Sustainable Healthcare

Sustainability

"A way of using resources that could continue forever, like renewable energy. A sustain-able activity is able to be sustained without running out of resources or causing harm." - GreenpeaceLink opens in a new window
 

Sustainable Healthcare

"Focuses on the improvement of health and better delivery of healthcare, rather than late intervention in disease, with resulting benefits to patients and to the environment on which human health depends, thus serving to provide high-quality healthcare now without compromising the ability to meet the health needs of the future" - Tun S (2019). Medical TeacherLink opens in a new window.

Planetary Health

"Planetary health is a solutions-oriented, transdisciplinary field and social movement focused on analyzing and addressing the impacts of human disruptions to Earth’s natural systems on human health and all life on Earth" - The Planetary Health AllianceLink opens in a new window

Education for Sustainable Healthcare (ESH)

"The process of equipping current and future health professionals with the knowledge, values, confidence and capacity to provide environmentally sustainable services through health professions education" - AMEELink opens in a new window

The ESH curriculumLink opens in a new window, endorsed by the Medical Schools Council, provides medical schools with a comprehensive framework of learning outcomes and core content to equip future doctors with the knowledge and skills to address the health impacts of climate and ecological change. It offers clear guidance on what to teach, and resources and evidence to support curriculum design, teaching, and assessment.

The curriculum includes learning outcomes about specific harms to health from environmental degredation (e.g. extreme heat, water polluiton and scarcity, infectious diseases). It also includes specific outcomes for each medical speciality, and strategies for clinical practice (e.g. prescribing, quality improvment, prevention). Some examples are explored below.

Neurology

• Temperature extremes, heat exposure and air pollution are risk factors for acute cerebrovascular events (ref1Link opens in a new window, ref2Link opens in a new window).
• Neurotoxicity can occur from chemical pollutants such as per- and polyfluoroalkyl substances (PFAS). These pollutants have been found in soil and drinking water due to industrial processes (e.g. manufacture of fluoropolymers used in non-stick cookware (like Teflon), waterproof clothing, and electronics) and waste contamination (e.g. landfill and sewage leaks) (ref).Link opens in a new window
  
  

Infection

• Disrupted rainfall and temperature patterns are altering the distribution of zoonotic and vector-borne diseases e.g. malaria, dengue, Lyme disease, chikungunya, and various forms of encephalitis (refLink opens in a new window).

• Some human activities (e.g. deforestation, intensive livestock farming, destroying habitats) is driving the emergence of infectious diseases passed from wildlife to humans, risking further pandemics (ref1Link opens in a new window, ref2Link opens in a new window).
• Some food-borne viruses (e.g. campylobacter, salmonella) replicate faster at warmer temperatures, which may increase their burden (ref1Link opens in a new window, ref2Link opens in a new window).

Food + Water

• Plant based diets can benefit both human health (e.g. red meat consumption is linked to colon cancer, cholesterol in animal products can contribute to cardiovascular disease) and planetary health (ref1,Link opens in a new window ref2Link opens in a new window, ref3Link opens in a new window).
• Rising temeperatures and sea levels may contribute to food scarcity and increased prices, which may exacerbate health inequalities (ref).Link opens in a new window
• Flooding causes persistent mental health impacts (e.g. PTSD) and places patients at risk of traumatic injuries and water-bourne disease (e.g. leptospirosis) (ref1,Link opens in a new window ref2Link opens in a new window).

Prescribing

• Safe deprescribing (e.g. using STOPP guidelines in older patients) can benefit patients (e.g. reduce uncessary side effects, interactions and cognitive burden) and the planet (e.g. reduced medication waste) (ref1Link opens in a new window, ref2Link opens in a new window, ref3Link opens in a new window)Link opens in a new window
• Green prescribing (recommending activies in green spaces e.g. walking in the park, community gardening) and blue prescribing (recommending water-based activites e.g. swimming, going to the beach) can be used to support patients mental and physical health, as well as benefit the planet by promoting wildlife conservation (ref1Link opens in a new window, ref2Link opens in a new window).
• Some medications can be offered in greener formats e.g. powdered inhalers as opposed to metered dose inhalers, providing tablets in a single dose where possible rather than multiple smaller doses (ref1Link opens in a new window, ref2Link opens in a new window).

Women's Health

• Higher temperatures during pregnancy are linked to increased risk of premature childbirth (refLink opens in a new window)
• Women and children are more vulnerable to the potential impacts of climate change. For example, female survivors of climate-related disasters are more likely to experience mental health problems and have a reduced life expectancy relative to male survivors (refLink opens in a new window).
• With increasing water scarcity and temperatures, the risk of maternal dehydration increases and is linked to maternal anaemia, poor fetal growth, pre-eclampsia and premature births (refLink opens in a new window).

General Practice

• Prevention is key to sustainable healthcare and has scope to have the largest impact on planetary health and sustainability: if we prevent people from becoming unwell they won't need as much treatment in the future, preserving resources and emissions (refLink opens in a new window).