Planetary health and what it means to us

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Planetary health and personal health are intertwined. That was one of the messages when VCH Regional Medical Director of Planetary Health, Dr. Andrea MacNeill gave a presentation to VMDAS and VPSA members at the organizations’ joint December annual general meeting.

“If healthcare were a country, it would be the world’s fifth highest emitter of greenhouse gases,” said Dr. MacNeill. “It accounts for 4.6 per cent of all global emissions—the same as the aviation industry. One positive move announced at COP26 is that Canada has signed onto the WHO initiative on resilient, low-carbon health systems. A federal mandate to decarbonize healthcare is a powerful statement.”

VCH has identified planetary health as a strategic priority, a step that Dr. MacNeill describes as bold and progressive. The move calls for VCH to “build an integrated strategy and plan for Planetary Health.” It is considered a critical part of providing safe, quality care and is recognized by senior leadership as an opportunity for VCH to be a local and global leader in protecting the health of our people, communities, and planet.

Dr. MacNeill gave a quick overview of the VCH teams working on planetary health. They include the Energy & Environmental Sustainability team within the Facilities & Real Estate department, Public Health, which oversees environmental health as well as population health and surveillance, Clinical Services (all frontline healthcare workers), the Quality and Patient Safety Department, and the Office of Transformation and Strategy.

“We need more medical leadership working on this initiative and I am thrilled to be in the regional medical director role,” added Dr. MacNeill, whose appointment was announced in October. “VCH is the first and only health authority in Canada to have this type of role in its leadership structure.”

VPSA is currently discussing with Dr. MacNeill ways it can support her work. Several members are keen to get involved.

BC was no stranger to the impact of climate change in 2021 and, as Dr. MacNeill notes, extreme weather events and their repercussions are only going to become more frequent. This means our health authority needs to become more resilient. Our services and facilities need to adapt to a changing climate in order to continue to deliver quality care in the face of ongoing disruptions.

Close to Dr. MacNeill’s heart is the Nourish Initiative, a national community of practice using the power of food to build the health of people and the planet. Dr. MacNeill’s interest lies primarily with improving patient experience and health outcomes while addressing climate through reduced food waste, plant-rich diets, and local, sustainable purchasing.

“Up to 70 per cent of hospital food is wasted,” said Dr. MacNeill. “We will be running a planetary health diet trial next summer including improved culturally appropriate foods to see if we can improve patient intake, experience and cultural safety. We also want to improve staff access to healthy, low-carbon foods.”

It’s not enough to decarbonize our activities; we also need to reduce the demand for health services. By understanding the social determinants of health, promoting healthy living, preventing disease, and managing chronic illnesses, we can reduce strains on the health system. We can also focus on appropriateness of care and eliminate the overuse of health services that add no value to patient care but instead introduce potential harm. This is where the greatest opportunities are for clinical engagement, as we need to develop stewardship strategies in partnership with each clinical service.

“It is estimated that 25 per cent of healthcare is inappropriate, or of no value, and in the US alone this comes at a  cost of over a $100 billion a year,” said Dr. MacNeill. “This happens because of systems structure and funding, and clinician behaviours.”

She pointed to the number of patients who receive unnecessary bloodwork, which results in patient discomfort, blood loss and  unnecessary carbon emissions. Dr. MacNeill also demonstrated how a lack of care coordination within the health system can lead to duplication of services or unnecessary care.

While planetary health is a new concept to many in healthcare, Dr. MacNeill’s presentation demonstrated that it is vital that we pay attention and adapt our ways of working.

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