Sustainability and Health Care: Links, Relevance Strategies

1. Sustainability and Health Care:Links, Relevance & Strategies Mardie Townsend Deakin University

2. Environment as a determinantof health: Humans are dependent physiologically on nature (Boyden, 1992) > 25% of world�s disease burden is attributable to environmental factors (World Health Organisation, 2005) Figures relate only to environmental degradation Humans are physiologically dependent on nature. We may think this is not true, with recent technological advancements, but one only needs to look at the Boxing Day tsunami of 2004 or indeed the current drought in Australia to realise just how dependent on the goodness of nature we are! WHO claims that more than 25% of the world�s disease burden is attributable to envl. factors but this is really only referring to the effects of envl degradation. Certainly, this is going to get worse. The recent report of the Intergovernmental Panel on Climate Change (2007) indicates that climate change is likely to underline this dependence in stark terms, with the health of millions affected detrimentally. But there is also the issue of what I term �environmental deprivation�. According to Edward Wilson, a Harvard zoologist who sought an explanation for the almost universal affinity he observed that humans have for natural things (plants and animals), humans have evolved in the company of other species and need nature contact. Wilson and others suggest that recent changes in human society have occurred at a rate too rapid for human evolution, so there is a mismatch between our innate needs and the ways we currently live (in highly urbanised societies). Wilson says that this is detrimental to our health, as we are dependent on nature psychologically, intellectually and spiritually. Humans are physiologically dependent on nature. We may think this is not true, with recent technological advancements, but one only needs to look at the Boxing Day tsunami of 2004 or indeed the current drought in Australia to realise just how dependent on the goodness of nature we are! WHO claims that more than 25% of the world�s disease burden is attributable to envl. factors but this is really only referring to the effects of envl degradation. Certainly, this is going to get worse. The recent report of the Intergovernmental Panel on Climate Change (2007) indicates that climate change is likely to underline this dependence in stark terms, with the health of millions affected detrimentally. But there is also the issue of what I term �environmental deprivation�. According to Edward Wilson, a Harvard zoologist who sought an explanation for the almost universal affinity he observed that humans have for natural things (plants and animals), humans have evolved in the company of other species and need nature contact. Wilson and others suggest that recent changes in human society have occurred at a rate too rapid for human evolution, so there is a mismatch between our innate needs and the ways we currently live (in highly urbanised societies). Wilson says that this is detrimental to our health, as we are dependent on nature psychologically, intellectually and spiritually.

3. Environment as a determinantof health: Humans are also dependent on nature psychologically, intellectually & spiritually (Wilson, 1984; Kellert & Wilson, 1993; Gullone, 2000; Suzuki, 1997; Kellert, 1997) i.e. humans require contact with nature Explained by the biophilia hypothesis (Wilson,1984) Health impacts of �environmental deprivation� (Townsend & Ebden, 2009)

4. Environment as a determinant of wellbeing: Wellbeing depends on: the natural environment the human made environment social arrangements (families, social networks, associations, institutions, economies) human consciousness (Australian Bureau of Statistics, 2001 p. 6) Wellbeing includes: satisfactory human relationships, meaningful occupation, opportunities for: contact with nature, creative expression, & making a positive contribution to human society (Furnass, 1996) The environment in which we live includes physical places (eg. wilderness, parks, farms, gardens) and living things (e.g.. wild animals, pets, plants, people). These two statements about wellbeing � the first from the Australian Bureau of Statistics, and the second from Bryan Furnass - share a common view: that our wellbeing is dependent on nature or the natural environment. The environment in which we live includes physical places (eg. wilderness, parks, farms, gardens) and living things (e.g.. wild animals, pets, plants, people). These two statements about wellbeing � the first from the Australian Bureau of Statistics, and the second from Bryan Furnass - share a common view: that our wellbeing is dependent on nature or the natural environment.

5. �The [Garnaut] Review takes as its starting point, on the balance of probabilities and not as a matter of belief, the majority opinion of the Australian and international scientific communities (is) that human activities resulted in substantial global warming from the mid-20th century, and that continued growth in greenhouse gas concentrations caused by human-induced emissions would generate high risks of dangerous climate change.� (Garnaut, 2008 p. xxxv)

6. But what about the Climate Change sceptics? �To grasp on to the views of that tiny minority would be imprudent beyond the realms of human rationality� (Ross Garnaut, in address to the Committee for Geelong, 13th February, 2009) �The uncertainty associated with climate change encourages skeptics to argue that policymakers cannot take action in anticipation of future trends or events.� (Synthesis Workshop on Climate Variability, Climate Change and Health in Small-Island States Bandos Island Resort, Maldives, 1-4 December 2003 p. 86)

8. Public health effects of CC-related environmental degradation: Direct risks from: Heatwaves, bushfires, severe storms, cyclones, floods etc. Indirect risks from: Increased UV radiation Food & water contamination Increased air pollution (e.g. from bushfire smoke) Increased airborne allergens Changes in distribution of disease vectors Nutritional deficits due to ? availability or ? costs of some foods Mental health problems due to loss of livelihood, displacement Loss of some natural medicines ? physical activity and/or ? injury and heat stress due to heat, ground conditions

9. Projected increases in no. of days of very high � extreme fire risk:

10. Temperature-related deaths as an example:

11. Public health effects of CC-related environmental deprivation: Direct risks: Reduced engagement with outdoors because of heat, UV Reduced gardening activity because of heat, water shortages, UV Indirect risks: ? stress, mental illness (due to not accessing restorative nature) Reduced physical activity, increased obesity Increased rates of dementia Increase in vitamin D deficiency Increase in myopia Loss of affiliation with nature ? loss of environmentalism ? further environmental degradation

14. Some practical outcomes of CC: By 2020, health professionals will be faced with patients experiencing a range of climate change related illnesses Vulnerable groups (incl. the young, the elderly, rural, remote and indigenous people) will be most affected Refugees will increase in number, with all the associated health and social issues (? need for policy responses) Demands on health services will increase (incl. disaster management and emergency medicine services, as well as chronic illness) As the health service sector is stretched to the limit, there will be an increasing need for prevention and education

15. Examples of public health benefits of addressing climate change: Health co-benefits � �health dividend to be gained by mitigating the effects of greenhouse gas emissions� (Horton, 2009 p. 1869) Strategies to improve UK household energy-efficiency estimated to ? 850 fewer DALYs + saving 0.6 mega tonnes of CO2 per 1 million popn. per year (Wilkinson et al., 2009) Combining active travel with lower emission motor vehicles in London would ? 7439 fewer DALYs related to 10-19% reduction number of YLLs (Woodcock et al., 2009)

16. Responses to climate change: Coping strategies: �ways people invent to maintain their wellbeing and livelihood in adverse circumstances. They do not suggest deep changes to a culture, lifestyle or social institutions.� (Walker & SEHCP 2009 p. 278) Adaptive strategies: �changes to �ways of doing business�, to priorities and to organisations that develop and consolidate in a community over a period of time.� (Walker & SEHCP 2009 p. 278) Mitigation strategies: �those that seek to reduce the production of greenhouse gases or to increase their removal from the atmosphere.� (Walker & SEHCP 2009 p. 278)

17. COAG National CC Adapt�n F�work: research on climate change impacts on physical and mental health and identify key vulnerabilities; identifying the capacity of the p.h./hospital system to plan for and respond to these vulnerabilities; and incorporating the potential for cc impacts on health into community and public health education programs. dev� p & impl�t heat wave warning & response systems. NH&MRC to ? its focus on research on cc and health. Sport & Rec Ministers� Council dev�p & impl�t action plan around the impact of cc on sport & rec.

18. WHO top 10 actions for national & local policy-makers: Advocate for strong and equitable climate change agreements Promote the need for health-oriented agreements Establish multisectoral processes to oversee climate change and health policy development Protect the most vulnerable Strengthen healthy system adaptive capacity Take into account health co-benefits when considering different greenhouse gas mitigation options

19. WHO top 10 actions for national & local policy-makers (ctd.): Increase funding for interdisciplinary research on climate change mitigation technologies and strategies across a range of sectors Measure public awareness and attitudes Measure and address the �carbon footprint� of your public institutions Incentivize your workforce and all stakeholders.

20. Framing strategies using the Ottawa Charter for Health Promotion: Local actions: Build healthy public policy Create supportive environments Strengthen community action Develop personal skills Re-orient health services (Rowe & Thomas, 2008)

21. Build healthy public policy: Transport: Public sector investment in public transport Policies supporting walking school bus program Energy: State Government policy to retrofit public housing Policies requiring energy efficiency as a condition of building permits Rebates for energy efficiency and/or �green energy� sources

22. Create supportive environments: Transport: Provision of bike racks, cycle paths, showers at workplaces Urban design involving neighbourhood-based services Energy: Provision of emissions scores for households & businesses Showcase energy efficient housing Develop programs to provide energy efficient appliances at discount rates to disadvantaged households

23. Strengthen community action: Transport: Support advocacy groups (e.g. Bicycle Victoria) Encourage community service clubs to develop bicycle recycling programs Energy: Partner with community groups interested in energy efficiency action Support the development & up-skilling of such groups

24. Develop personal skills: Transport: Increase community knowledge of the benefits of physical activity Increase community knowledge of public transport options Energy: Increase knowledge of household energy efficiency strategies Increase knowledge of carbon credit schemes

25. Re-orient health services: Transport: Identify service outreach models to reduce trips Health service involvement in Regional Managers� Forum CC WG Energy: Health services to adopt energy efficiency strategies Health service staff participation in Municipal Public Health Planning

26. But what can I do as a health practitioner, health educator or health-related policy-maker? Recognise the connections between your role and climate change: E.g. as an academic involved in the training and education of health professionals, I have an opportunity to ensure that in all disciplines content about climate change, sustainability and environment and their relationships to health are addressed. But graduates also need a range of other skills, including capacity to engage with the community, to work in collaborative and multi-disciplinary ways, to understand issues of justice and equity, and I have the chance to offer this.

27. But what can I do as a health practitioner, health educator or health-related policy-maker? (ctd.) Identify the opportunities for you professionally to influence outcomes: E.g. GPs can influence their patients� diets and exercise patterns (including active transport choices) and thereby affect greenhouse gas emissions; they can also advocate at local and state public policy levels for bicycle paths. E.g. staff of medical facilities can lobby governments to enhance public transport access to their facilities, and can encourage patients to use public transport. Governments at all levels can improve their disaster preparedness, including developing monitoring and early warning systems

28. But what can I do as a health practitioner, health educator or health-related policy-maker? (ctd.) Consider/explore opportunities to reduce the carbon footprint of your own workplace/home and to improve the thermal performance of your building/s: Practise what you preach! Be an example both upwards and downwards. One UK study explored the CO2 emissions associated with breast screening services, comparing centralised facilities with mobile services. They found that the mobile service saved 1,429,908 kms. over 3 years, and saved 75 tonnes of CO2 The NHS has now prepared a Carbon Reduction Strategy for NHS England.

29. If not, why not? The barriers to adopting actions such as these: Barriers: Ostriches Gamblers Silo mentality Don�t know what we don�t know The electoral cycle Solutions: Communication Collaboration Challenging the status quo Remember both sides of environmental health �

30. John Muir, the founder of the Sierra Club, the largest grassroots environmental organisation in USA, was a man ahead of his time when he said (in 1912): �Everybody needs beauty as well as bread, places to play in and pray in, where Nature may heal and cheer and give strength to body and soul alike.� In modern societies which are so often self-centred, a-spiritual, this is a timely reminder of our psychological and physiological dependence on nature. John Muir, the founder of the Sierra Club, the largest grassroots environmental organisation in USA, was a man ahead of his time when he said (in 1912): �Everybody needs beauty as well as bread, places to play in and pray in, where Nature may heal and cheer and give strength to body and soul alike.� In modern societies which are so often self-centred, a-spiritual, this is a timely reminder of our psychological and physiological dependence on nature.

31. If my presentation has been of interest to you, then please consider coming (and if appropriate presenting your research or practice) at the HPHP2010 International Congress. I�m chair of the program committee, and I can guarantee you some wonderful speakers from around the world. Many thanks.If my presentation has been of interest to you, then please consider coming (and if appropriate presenting your research or practice) at the HPHP2010 International Congress. I�m chair of the program committee, and I can guarantee you some wonderful speakers from around the world. Many thanks.