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The Lancet Countdown on Health and Climate Change: 2020 report

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Carbon and waste neutral by 2030

Hunter New England Local Health District will be carbon and waste neutral by 2030.

Under the ambitious new initiative, Sustainable Healthcare: Together Towards Zero, we are setting our sights on an environmentally sustainable future.

Significant investments will be made in solar power, water sustainability and energy efficient practices during the next decade to lighten and, eventually, eliminate the organisation's carbon footprint.

We will be doing a huge amount of work in the coming years to achieve this green vision and take our place as an industry and community leader in sustainability.

Why are we going Carbon and Waste Neutral?

Health staff and services work incredibly hard to keep our community healthy.

At the same time, we know 25 per cent of all human disease and death in the world is attributed to unhealthy environments, like unclean air and water, and that health as an industry is a major contributor of carbon emissions.

The reality is, it's no longer possible to be committed to the health of our community without addressing the health of our environment.

In response, we're taking a giant step towards clean, green healthcare, investing in solar power, exploring sustainable water practices, reducing waste to landfill and much more.

Work starts today, so we can leave behind a truly healthy legacy, for our generation and many generations to come.

Embracing change for a cleaner future

Solar - Investment in clean, renewable power

In coming years, solar panels will be installed on the rooftop of all of our health facilities, including John Hunter Hospital, which will soon be home to the largest solar panel installation on any hospital in the country.

The $3.2 million solar panel installation will cover 12,000 square metres, about 85 per cent, of the hospital's roof space.

We've already made a head-start on our solar panel targets. We're already harnessing clean, renewable power at a number of hospitals and work is underway to begin panel installation on more facilities in coming months. Our work will also significantly contribute to the state's Net Zero Plan aspirational solar target.

Rethinking waste management

The District is also working to achieve zero general waste to landfill by 2030.

We're now investigating innovative ways we can approach the everyday disposal of food scraps, general waste and recycling.

We'll also be taking a closer look to see what health-specific waste normally thrown in the rubbish, like oxygen masks, PVC tubing, and clean, single-use plastics used every day in our operating theatres, are appropriate and safe for recycling.

Water sustainable practices

The recent drought, arguably the worst NSW has ever seen, was the catalyst for key water sustainability initiatives to be introduced under our bold initiative.

Between now and 2030, we will be aiming to collect 100 per cent of the rainwater that falls on our hospitals' rooftops.

We'll also be working with staff at each of our hospitals to find appropriate ways to reuse and recycle water to make the most of the precious resource.

An award-winning strategy is already putting clean, excess water, produced as a by-product of renal dialysis, to good use at Tamworth Hospital.

The excess 50,000 litres a week was once considered wastewater, but is now used to flush hospital toilets. With an investment of $15,000, the hospital is now saving 2.5 million litres of clean water going down the drain each year. This simple yet effective initiative will be rolled out to 10 more renal units in the District in coming years.

Transport's going green

The District's fleet of work vehicles is also going green. Gradually, fleet vehicles will be transitioned firstly to hybrid and then pure electric models, replacing petrol and diesel vehicles. E-charging stations will be installed on our sites.

Wherever possible, our staff will use video conferencing to reduce unnecessary travel for everyday business, and when they need to drive it will be cleaner than ever.

We'll also be making it easier for staff to carpool or ride their bikes to work and when they travel out of town for work we'll identify preferred 'green' accommodation and flight providers.

Annual targets to achieve success

Each year, we will measure our progress to ensure we're on track to achieve the ambitious plan.

Some targets, such as our strategy to incrementally overhaul our fleet of work vehicles, will be simple to measure.

In the coming three years, our petrol-fuelled fleet cars will be replaced with hybrid models as each vehicle is due for renewal. Hybrid cars use a combination of electric and petrol combustion, use less fuel and produce less emissions than petrol-fuelled vehicles.

In addition to our District's transition to hybrid vehicles, we have also committed to converting the entire fleet to pure electric vehicles by 2030. Between 2020 and 2030, we will replace 10 percent of our fleet with pure electric models. At the end of the decade we will, without a doubt, be able to say we have achieved our target - 100 percent of our fleet will be clean, green pure electric vehicles.

The success of our solar and water recycling investments will be measured using the savings we make on our hospitals' energy and water bills. For example, every time we install solar panels on one of our facilities, our District becomes a little less reliant on coal-fired power, and closer to our carbon neutral target.

Deciding on the ideal measurement of some of our targets is still a work in progress. We're establishing baselines and investigating the best tools and methods for tracking our success. This work will continue into 2021.

Staff as Sustainability Champions

In early 2020, we issued an Expression of Interest seeking staff with a passion and willingness to invest time and energy to help us achieve some of these major goals.

We are so impressed with the groundswell of support from staff nominating to be Sustainability Champions, to make lasting change across the organisation. There's still time for staff to nominate as a Sustainability Champion and get involved.

Pleasingly, we have also received a number of new, simple and achievable ideas from staff, keen to make their own individual services more eco-friendly. We're pleased this strategy is creating discussion and encouraging staff to offer their ideas knowing we're keen to hear about any projects that can bring us one step closer to green healthcare.

It's the small, grassroots ideas we're hearing that give hope the legacy of green healthcare we are about to establish will carry on well after the year 2030.

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hunter new england local health district

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Hunter New England Local Health District will be carbon and waste neutral by 2030. Under the ambitious new initiative, Sustainable Healthcare: Together Towards Zero, we are setting our sights on an environmentally sustainable future. Significant investments will be made in solar power, water sustainability and energy efficient practices during the next decade to lighten and, eventually, eliminate the organisation's carbon footprint.

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Sustainability in the health and care sector

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WE present six practical measures doctors can take, and can encourage their patients to take, which will have a positive impact on emissions and climate change while also improving health outcomes.

The global scientific consensus on anthropogenic climate change is now unequivocal.

The 2015 Lancet Commission article Health and climate change: policy responses to protect public health emphasised that "tackling climate change could be one of the greatest global health opportunities of the 21st century". Within this response, the health community has a vital role to play.

The United Nations Environment Programme Emissions gap report 2019 found that we are still on course for a 3.2°C temperature rise by the end of the century, leading to severe health, social, economic and environmental impacts. Extreme weather events, changing disease vectors, food and water scarcity, air pollution and major social and economic impacts have far-reaching implications for the health of communities on local and global scales, highlighting the social and ecological determinants of health.

The health care system accounts for 4-6% of global greenhouse gas emission, meaning if it were a country, it would be the fifth largest emitter on the planet. Given the enormity of this challenge, what actions for therapists and patients are pragmatic, achievable and have potential for major positive impacts?

Here we review six practical changes health professionals can do themselves and recommend to their patients. The following six points are not a complete list, nor a complete examination of the nuances of each point. They are, however, what we consider to be simple changes with high yields resulting in a "win-win-win" situation for individuals, the health system and our planet.
Deprescribing versus lifestyle and social prescribing
The sectors responsible for the greatest proportion of total greenhouse gas emissions are hospitals (44%) and medications/pharmaceuticals (18%), with pharmaceutical prescriptions being the largest contributor in general practice. Non-communicable chronic diseases are now the greatest disease burden in Australia, with about 80% being preventable with lifestyle interventions.

Here is a clear opportunity for replacing medication, where appropriate, with evidence-based lifestyle interventions for common chronic diseases such as type 2 diabetes, hypertension, major depressive disorder and anxiety disorders. Evidence-based guidelines from Primary Health Tasmania are available to assist with sensible deprescribing and reduction of polypharmacy.

Where deprescribing is not an option, prescribing low carbon alternatives - such as dry-powder inhalers (eg, accuhalers, handihalers and turbohalers) instead of metered-dose inhalers - may be considered. A 2017 assessment of GSK respiratory inhalers by the Carbon Trust showed that the lifecycle carbon footprint of DPIs is around 24 times lower than a propellant-based inhaler for one month's treatment.
Access to medical appointments
The Kings Fund calculated that 17% of the UK's National Health Service carbon emissions are linked to health staff and patient travel. Hence, greater use of telehealth appointments and lower carbon alternatives to transport (eg, walk, ride, public transport) are effective strategies, where safe and appropriate. What's more, active transport in a clean environment is good for health.
Food choices
The EAT-Lancet Commission report indicated that food production is responsible for up to 30% of global greenhouse gas emissions and 70% of freshwater use. Food sourced from animals, especially red meat and grain fed livestock, has relatively high environmental footprints per serving compared with other food groups, affecting greenhouse gas emissions, land use, and biodiversity loss.

Replacing 100% of beef intake with poultry reduced mean dietary greenhouse gas emissions by 35.7%. When replacing all beef, pork or poultry intake with plant-protein foods, the greenhouse gas emissions decreased by 49·6%, the mean Healthy Eating Index increased by 8·7%, and dietary costs decreased by 10·5%. When choosing meat, the EAT- Lancet Commission recommends sourcing meat from farmers that practise regenerative agriculture. This type of farming contributes to carbon storage in the soil, keeps water away from pollutants, and provides room for local biodiversity to flourish.

Dr Charles Massy, agricultural scientist and author of Call of the reed warbler, offers inspiring insights for the role of regenerative agriculture in Australia.

"The common ground amongst these sources, which allows for a variety of eating styles personalised to individual and cultural needs, is minimal processed food (like sugar and refined grains) and industrialised meat, more plant foods and when choosing meat then to make it from regenerative agriculture and permaculture sources."

Furthermore, between 20% and 40% of fruits and vegetables are rejected before they even reach the supermarket shelves, and Australians discard at least 20% of the food they purchase. Hence, utilising what food we produce and buy is a simple and easy measure to achieve a more sustainable impact.
Switch to renewable energy
The energy sector continues to be the dominant source of Australia's greenhouse gas emissions, accounting for 74% of net emissions and a major source of air pollution, both largely due to fossil fuels. Air pollution is a major health risk, accounting for almost 800 000 deaths a year in Europe. In Australia, the health costs from air pollution-associated mortality alone are estimated to be in the order of $11-24 billion per year. There are now multiple energy providers that source 100% of their energy from renewables and are similar in price as standard providers, hence an easy switch. Installing renewable energy sources, such as solar power and batteries are also options, but require more initial investment.
Invest ethically
Moving our money to align with community and planetary health is a very effective strategy. Unless specifically requested otherwise, money placed in superannuation and investment portfolios will be in a "default" fund that is invested in industries that undermine human health, such as tobacco, alcohol, fossil fuels, gambling and weapons manufacturing.

Multiple superannuation and investment organisations solely focus on ethical and socially responsible investment and many mainstream funds now offer ethical and socially responsible portfolio options. A 2020 analysis by the Responsible Investment Association Australasia showed that responsibly invested Australian share funds produce comparable outcomes to mainstream funds, and responsibly invested international share funds outperformed their mainstream peers over 3-, 5- and 10-year time frames.
Offsetting emissions
Per person, Australia's carbon dioxide emissions in 2013 were 16.8 tonnes per year, the second largest of countries in the OECD, 75% higher than the OECD average of 9.6 tonnes. Greenhouse gas emissions associated with our personal and professional lives or medical practice are easy to calculate online. It is then possible to donate to an organisation that offsets those emissions with various projects, such as tree planting, soil sequestration projects, renewable energy projects and sustainable farming education.

The cost to offset these can be less than $10 per tonne to up to $50 per tonne depending on the project supported, which equates on average to about $170-$850 per year or $14-$70/month per individual, an expense well within the grasp of most health professionals. The majority of carbon offset providers in Australia are now legitimate as a result of stringent standards.

Another option for donations is to organisations that empower women with education and autonomy (including sexual autonomy). The greater the education and autonomy that girls and women have the better the outcomes for them, their children, the society and natural world at large. They are more likely to decide if and when to have a family, have lower rates of infectious illness (e.g. HIV), marry later, have the choice to pursue careers, have fewer children with higher childhood survival rates, leading to the stabilisation of populations.

We have reached a time in human history when we are called, as health professionals, to truly understand that human health is intimately related to, and dependent upon, the health of the earth. We are faced with a great challenge: an impetus to act. As we join the global movement of health professionals who are practising planetary health, we invite you to join too. Why? Because everyone's health depends on it.
Dr Sam Manger is a GP, host of The GP Show podcast, Senior Lecturer with James Cook University and President of the Australasian Society of Lifestyle Medicine. Dr Nicole Sleeman is a GP and active member of Royal Australian College of General Practitioners Climate and Environmental Medicine special interest group and Doctors for the Environment Australia. The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.

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Let's get practical: how we can heal the planet and our patients

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climate change We have reached a time in human history where we are called, as health professionals, to truly understand that human health is intimately related to, and dependent upon, the health of the earth, write Sam Manger and Nicole Sleeman

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List the organisational level drivers here:

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List the organisational level drivers here:

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e.g. high carbon foot print

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List the organisational level solutions/strategies here:

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List the organisational level solutions/strategies here:

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e.g. think of strategies to reduce the high carbon foot print

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List the individual level solutions/strategies here:

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List the individual level solutions/strategies here:

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the more people we have, the more infection prevention control we need.

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the more people we have, the more infection prevention control we need.

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there has been such an intense focus on single-use sanitary items in the past year, and i imagine this will only increase in the decades to come, as we encounter these kinds of pandemics with more frequency. how do we address this increased need for hygiene and isolation, and the need to reduce waste and single-use items?

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I think you'd be sensitive to the context and your patient's readiness to hear 

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I think you'd be sensitive to the context and your patient's readiness to hear 

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Maybe try a platform that enables mind mapping, such as Mindomo.

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More mindful sourcing of food / selection of food providers in hospital cafeterias.

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More mindful sourcing of food / selection of food providers in hospital cafeterias.