Although the healthcare sector is a critical service provider in every country, it possesses a significant environmental footprint (Malik, Lenzen, McAlister, & McGain, 2018). Without intervention, emissions from the healthcare sector are predicted to rise due to a number of factors, including global population growth, ageing populations and the rise of increasingly energy and resource-intensive medical technologies (Malik et al., 2018). The healthcare sector has been slow to recognise the negative environmental sustainability impacts of its operations and implement improvements (Karliner, Slotterback, Boyd, Ashby, & Steele, 2019).
Within most countries healthcare sectors, hospitals account for the majority of CO2e emissions (Malik et al., 2018). This is due to their high energy usage and single-use item policies (Australia, 2020). As hospitals are the largest emitters, there has been considerable research on decarbonisation and improving sustainability outcomes for them (Lewis, 2018). Common initiatives that are cited include improving energy efficiency and waste minimisation (4). However, clinical decision making and preventative health measures that avoid hospital procedures in the first place will reduce far more emissions and avoid excess resource use than incremental changes to operational efficiency or technology in hospitals (McGain & Naylor, 2014). This is where healthcare clinics (including Physiotherapy clinics) can assist in reducing the need for patient hospitalisation.
Plainly, the less people that need to access healthcare services the less resources the sector will use. To find ways to use less resources is a base sustainability principle (Wheeler, 2013), it is analogous with the “reduce” part of the “3 R’s” for resource use. This is difficult when many countries populations are becoming more and more ill (Australian Bureau of Statistics, 2021). Improving population health or public health (preventative health) is a complex task that involves many stakeholders and sectors (Australia, 2020). Many industries are interconnected in this complex problem, an example is populations consuming unhealthy food, beverages and tobacco (that all create emissions along their production path) that result in poor health requiring increased access to healthcare services which in turn increases healthcare consumption of products and creates further emissions (Aldakhil, Nassani, Abro, & Zaman, 2018). In another example, in the US, more than 50% of healthcare resources are used on 5% of patients for chronic disease management, with the vast majority of these conditions being lifestyle and behaviour based and therefore almost completely preventable (Sherman et al., 2021). When added to the fact that globally, only 20% of people’s health and well-being is contributed to by the health sector (the other 80% is due to social, environmental and economic factors), it is clear that focusing on preventative healthcare is an efficient pathway to decarbonise the health sector (Sherman et al., 2021) and one that healthcare clinics (such as Physiotherapy) can play a major role in.
David Duindam (MSc)
Senior Physiotherapist, Brisbane, Australia
A straightforward example of this principle comes from the dental world. In a case study of two 50-year-old individuals, patient A presents for a routine dental checkup with no active oral disease and good oral health. Patient B presents with poor oral health, active oral disease, and tooth loss. Patient A has accessed effective preventative oral care throughout their life, practices good hygiene and makes positive lifestyle choices, this results in a much lower lifetime dental emissions profile with reduced physical travel to appointments and not needing resource-intensive dental procedures (Martin & Mulligan, 2021). Patient B has been on a very different oral health journey, with societal and behavioural factors playing a role in reduced preventative care and poor lifestyle choices resulting in a much higher dental emissions profile (Martin & Mulligan, 2021). This highlights the interlinkages across sectors of society that can add up to increasing a person’s resource use in many sectors including their healthcare (Martin & Mulligan, 2021).
Increasing the exposure and quality of preventative healthcare is a core opportunity of decarbonising healthcare that results in direct public health benefits (Gao et al., 2018). Preventative healthcare has many known benefits including improving public health, costing taxpayers less in health spending and reduced emissions from the healthcare sector (Malik et al., 2018). For example, consuming a more plant-based diet, not smoking, reducing alcohol intake, and using active transport (walking, running, cycling) all improve personal and community health outcomes (WHO, 2021). These same lifestyle-based decisions mean reduced methane and other GHG emissions from livestock farming and land clearing, reduced emissions from less frequent car use and less health resources needed for chronic health conditions (Malik et al., 2018).
Physiotherapy and other allied health services are especially “low-emission” and are often effective non-pharmaceutical means to remedy pain and dysfunction while encouraging positive long-term health measures such as increased exercise and reduced obesity (Maric et al., 2021). Allied health clinic services can help reduce environmental harm of the healthcare sector in many ways (Maric et al., 2021). An example is a clinic-based physiotherapist guiding a patient through an evidence-based strengthening exercise treatment plan for their knee osteoarthritis while enlightening them on healthy lifestyle education. This improves the patient’s knee pain and also reduces their risk of needing a resource (and emissions) intensive surgery in a hospital in the future.
As part of a larger sustainability picture, finding the funds for increased healthcare spending as well as increased research is a practical discussion point. Funding national, evidence-based preventative health campaigns have been shown to be cost-effective but, for complex reasons, are politically difficult to execute (White, Skirrow, George, & Memon, 2018). Spending more of healthcare budgets on effective preventative health initiatives (including exercise prescriptions from physiotherapists and exercise physiologists) would benefit the public economically, socially and with improved health.
Aldakhil, A. M., Nassani, A. A., Abro, M. M. Q., & Zaman, K. (2018). Food-beverage-tobacco consumption, smoking prevalence, and high-technology exports influenced healthcare sustainability agenda across the globe. Environmental Science and Pollution Research, 25(33), 33249-33263.
Australia, D. f. t. E. (2020). Net zero carbon emissions: responsibilities, pathways and opportunities for Australia’s healthcare sector.
Australian Bureau of Statistics, A. (2021). Health conditions and risks. Retrieved from https://www.abs.gov.au/statistics/health/health-conditions-and-risks
Gao, J., Kovats, S., Vardoulakis, S., Wilkinson, P., Woodward, A., Li, J., . . . Wang, J. (2018). Public health co-benefits of greenhouse gas emissions reduction: a systematic review. Science of the Total Environment, 627, 388-402.
Karliner, J., Slotterback, S., Boyd, R., Ashby, B., & Steele, K. (2019). Health care’s climate footprint. Retrieved from Health Care Without Harm and ARUP: https://noharm-uscanada.org/sites/default/files/documents-files/5961/HealthCaresClimateFootprint_092319.pdf
Lewis, T. M. A. (2018). Becoming a climate-friendly hospital: Implications for nursing practice within the Australian healthcare context.
Malik, A., Lenzen, M., McAlister, S., & McGain, F. (2018). The carbon footprint of Australian health care. The Lancet Planetary Health, 2(1), e27-e35.
Maric, F., Chance-Larsen, K., Chevan, J., Jameson, S., Nicholls, D., Opsommer, E., . . . Stone, O. (2021). A progress report on planetary health, environmental and sustainability education in physiotherapy–Editorial. European Journal of Physiotherapy.
Martin, N., & Mulligan, S. (2021). Environmental sustainability through good-quality oral healthcare. International Dental Journal.
McGain, F., & Naylor, C. (2014). Environmental sustainability in hospitals–a systematic review and research agenda. Journal of health services research & policy, 19(4), 245-252.
Sherman, J. D., McGain, F., Lem, M., Mortimer, F., Jonas, W. B., & MacNeill, A. J. (2021). Net zero healthcare: a call for clinician action. BMJ, 374.
Wheeler, S. M. (2013). Theory of sustainability planning In Planning for sustainability: creating livable, equitable and ecological communities (pp. 34 – 52): Routledge.
White, P., Skirrow, H., George, A., & Memon, A. (2018). A systematic review of economic evaluations of local authority commissioned preventative public health interventions in overweight and obesity, physical inactivity, alcohol and illicit drugs use and smoking cessation in the United Kingdom. Journal of Public Health, 40(4), e521-e530.
WHO, W. H. O. (2021). Compendium of WHO and other UN guidance on health and environment. Retrieved from WHO: https://www.who.int/publications/i/item/WHO-HEP-ECH-EHD-21.02