Systemic change faces climate change head on

In WA, climate words are turning into climate and sustainability action, from advocacy to change of health practice.  

Jan Hallam reports

Doctors are playing an increasingly vocal role in highlighting the impact on health of the increase in global temperatures and its devastating ramifications.

Dr Richard Yin
Dr Emma-Leigh Synnott

In Australia, Doctors for the Environment (DEA), which has swelled in number and influence over the years, bringing in the support of many of the professional colleges and the AMA, have been advocating loud and long for climate action.

Most lately, awareness campaigns against the contentious fracking project in the Northern Territory’s Beetaloo Basin in Canberra, and last month, representation on the steps of the WA Parliament calling on the State government to “say no to gas”, have put health at the centre of climate action.

WA doctors have long been at the head of the climate charge. Currently, retired GP Dr Richard Yin is deputy chair of DEA and rehabilitation specialist Dr Emma-Leigh Synnott is chair of the WA chapter.

Dr Synnott has also found herself at the centre of change in her day job at South Metropolitan Health Service (SMHS), where apart from her clinical duties, she was the inaugural Medical Lead for Climate Health and has been deeply involved in the development and the ongoing implementation of its sustainability strategy.

SMHS has set the goal of achieving net-zero carbon emissions by 2040. 

This ambitious blueprint not only addresses the imperative of mitigating climate change but also encompasses myriad other goals aimed at transforming the healthcare system into an eco-conscious and resilient entity.

Dr Synnott (right) is keenly aware of the impact the climate crisis will have on people’s health and the delivery of healthcare if changes are not made.

“We know that patients will suffer increasing health concerns associated with climate change, so we are in the process of understanding that risk and ensuring that we’ve got a plan for adaptation,” she said.

Big strides

The SMHS Environmental Sustainability Strategy, which is available on the service’s website, outlines its ambitious goals but also the numerous specific initiatives aimed at waste reduction, procurement, and energy efficiency. The core philosophy revolves around maintaining high-quality patient care while simultaneously fostering long-term well-being for current and future generations.

Ironically, it was one of the biggest health challenges in recent times, COVID, that has sharpened the antennae, particularly around PPE, which created a single-use waste mountain not just here in Australia but everywhere else in the world.

Addressing the question of reusable versus single-use items, particularly in light of challenges posed by COVID-19, the strategy acknowledges the complexities involved. While there is a growing interest in reusable options, barriers such as infection control, lack of facilities for reprocessing, and environmental considerations like energy and water usage must all be carefully navigated. 

SMHS is exploring innovative solutions, including bioplastics and biotechnologies, to source environmentally friendly alternatives for various medical applications.

While the pandemic led to an increased use of disposable items, it also served as a consciousness-raising episode. The SMHS ‘Think Before You Glove’ campaign, initiated during Plastic Free July 2023, encourages healthcare professionals to critically evaluate the necessity of using non-sterile gloves in various situations. This initiative, along with others like it, aims to claw back environmentally detrimental practices adopted during the peak of the pandemic, emphasising the need for thoughtful and sustainable choices.

“Glove usage is ubiquitous across the health system and during COVID it became second nature. They are still, in some instances absolutely necessary, but in a vast majority of situations, they are actually more detrimental to hand hygiene and to infection control because they prevent you from doing the five steps of hand hygiene,” Dr Synnott said.

“Using hand gels on unsoiled hands is the most appropriate step when managing a patient or their surrounds and has the highest evidence for infection control in healthcare settings.

“The Think Before You Glove campaign asks SMHS staff to step back from that automatic reach for gloves, and to assess ‘do I actually need them?’.

Conscious care

“Our nursing colleagues are acutely aware of the amount of waste that we create because they are on the coalface of this situation. They see it day to day. They’re the people doing the dressings, the catheters, the bed linen.

“The ‘Think Before You Bluey’ campaign, launched in July 2022, specifically targeted the prevalent use of the blue, triple-layered plastic lining sheets in clinical settings, known as blueys. 

“These seemingly innocuous sheets take about 450 years to break down, so our sustainability officer set about an exhaustive process looking for the opportunities for behaviour change, which has resulted in a 21% overall reduction in use, and a significant 56% reduction in bluey use in high use areas, demonstrating the power of small changes in practice.”

Dr Synnott said that the staff have become the agents of change, urging more action.

“The 2023 Department of Health annual Your Voice in Health survey is telling – about 80% of the workforce respondents said that they believe that hospitals and health services should be acting in environmentally sustainable ways.

“This 80% is across the across the board, from every single health service. Everyone’s attention is on sustainability.”

While waste is a visible and, in some ways, a tangible, if difficult, problem to tackle, the SMHS sustainability strategy has also set some powerful targets in areas of medical practice and consumable usage, digital healthcare and in-service improvements.

In a clinical setting there has been a successful project to eliminate the anaesthetic gas desflurane, a noxious greenhouse gas far more potent than carbon dioxide in terms of its global warming potential. 

“SMHS anaesthetists studied the evidence about three years ago and found that desflurane use versus some of these less polluting agents made little to no difference to patient outcomes, so as an act of environmental sustainability, we have stopped using desflurane.

(ED: Desflurane was recently removed from the State-wide Medicines Formulary).

“That clinical evaluation was done by our own anaesthetist team. And there are many other teams within the service that are evaluating their practices and coming up with great initiatives – food organics recycling in patient catering is just one.”

Energy focus

There are ongoing LED replacement programs, the upgrade of Fremantle Hospital air conditioning and plant has delivered improved energy efficiencies, and SMHS participates in the National Greenhouse Energy Reporting Scheme.

SMHS supply chains will need to meet specific ‘green’ criteria by 2026 with a target of 80% of its suppliers having to have a net zero strategy by 2030, and the aim is to have the SMHS transport fleet fully electrified in the near future.

Dr Synnott believes the Black Summer of bushfires in 2019-2020 was pivotal in changing public perceptions of the climate crisis, with the realisation that climate change was destructive and that it was intrinsically linked to health outcomes, including respiratory issues, fetal distress, and long-term chronic diseases. 

This thinking has been gaining traction in wider medical circles ever since and been responsible for the establishment of units and initiatives within health departments dedicated to sustainability and climate risk, which signifies a growing recognition of the health threat posed by climate change.

“This is a wicked problem, and wicked problems are really hard because in order to tackle them, you have to change “business as usual” behaviour,” she said. “But
our recent experience with COVID has shown us how we can adapt,” she said.

“We saw partnerships between government, non-government, inter-government and within the health system itself when a national emergency was upon us. Everyone went, ‘right, what do we need to do? Let’s do this together and let’s get it done’.

“The challenge with climate change is that many people still don’t see the connection with health as tangibly as they do with infection, and we need a better public health campaign around climate change so that it is seen as a palpable health threat.

“Because it is – from heatwaves to extreme events to air pollution and water and food security issues to the infectious diseases that will emerge and with them the potential for civil unrest.

“It will cause issues with supply chains and economic hardship and all of those other things that we saw unfold with COVID and they will impact on community and individual health and wellbeing.”

And there will be no vaccine to help slow or halt it.

“If we want to achieve regenerative change, where we are nourishing society, where we are connected with our communities and our communities are connected to the earth beneath their feet and the rich biodiversity around them, then we need to shift the way we interact with and within the world.

“It necessitates an interdisciplinary way of working, which is collaborative and co-designed and not reductionist in its approach. It’s a commitment to sustainability that reflects a paradigm shift where environmental responsibility is not just a goal but a guiding principle.”