td-conference, 2010, Geneva – Willi Haas, Ulli Weisz, hospitals & sd health & sd environ. efficiencyproduct outcome quality 1 A significant sustainability question: Increase number of health treatments or increase public health? Willi Haas, Ulli Weisz IFF Institute of Social Ecology Vienna, Klagenfurt University td-conference, September 2010, Geneva, Switzerland

td-conference, 2010, Geneva – Willi Haas, Ulli Weisz, hospitals & sd health & sd environ. efficiencyproduct outcome quality 2 manifold relations between health and sustainable development public health is an objective of sustainable development public health is a means to achieve sustainable development health & sd

td-conference, 2010, Geneva – Willi Haas, Ulli Weisz, hospitals & sd health & sd environ. efficiencyproduct outcome quality 3 health care systems in developed countries contribute significantly to climate change climate change threatens public health health & sd

td-conference, 2010, Geneva – Willi Haas, Ulli Weisz, hospitals & sd health & sd environ. efficiencyproduct outcome quality 4 Anteil der Krankenhäuser am österreichischen CO 2 -Ausstoss inkl. Vorleistungen Source: own calculations using an extended IO- table for Austria based on NAMEA 2000 and national accounts 2000 HOSPITALS Share of hospitals on Austrian CO2 emissions 2000 (direct and indirect) Source: OECD, Statistik Austria 9,6% of GDP 7,5% of GDP National costs for health care system health & sd

td-conference, 2010, Geneva – Willi Haas, Ulli Weisz, hospitals & sd health & sd environ. efficiencyproduct outcome quality 5 While the health care systems core business is to cure, it threatens public health Green hospital initiatives can not address this issue sufficently health & sd

td-conference, 2010, Geneva – Willi Haas, Ulli Weisz, hospitals & sd health & sd environ. efficiencyproduct outcome quality 6 3. Specific actions and examples of change in the health-care setting 3.1 Energy efficiency 3.2 Green building design 3.3 Alternative energy generation 3.4 Transportation 3.5 Food 3.6 Waste 3.7 Water health & sd 2009

td-conference, 2010, Geneva – Willi Haas, Ulli Weisz, hospitals & sd health & sd environ. efficiencyproduct outcome quality 7 Energy consumptionin kg oil equivalents per person and year Average life expectancy and average energy consumption per capita of more than 100 countries for 2003 Quelle: Wilkinson Paul, R Smith Kirk, Joffe Michael, Haines Andrew (2007): A global perspective on energy, health effects and injustices. Series Energy and Health 1. The Lancet: 5-18 Life expectancy in years 76 In developing countries the more energy consumption the higher the life expectancy In developed countries energy consumption and life expectancy are independent from each other environ. efficiency

td-conference, 2010, Geneva – Willi Haas, Ulli Weisz, hospitals & sd health & sd environ. efficiencyproduct outcome quality 8 Global problems require a fundamental change how our societies operate, if we want to avoid unfavourable development of living conditions Health systems in developed countries need to change as well In addition to energy efficiency of single units e.g. hospitals health systems need to be efficient as a whole – relation of output public health situation to environmental pressure environ. efficiency

td-conference, 2010, Geneva – Willi Haas, Ulli Weisz, hospitals & sd health & sd environ. efficiencyproduct outcome quality 9 There is very little information available on the health systems environmental efficiency. However, it seems to be that there are many possible path ways – e.g. prevention What you don‘t observe you do not react upon What then hospitals can do? environ. efficiency Instead of focussing on maximising number of treatments the most efficient improvements of the public health situation are required

td-conference, 2010, Geneva – Willi Haas, Ulli Weisz, hospitals & sd health & sd environ. efficiencyproduct outcome quality 10 Analysing hospitals reveals serious sustainability problems Aging society More and more is possible hospitals & sd More complex illness patterns Shift from acute to chronic Medical science/technical progress Financial constraints Health jobs count already as most burdened

td-conference, 2010, Geneva – Willi Haas, Ulli Weisz, hospitals & sd health & sd environ. efficiencyproduct outcome quality 11 Sustainable solutions have two basic requirements if they want to be successful: They need to be scientifically plausbile to be appropriate to reduce global sustainability problems hospitals & sd They need to be attractive and feasible for the ones who have to take action Solutions require a co-production from actors form practice and science

td-conference, 2010, Geneva – Willi Haas, Ulli Weisz, hospitals & sd health & sd environ. efficiencyproduct outcome quality 12 Collaboration over years with hospitals and with health promotion researcher In varying and complex settings between scientists and actors from hospital association, hospital management, nursing and medical staff Key were networking meetings outcome quality

td-conference, 2010, Geneva – Willi Haas, Ulli Weisz, hospitals & sd health & sd environ. efficiencyproduct outcome quality 13 Outcome quality: To observe and minimize side and long term effects of the core business With other words to become more sensitive on issues of problem shifting outcome quality

td-conference, 2010, Geneva – Willi Haas, Ulli Weisz, hospitals & sd health & sd environ. efficiencyproduct outcome quality 14 Environments of the Hospital Hospital Economical Sustainability Ecological Sustainability Social Sustainability Grafik-Design: Angy Rattay A multi-criteria approach for a “Sustainable & HP hospital” (developed and tested in the “Sustainable Hospital Project”, Vienna ) Health Promotion Diagnostic Treatment outcome quality

td-conference, 2010, Geneva – Willi Haas, Ulli Weisz, hospitals & sd health & sd environ. efficiencyproduct outcome quality 15 Environments of the Hospital Hospital Economical Sustainability Ecological Sustainability Social Sustainability Grafik-Design: Angy Rattay By a multi-criteria approach defining a “Sustainable” & Health Promoting hospital (developed and tested in the “Sustainable Hospital Project”, Vienna ) Health Promotion Diagnostic Treatment These criteria have to be implemented in the hospital by …  Explicit policies, targets, action planes, indicators, …  Defined responsibilities (roles, units)  Integration in management system (QM, Balanced Scorecard, … and/or special environmental MS such as EMAS, ISO 14000)  Monitored operational change in core & support processes

td-conference, 2010, Geneva – Willi Haas, Ulli Weisz, hospitals & sd health & sd environ. efficiencyproduct outcome quality 16 product

td-conference, 2010, Geneva – Willi Haas, Ulli Weisz, hospitals & sd health & sd environ. efficiencyproduct outcome quality 17 Thank you for your attention! Contact: f i n