Climate change: a decade of difference

Daniel Maughan, our Associate Registrar on Sustainability, looks at what’s happened since the 2008 Climate Change Act and how the College can help in the future. 

A decade of difference

Ten years ago the UK did a world leading, exemplary and tremendously ambitious thing. It passed legislation that committed the UK to reduce its carbon emissions by 80% by 2050.

The 2008 Climate Change Act. The NHS signed up to this target.  

This legislation took very seriously the state of global health. Human activity is destroying the ecosystems upon which we depend.

• Since 1970, the world’s vertebrate populations have halved. 
• The planet is currently experiencing the biggest global extinction it has ever known; up to 8 species are becoming extinct every hour.
• There are now 2,200 coal power stations in the world; there are this number being built that will be operational in the next 5 years; emissions from these alone will increase global temperatures by 2.3 degrees in 5 years.
  

This brings forward the catastrophic events that will occur if global temperatures increase by 6 degrees.

Humanity’s current addiction to carbon is not sustainable.

Climate change and mental health

Between 2030 and 2050, climate change is expected to cause approximately 250,000 additional deaths per year. These impacts extend to mental health. Desertification, wildfires, tornadoes and floods are causing huge impacts on mental health.

Putative biological pathways have been discovered that link nanoparticles from air pollution to the development of dementia; these have been verified by population level data. Here in the UK, during the 1995 heat wave in the UK, suicide increased by 46.9%; every 1oC increase in mean temperature above 18oC was associated with a 4-5% rise in suicide.

Strong evidence for the 2007 floods exists, where climate change was thought to be the likely cause; which showed a large impact on the mental health of the affected communities.

This is an issue for health professionals because the carbon footprint of health care worldwide is enormous, far larger than that of global aviation.  The carbon footprint of health care in the UK is larger than the carbon footprint of whole countries such as Estonia and Slovenia combined. The US health care system has a carbon footprint larger than the entire UK’s carbon footprint.

Our current health care systems are supporting health, but their combined carbon footprint is serving to undermine human health through anthropogenic climate change. We are giving with one hand and taking away with another. 

Now, a decade on from the passing of this Act, in the NHS in England, where we have the data, the carbon footprint of health care is now 22.8 million tonnes of carbon dioxide equivalents (MtCO2e). This is a reduction of 11% since the Climate Change Act.

Estates and facilities have led the way with NHS organisations using more renewable energy and having far greater scrutiny on sustainable procurement. But we know that the majority of the carbon footprint of health care is not due to energy or travel but clinically related.

The single largest component of the carbon footprint of health care is medication. We clinicians have much to learn from our colleagues in estates about the importance of reducing our carbon footprint.

A major sticking point currently is that the global pharmaceutical industry has very little incentive to either reduce their carbon footprint or to publish their carbon footprint data, which could then enable discriminate prescribing, as we do with cost. Ultimately, to be impacting, we need a BNF that publishes carbon footprint data alongside cost to ensure responsible prescribing.

We’ve led the way…

We as a College have led the way in thinking about sustainable health care in many respects. We are the first College to have a fully integrated and funded sustainability committee.

We were the first College to produce a position statement on sustainable health care and to provide guidance on sustainable commissioning. We are also the first College to put sustainable thinking into our quality standards. 

This past year we have integrated sustainability into CCQI, with Memory and Liaison Services now able to achieve a Sustainability Commendation alongside their CCQI accreditation, with other services to follow.  

Our College also support the UK Health Alliance on Climate Change that lobby the government on human health issues related to climate change and they have had a big impact, particularly around air quality in urban areas.

Our College premises are taking this seriously too; we were the first Medical College to have an organisational sustainability policy, we have started meat-free Mondays, have a zero disposable plastic and a zero waste to landfill policy.

But there’s a way to go

There is far more to be done. The College sustainability committee aim to get sustainable health issues into the curriculum, influence NHS organisations to start reporting on their carbon footprint across all domains rather than just energy and travel.

We will continue to lobby the government on sustainable models of care such as social prescribing. We will continue to increase awareness about the issue of over-diagnosis and over-prescription through the Choosing Wisely programme.

We continue to run the RCPsych Sustainability Award, support green care initiatives and inform College policy development.

The NHS has a long way to go to achieve this 80% reduction target by 2050. We are not even close to halfway there after 10 years, despite having capitalised on the easy wins. Reducing our resources is not enough; we need to change the way services are delivered.

Every little helps and we can all act by thinking critically about our use of resources and by embedding the principles of sustainable health care into our services; prevention, empowering patients to self-manage, improving value and reducing our use of carbon.

(This blog was featured in the December 2018 Members enewsletter)