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How health systems can fight climate change at the grassroots level

By Miles CottierPaul Trigonoplos

March 25, 2021

    Climate change is already making it harder for health care to keep people healthy. And it may even threaten to undermine efforts to ensure universal coverage by disrupting local health systems and contributing to negative health outcomes. This is especially problematic because many regions which currently have low health coverage also are the most vulnerable to climate change. 

    How hospitals are forging nontraditional partnerships amid Covid-19—and beyond

    This threat makes it all the more concerning that health care also happens to be a major contributor to climate change: The global health care industry has an emissions footprint equivalent to 4.4% of global net emissions. One startling statistic comes from Canada—a 2019 study found that Canada's health system pollution alone annually results in the loss of 23,000 years of life due to disability or death. Figures such as these highlight the need for immediate action across the global health sector.

    That said, the increased attention that climate change has received over the past 10 to 20 years—and the scrutiny that has come with it—has already forced some jurisdictions and organizations into action.

    Policy changes key to minimizing health care's emissions footprint, but there are few examples to learn from yet

    England's NHS is an early mover. Having already cut its carbon footprint by around 30% since 2010, the NHS recently committed to becoming "carbon net zero" by 2040, becoming the first national health system to make such a promise. The NHS plans on achieving this commitment by making progress in five areas:

    1. Expanding home-based care delivery
    2. Extending use of low-emission ambulances
    3. Reducing consumable waste
    4. Building new facilities to net-zero emission standards
    5. Educating staff in energy conservation

    Although the NHS is well on its way to making widespread and sustainable changes, few other countries have done the same at a national level, even those experiencing climate change crises in recent years. One example is Australia, which last year saw its worst bushfires in decades.

    Australia has instead adopted a federated alternative, with responsibility assumed by states. For example, in 2018 Queensland released its health care Climate Adaptation Strategy, which includes Priority Adaptation Measures for local services to plan across their footprint. These provide guidance in various aspects of climate change adaptation policy—from leadership and governance to risk management to finance.

    Bottom-up efforts influence change ahead of national or regional policy

    Where national or provincial policy is not mandating change, it will be up to local organizations to step in. One strategy employed in Germany is a bottom-up project called KLIK green, a project established and run by a collaboration of cross-industry organizations.

    This project was set up to instill localized change within individual hospitals, with a target for 250 hospitals to save a total of 100,000 tons of CO2 emissions by 2022. Participants receive funding via grants through the Federal Environment Ministry.

    Hospitals that sign up for the project designate sustainability ambassadors—called "climate managers"—who receive training by KLIK green and a recognized qualification in the process. Climate managers work within their hospital to drive changes from the ground level. They have access to educational resources, funding application advice, implementation support, and a professional climate manager network, all facilitated by KLIK green.

    We recently interviewed one climate manager, Laura-Marie Strützke, about her role. Laura-Marie is an ICU nurse at Berlin-based Evangelisches Hospital Hubertus, an Advisory Board member and one of 142 hospitals currently participating in KLIK green. As a climate manager, Laura-Marie has the authority to identify areas for improvement and has a direct line of communication with the executive team. That way, her recommendations are heard, and decisions can be made from the top level to enact changes without waiting for national or regional policy.

    Although much of her time recently has been occupied with Covid-19, Laura-Marie has initiated several hospital-wide projects to educate staff on sustainable actions, reduce waste of consumables, and improve procurement sustainability.

    The key to Laura-Maries's work is making sustainability "top-of-mind" to all staff. Staff are routed to Laura-Marie for any climate-based questions or ideas, and she talks to people throughout the hospital within different fields and locations to find areas of improvement and garner support to make changes. For example, in 2020, Laura-Marie met with catering staff to change all the food offered within the hospital to organic and seasonal produce. 

    Health systems don't need to wait for policy to make sustainable changes

    Health systems have room to establish their own mandate on climate change and sustainability and can look inwards to begin making changes. At all levels, it's about supporting each other, publicly advocating for sustainability, and building resiliency across the system. That means empowering staff throughout your organization to support and enact change from the ground up. Changes can be small and will likely gain more support from the executive team if they preserve more of the hospital's stretched budget.

    How hospitals are forging nontraditional partnerships amid Covid-19—and beyond

    hospitalAs the Covid-19 epidemic continues to pose an immense challenge for health care systems, physician executives are thinking outside the box to forge unprecedented levels of cooperation with new-in-kind partners.

    Read on to learn the five ways hospitals and health systems are engaging in unprecedented cooperation today—and expecting to sustain these relationships post-epidemic.

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