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

2. 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?

3. 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

4. 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…

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

6. 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

7. ‘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.

8. 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

9. 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): e
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.

10. 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.

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

12. 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)

13. 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)

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

15. 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

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

17. 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

18. ‘No regret’ policies will improve health, enhance resilience, alleviate poverty and address inequality:
Clean energy
Active travel
Housing improvements
Green spaces
Three min. film:

19. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. https://networks.sustainablehealthcare.org.uk/network/eyehealth-susnet