1. 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

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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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?

10. 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?

11. 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?)

12. Sustainable development unit data

13. 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

14. 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?