Driving change for planetary health

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We are in the midst of one of the most challenging periods of our lifetime. COVID-19 has opened our eyes to worldwide threats to our health. Yet it also provides the opportunity for a global reset as we prepare to face the greatest public health threat of the 21st century: climate change. The need for physicians to take a leadership role was the focus of the third session of My Hospital Footprint: How hospitals can be leaders in planetary health – A post-pandemic plan for VGH. This special Zoom presentation was hosted by family physician Dr. Larry Barzelai, chair of the B.C. chapter of the Canadian Association of Physicians for the Environment. He was joined by oncological surgeon Dr. Andrea MacNeill, lead author of The Lancet Planetary Health study on the impact of surgery on the global climate and the VCH Energy and Emissions Manager Kori Jones. VCH’s Interim President and CEO Vivian Eliopoulos provided a response to their presentations and attendees were able to ask questions about how to move forward. (Watch or listen to the session here.)

Dr. MacNeill pointed to studies that show Canada has the third highest per capita greenhouse gas emissions from healthcare in the world. Healthcare accounts for approximately four per cent of the country’s total emissions.

“Healthcare emissions come from three main sources,” she said. “They are infrastructure and operations, which fall within the purview of facilities management, and clinical services, and consumables over which clinicians have considerable control. Together there are a number of ways we can significantly reduce our footprint.”

Clinical decision-making to ensure appropriateness of care is key: 30 per cent of healthcare activities add no value so physicians should first and foremost avoid unnecessary investigations and interventions. Telehealth—an encouraging legacy of COVID-19—can have many positive outcomes for patient care, including lowering GHG emissions. In some instances, clinicians can choose products that are known to be environmentally preferable, such as anesthetic strategies that avoid or minimize inhaled agents. But in most cases, there is a paucity of data to guide environmentally preferable decision-making, and here the principles of the circular economy must be invoked. Selecting reusable products such as masks and gowns and actively countering the trend towards single-use disposables not only reduces our vulnerability to supply chain disruption, as experienced during the pandemic, but also significantly decreases our environmental footprint.

Kori Jones took attendees through more numbers. VCH produces 6,791 tonnes of operational waste annually. While 57 per cent of this waste is sent to landfills, 40 per cent of that could be composted or recycled. VCH has over 15,000 full-time-equivalent staff members; 48 per cent use single occupancy vehicles to get to and from work. In one year, VCH is responsible for over 40,000 tonnes of CO2 emissions and consumption of nearly a billion litres of water. Jones and his team work to reduce energy and emissions in infrastructure projects, embed sustainable design with health outcomes into major construction projects and site strategies, and conduct utility and carbon reporting and research.

“The good news is while VCH’s floor area has increased by 16 per cent since 2007, we’ve seen an 18.8 per cent reduction in emissions,” said Jones. “Low carbon resilience infrastructure planning is required to meet our goals under the Climate Change Accountability Act. We need to be smarter about how we use energy and water and we need to reduce our waste and toxicity. Opportunities exist to address environmental sustainability that will also build resilience in the face of pandemics.”

“The board and senior executive are excited about the work being done at VCH to address planetary health and we are committed to change,” commented Vivian Eliopoulos. “Our contributions to improving the health of the planet is one of our key strategic priorities. We need to transform the way we think about planetary health and VCH is open to innovative ideas. We can see climate change as our biggest health threat or as its greatest opportunity. We all need to become environmental stewards; we have lots of opportunities to do things differently.”

The My Hospital Footprint series was funded by VPSA’s Small Steps, Big Idea and is seen by those who worked on it as a prelude to further work. If you have ideas for future physician projects that meet the funding criteria, please contact VPSA Project Manager Lina Abouzaid.

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