historians say that we are already in an era of mass extinction of many species of animals, birds, fish and insects, thousands of times faster than any previous extinction in the fossil record, so that 50% of current species may be extinct by 2050 (he didn’t speculate as to whether human beings might be one of them…)

There was then a debate about whether carbon offsetting was a useful enabling device or just a ‘conscience opiate’, and various workshops about initiatives to reduce carbon emissions – including an NHS nursery that introduced organic cotton washable nappies rather than disposables, and a company that makes a computer system in which individual workstations use less energy than light-bulbs.

A final panel discussion emphasised what delegates needed to go away and do in our own workplaces, and there have been email follow-ups on this from Robin Stott of the Climate Change and Health Council.

More information on these issues is available at:

http://www.climateandhealth.org/
http://www.fph.org.uk/
http://www.carbontrust.co.uk/

JW