Willi Haas, Ulli Weisz IFF Institute of Social Ecology Vienna, Klagenfurt University

1. A significant sustainability question: Increase number of health treatments or increase public health? Willi Haas, Ulli Weisz IFF Institute of Social Ecology Vienna, Klagenfurt University td-conference, September 2010, Geneva, Switzerland

2. health & sd health & sd manifold relations between health and sustainable development • public health is an objective of sustainable development • public health is a means to achieve sustainable development

3. health & sd health & sd health care systems in developed countries contribute significantly to climate change • climate change threatens public health

4. health & sd health & sd Share of hospitals on Austrian CO2 emissions 2000 (direct and indirect) National costs for health care system 9,6% of GDP HOSPITALS 7,5% of GDP Anteil der Krankenhäuser am österreichischen CO2-Ausstoss inkl. Vorleistungen Source: own calculations using an extended IO-table for Austria based on NAMEA 2000 and national accounts 2000 Source: OECD, Statistik Austria

5. health & sd health & sd While the health care systems core business is to cure, it threatens public health • Green hospital initiatives can not address this issue sufficently

6. health & sd health & sd 3. Specific actions and examples of change in the health-care setting3.1 Energy efficiency3.2 Green building design3.3 Alternative energy generation3.4 Transportation3.5 Food3.6 Waste3.7 Water 2009

7. environ. efficiency In developed countries energy consumption and life expectancy are independent from each other 76 Life expectancy in years In developing countries the more energy consumption the higher the life expectancy Energy consumptionin kg oil equivalents per person and year Average life expectancy and average energy consumption per capita of more than 100 countries for 2003 Quelle: Wilkinson Paul, R Smith Kirk, Joffe Michael, Haines Andrew (2007): A global perspective on energy, health effects and injustices. Series Energy and Health 1. The Lancet: 5-18

8. environ. efficiency Global problems require a fundamental change how our societies operate, if we want to avoid unfavourable development of living conditions • Health systems in developed countries need to change as well • In addition to energy efficiency of single units e.g. hospitals health systems need to be efficient as a whole – relation of output public health situation to environmental pressure

9. environ. efficiency There is very little information available on the health systems environmental efficiency. However, it seems to be that there are many possible path ways – e.g. prevention • Instead of focussing on maximising number of treatments the most efficient improvements of the public health situation are required • What you don‘t observe you do not react upon • What then hospitals can do?

10. hospitals & sd Analysing hospitals reveals serious sustainability problems • Aging society • More complex illness patterns • Shift from acute to chronic • Medical science/technical progress • More and more is possible • Financial constraints • Health jobs count already as most burdened

11. hospitals & sd Sustainable solutions have two basic requirements if they want to be successful: • They need to be scientifically plausbile to be appropriate to reduce global sustainability problems • They need to be attractive and feasible for the ones who have to take action • Solutions require a co-production from actors form practice and science

12. outcome quality Collaboration over years with hospitals and with health promotion researcher • In varying and complex settings between scientists and actors from hospital association, hospital management, nursing and medical staff • Key were networking meetings

13. outcome quality Outcome quality: To observe and minimize side and long term effects of the core business • With other words to become more sensitive on issues of problem shifting

14. outcome quality Economical Sustainability Diagnostic Treatment Health Promotion Ecological Sustainability Social Sustainability Hospital Environments of the Hospital A multi-criteria approach for a “Sustainable & HP hospital”(developed and tested in the “Sustainable Hospital Project”, Vienna 2007-10) Grafik-Design: Angy Rattay

15. Economical Sustainability Diagnostic Treatment Health Promotion Ecological Sustainability Social Sustainability Hospital By a multi-criteria approach defining a “Sustainable” & Health Promoting hospital(developed and tested in the “Sustainable Hospital Project”, Vienna 2007-10) • These criteria have to be implemented in the • hospital by … • Explicit policies, targets, action planes, indicators, … • Defined responsibilities (roles, units) • Integration in management system (QM, Balanced Scorecard, … and/or special environmental MS such as EMAS, ISO 14000) • Monitored operational change in core & support processes Environments of the Hospital Grafik-Design: Angy Rattay

16. product http://www.das-nachhaltige-krankenhaus.at/

17. f i n Thank you for your attention! Contact: willi.haas@uni-klu.ac.at ulli.weisz@uni-klu.ac.at