Health promotion and disease prevention 3. Define the terms adaptation and mitigation and their relevance to different levels of prevention To understand the concept of co-benefits in relation to encouraging health promoting behaviours

What are the current crises in healthcare? List as many as you can

Are there any links that can be made? Increasing Demand Decreasing resources Increased energy prices Chronic diseases Ageing population Obesity Antibiotic resistance In terms of their effect on healthcare… What about cause? – over consumption? Climate change Increasing public expectations Financial crisis

Case Study - The August 2003 European Heat Wave IPCC A heat wave doesn’t superficially seem very dangerous – use to emphasise how our assumptions may be wrong, and how being unprepared can lead to thousands of excess deaths

The August 2003 European Heat Wave – France Case Study The Health Impact? 15,000 deaths in France 35,000 in total including Belgium, the Czech Republic, Germany, Italy, Portugal, Spain, Switzerland, the Netherlands and the UK 60% of deaths were in the elderly (>75) Why so devastating? Heat-Island Effect Surveillance for heat wave deaths was inadequate Limited public-health response was due to a lack of experts, Limited strength of public-health agencies, Taken from IPCC AR 4 Working Group II Chapter 8

Adaptation vs. Mitigation Reduce impacts of climate change Short-term Necessary because of climate latency E.g. Heat Health-Warning systems Mitigation Reduce intensity of climate change Long-term Necessary in the long run E.g. Reduce transport

Co-benefits of mitigation Carbon reduction strategies Public health measures Split into groups and get students to start from one side or the other - eg thinking of carbon reduction strategies they know of and their potential public health benefits and vice versa. Examples of combining adaptation and mitigation: Increasing urban green space, cycle paths, pedestrian zones Low energy (heat resilient) buildings Increased local food production (reduces vulnerability to interruption of food imports) Taxes on red meat and dairy Renewable and clean energy usage – reduced lung disease due to air pollution Eg cutting motor traffic: Traffic injuries, air pollution, obesity, chronic disease, carbon reduction Evidence that climate change might also be good news for public health streets safer 3k road deaths per day, internationally Many more injuries daily as gas prices go up, child injuries go down cities are grinding to a halt across the world urban air pollution 800k deaths per year from this

Health promotion and disease prevention 4. To articulate his or her own values and principles in relation to sustainability. To understand the doctor’s responsibilities in relation to delivering sustainable healthcare: -as a decision maker committing resources at the point of care - as a team manager and a leader of public opinion

The responsibility of a doctor is to helping the patient in front of them The responsibility of a doctor is to improving the health and wellbeing of whole populations Split and come up with arguments – then discuss Are these arguments affected if you extend the population past the borders of our own country?

How primary prevention might come into conflict with concepts of free will. ‘nanny state’. Should doctors try and change or be guided by public opinion? Ideal might be to be sensitive to individual opinions whilst still trying to promote healthy behaviours?

Carbon footprint – NHS England ? The NHS is a contributor to climate change: 25% of public sector carbon emissions… Which is the big blue slice of the NHS carbon pie? (Energy, procurement or travel?)

Sustainable development unit data

Whose responsibility is cutting carbon emissions? drugs tests procedures outpatient visits Clinical activity drives the vast majority of the carbon footprint of the NHS: Energy – scans and equipment, inpatient stays Travel – appointments and admissions Procurement – drugs, clinical equipment, laboratory equipment… imaging hospital stays

What does sustainable healthcare mean for the Duty of a Doctor to protect & promote health - In clinical practice? - As a manager of health services? - As a public health doctor? - As a citizen?