Carbon Dependence

1. Carbon Dependence A healthcare challenge

2. The carbon addict: health effects of a high carbon lifestyle • Is the NHS addicted? • Complications: adverse effects of a high carbon health service • Detox: what can health professionals do about it? • Health services for a low carbon future

3. The carbon addict: health effects of a high carbon lifestyle on individuals

4. Carbon Dependence Epidemiology • Early case reports date back to the 19th century, with prevalence rising exponentially in the last 50 years • Now reached epidemic proportions in the UK – affecting almost 100% of the population • Fears of global pandemic Causes • No genetic influences identified • Environmental factors important – e.g. out-of-town shopping

5. Carbon DependenceSymptoms • T-Shirt in winter • Car journeys under 3 miles • Vegetable intolerance / meat-bingeing • New-variant Consumption (nvC)

6. A carbon-dependent society?… …What’s wrong with that?

7. Carbon DependenceEarly Complications • Reduced exercise tolerance • fossil fuel use is replacing physical activity in daily living negative impacts on cardiovascular health • Anxiety, stress • physical activity has psycho-protective effects, so doing less of it has negative impacts on mental health • dissatisfaction • Respiratory symptoms • asthma and allergies. Less air pollution and more time spentin natural environments could reduce the risk of these complications.

8. Carbon DependenceLate Complications • Obesity and diabetes– due to high fat diet and inactivity • Cardiovascular disease – high salt and fat diet, and inactivity • Colorectal cancer – correlates with high meat intake • Falls – inactivity  low muscle mass, falls due to SE of medication • Fuel poverty– using more fuel costs money • Social isolation – interaction via facebook? TV entertainment?

9. Am J Prev Med 2004;27(2) each hour in car per day:  risk obesity by 6%

10. Circulation July 6, 1999 Walking <0.25 mile/day:  risk CHD x2

11. Journal of the National Cancer Institute, Vol. 97, No. 12, June 15, 2005 Red/processed meat:  risk colorectal cancer

12. Carbon DependenceLate Complications • Obesity and diabetes– due to high fat diet and inactivity • Cardiovascular disease – high salt and fat diet, and inactivity • Colorectal cancer – correlates with high meat intake • Falls – inactivity  low muscle mass, falls due to SE of medication • Fuel poverty– using more fuel costs money • Social isolation – interaction via facebook? TV entertainment?

13. Carbon DependenceClimate Toxicity

15. 2004: Hurricane Catarina – the first South Atlantic hurricane.

17. Carbon DependenceClimate Toxicity • Already responsible for many deaths worldwide: malnutrition, malaria, diarrhoeal disease (WHO) • Severity not related to intensity of same individual’s carbon addiction

18. CO2 concentrations “Sustainable Energy – without the hot air” 2008 David MacKay. www.withouthotair.com

19. Climate projections IPCC Fourth Assessment Report (2007)

20. What’s happening now? Synthesis Report – Climate Change, Global Risks, Challenges & Decisions, Copenhagen 2009

22. Is the NHS addicted? Understanding the carbon footprint of NHS England.

23. Carbon Footprint NHS England 18 million tonnes CO2 in 2004

24. Carbon Footprint NHS England – procurement

25. Complications: adverse effects of a high carbon health service. “Is the NHS getting flabby…?”

26. High Carbon Care • Elective surgery cancelled after last-minute anaesthetic review • Blood tests repeated because not on system • Hospital-acquired infections • Post-operative pain • Drugs to treat side-effects – of drugs

27. High Carbon Care (2) • Patients attending for appointments without knowing why they are there • Drugs continued when no longer needed • Related conditions managed on separate days by separate teams • Hi-tech interventions preferred, even where alternatives exist 

28. High Carbon Care Activity ≠ outcome

29. Risk-benefit: can a move to single use instruments cause harm? Health risks? • lower quality surgical instruments > bleeding • chemical exposure? Environmental impacts? • energy and carbon for manufacture • transport • pollution from waste disposal Waste of NHS resources? 

30. Risk-benefit: can referral to a specialist cause harm? Health risks? • infection, side effects, complications of invasive tests Psychosocial factors? • perception of condition, stress • time off work Environmental impacts? • energy, transport - carbon emissions • production of material resources: needles, forms, gloves • pollution from waste disposal Waste of NHS resources? 

31. Climate ToxicityHospitals in heatwaves (press stories) • Nurses and administrative staff walked out in protest at high temperatures in brand-newPFI hospital "We can't work in this- we're suffering from heat exhaustionand everything“ • Angry relatives claimed hospital could not provide for its most vulnerablepatients. People on strict nil by mouth diet were left to lie in pools oftheir own sweat without ice and proper air conditioningas their limbsswelled in the heat • Hospital facing demands for an enquiry into how vital equipment was allowed to breakdown during recent heat-wave, forcing the cancellation of scores ofoperations

32. Climate ToxicityHospitals in heatwaves (press stories 2) • Public Health (Pathology) Laboratory stopped work - machines failed in heat. • Nurses on cardiac ward were in tears at their inability to keep patients as cool asthey should have been • Drugs may be vulnerable to extreme temperatures in summer

33. Andy Williamson, Chair – GSTT Kidney Patients’ Association: “As a kidney patient, I’m acutely aware of my own vulnerability to climate events, and my dependence on drugs and dialysis equipment which rely on cheap oil for their availability.”

35. Discussion point In your patients? Detox: what can health professionals do about carbon addiction? What are the barriers..?

36. Medical Intervention • Medical interventions are carbon intensive – risk of increasing carbon dependence • How can health professionals reduce medical interventions by PREVENTING ill-health?

37. Active Travel • Cycling burns about 300 calories per hour (5 calories per minute) • Regular cyclists enjoy a fitness level equal to that of a person ten years younger and a life expectancy 2 years above the average • Cycling regularly to work is the most effective thing an individual can do to improve health and increase longevity. • If one third of all short car journeys were made by bike, national heart disease rates would fall by between 5 and 10 percent   • Only 28% of women in England and Scotland and 24% in Wales meet the government’s guidelines for physical activity levels. • During rush hour a bicycle is about twice as fast as a car.

38. Housing & energy “Housing improvement programmes benefit almost all carbon addicts, but particularly the elderly, living alone, those with cardiovascular or respiratory disease” • Referral systems from health services to fuel poverty schemes • Educating patients on specific health benefits of housing improvements

39. J Epidemiol Community Health 2008;62:793–797 BP 142/85  123/73

40. Discussion point In the NHS? Detox: what can health professionals do about carbon addiction? What are the barriers..?

41. Health services for a low carbon future: designing clinical care which is preventative, develops self-reliance, uses lean pathways and low carbon technologies.

42. www.sdu.nhs.uk

44. sustainable estates & facilities + sustainableclinical practice sustainable healthcare =

45. Principles of Sustainable Clinical Practice (The Campaign for Greener Healthcare) • Prevention • Patient partnership • Lean systems • Low carbon treatment choices www.greenerhealthcare.org/clinical-transformation

46. Carbon DependencePrognosis • Recent advances have transformed outcome in what was previously a universally disabling disease. • With help of multidisciplinary team, addicts may even achieve full recovery.

47. Carbon Addict is an opensource project of The Climate Connection and The Campaign for Greener Healthcare. The illustrations are by www.worldofinferiors.co.uk and are licensed under a Creative Commons License. www.CarbonAddict.org