An introduction to sustainable healthcare @SusHealthcare Ingeborg Steinbach Centre for Sustainable Healthcare World Ophthalmology Congress 2018 Masterclass in Environmental Sustainability

What is sustainable healthcare? Why should healthcare professionals be concerned about sustainability? What general steps have been taken to address sustainability in healthcare? What steps have been taken towards sustainability in Ophthalmology?

Healthcare challenges in the 21st century ECONOMIC Rising demand Financial crisis Waste ENVIRONMENTAL Climate change Air and water pollution Where are we now? A focus on sustainability offers us a way to go at least some way to tackling all of these issues SOCIAL Inequalities Safety / quality Patient experience Staffing / morale

A. What is sustainable healthcare? Environmental Social Economic Bearable Sustainable Viable Equitable BIOSPHERE A healthcare system is sustainable if it works within its financial, environmental and social resources, improving and protecting health now and for future generations A definition…

What is sustainable healthcare? Why should healthcare professionals be concerned?

B. Why should healthcare professionals be concerned about sustainability? Climate Change is the biggest health threat of the 21st century. Dr. Margaret Chan WHO Director-General

‘Although vector-borne diseases will expand their reach and death tolls, the indirect effects of climate change on water, food security, and extreme climatic events are likely to have the biggest effect on global health.’ Lancet & UCL (2009). Managing the health effects of climate change.

B. Why should healthcare professionals be concerned about sustainability? Climate Change is the biggest health threat of the 21st century Healthcare contributes to climate change because of its high carbon emissions

Greenhouse gas emissions of healthcare Healthcare emits: 10% GHGs in the US1, 7% GHGs in Australia2, and 5% GHGs in England3 1 Eckelman M J, Sheman J (2016). Environmental Impacts of the U.S. Health Care System and Effects on Public Health. PLoS ONE 11(6): e0157014 2 Malik A, Lenzen M, McAlister S, McGain F. The carbon footprint of Australian health care. Lancet Planetary Health 2(1): e27-35 3 Sustainable Development Unit. (2016). Carbon Footprint update for the NHS in England.

NHS England carbon footprint (22.8 million tonnes CO2e) Commissioned Travel Building energy use Procured (pharmaceuticals, equipment, everything else) Sustainable Development Unit (2016). Carbon Footprint update for the NHS in England.

SDU (2012) NHS Goods and Services carbon footprint – carbon hotspots

B. Why should healthcare professionals be concerned about sustainability? Climate Change is the biggest health threat of the 21st century Healthcare contributes to climate change because of its high carbon emissions Resources are finite Legal reasons and international agreements Healthcare professionals are respected advocates Sustainability can improve productivity and value, saving money along the way 3. Water and scarce metals 5. UK Climate Change Act (2008)

Sustainable value in healthcare Informed by patient values outcomes (goods – harms) Value = environmental + social + financial costs (the “triple bottom line”) Academy of Medical Royal Colleges, 2016 (with CSH)

What is sustainable healthcare? Why should healthcare professionals be concerned about sustainability? What general steps have been taken to make healthcare more sustainable?

Governance Analysing healthcare’s greenhouse gas emissions and identifying its hotspots Securing support at executive level Developing organisational sustainable development management plans Developing partnerships to support the embedding of sustainable principle within healthcare

Summary of progress Health sector actions – NB ”shift to less intensive models of care” Gap - big chunk of carbon reduction not covered…

C. What general steps have been taken to make healthcare more sustainable? Sustainable estates Low carbon alternatives Lean pathways Self-care Prevention Global and national developments like the de-carbonisation influence sustainability of healthcare

‘No regret’ policies will improve health, enhance resilience, alleviate poverty and address inequality: Clean energy Active travel Housing improvements Green spaces Three min. film: http://www.thelancet.com/cms/attachment/2033405756/2049484881/mmc2.mp4

Sustainable clinical practice Secondary drivers Reduce carbon without reducing health Reduce activity Prevention Self care Lean pathways Reduce carbon intensity Low carbon alternatives Sustainable estates Primary driver Sustainable clinical practice Outcome needed Primary driver e.g. dry powder inhalers (1/18 x carbon of MDI) Infrastructure & process CENTRE for SUSTAINABLE HEALTHCARE Mortimer-F. The Sustainable Physician Clinical Medicine 2010, Vol 10, No 2: 110–11

Cumulative savings from Green Nephrology Innovations 6 infrastructure innovations: 30% of renal units 11 process innovations: 60% of renal units Potential ANNUAL savings in Renal £7 million 11,000 tCO2e 470 m l of water

What is sustainable healthcare? Why should healthcare professionals be concerned about sustainability? What general steps have been taken to make healthcare more sustainable? What steps have been taken towards sustainability in Ophthalmology

Working Groups International Agency for Prevention of Blindness (IAPB)’s Environmental Sustainability Working Group (IAPB ESWG) Royal College of Ophthalmologists’ Sustainability Working Group Network EyeHealth Susnet

Carbon footprinting and Triple Bottom Line Analysis in Ophthalmology The carbon footprint of cataract surgery D S Morris, T Wright, J E A Somner, and A Connor 1 cataract operation is responsible for 181.8kg CO2e A triple bottom line analysis of eye motility services comparing the main London eye hospital and satellite clinics K Mackenzie, I Steinbach, L Pilard On average, carbon emissions from travel per visit to the satellite were nearly half that of an average patient to the Moorfields hub Eyefficiency Tool

Royal College of Ophthalmologist’s Sustainability Prize 2017 Transferring lower complexity glaucoma patients into virtual glaucoma monitoring units – team in Leeds 2018 Using CatCam which boasts 100% sensitivity and specifity for picking up paediatric cataracts – team in Cambridge

https://networks.sustainablehealthcare.org.uk/network/eyehealth-susnet www.sustainablehealthcare.org.uk https://networks.sustainablehealthcare.org.uk/network/eyehealth-susnet ingeborg.steinbach@sustainablehealthcare.org.uk