Table Of ContentSustainable Healthcare
Sustainable
Healthcare
Knut Schroeder
GeneralPractitioner(FamilyPhysician),ConcordMedicalCentre
HonorarySeniorClinicalLecturer
CentreforAcademicPrimaryCare
SchoolofSocialandCommunityMedicine
UniversityofBristol
Bristol,UK
Trevor Thompson
GeneralPractitioner(FamilyPhysician),WellspringHealthyLivingCentre
ReaderinHealthcareEducation
CentreforAcademicPrimaryCare
SchoolofSocialandCommunityMedicine
UniversityofBristol
Bristol,UK
Kathleen Frith
President,GlynwoodandformerManagingDirector
CenterforHealthandtheGlobalEnvironment
HarvardMedicalSchool
Boston,MA,USA
David Pencheon
Director
NHSSustainableDevelopmentUnit
EastofEnglandStrategicHealthAuthority
Cambridge,UK
A John Wiley & Sons, Ltd., Publication
Thiseditionfirstpublished2013,2013byJohnWiley&SonsLtd.
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ISBN978-0-470-65671-6(pbk.)
I.Schroeder,Knut.
[DNLM:1.DeliveryofHealthCare.2.ClimateChange.3.ConservationofNaturalResources.W84.1]
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Contents
Preface,vii
Acknowledgements,ix
Abouttheauthors,x
Chapter 1 Greeningthegaze,1
Chapter 2 Climatescienceincontext,26
Chapter 3 Engagingwithsustainability,50
Chapter 4 Avisionforsustainablehealthcare,72
Chapter 5 Low-carbonclinicalcare,92
Chapter 6 Foodforpeopleandplanet,112
Chapter 7 Travelandtransport:movingtobetterhealth,138
Chapter 8 Healthybuildings,healthyspaces,157
Chapter 9 Resourcestewardship,183
Chapter10 TheGreenDeath,206
Chapter11 TheGreenAcademy,223
Chapter12 Thejourneytowardssustainablehealthcare,244
Index,259
Preface
Shouldpeopleworkinginthehealthsectorbeinterestedinsustainability?The
answer,wethink,isaresounding‘yes’.We,anauthorialteamcomprisinga
primarycareclinician(KS),amedicalteacher(TT),apublichealthspecialist
(DP) and a science educationalist (KF), have been exploring the interface
between medicine and sustainability for many years. In that time, general
publicinterestinthisareahasincreasedalot,butwithinthehealthsector
it has received relatively little attention. We have written this book as a
synthesis of a growing, but disparate, body of expert knowledge, and also
withthehopeofbringingsustainabilitytoitsrightfulplaceatthecentrestage
ofhealthcarepolicyandpractice.
Theearthsystemisawonderfulyetultimatelyvulnerablething.Itprovides
uswithendlessbenefitsuponwhichweareentirelydependentandwhichwe
caneasilycometotakeforgranted.These‘ecosystemsservices’includefresh
water,cleanair,fertilesoils,carbon-basedandrenewableenergysourcesand
a stable and relatively predictable climate. Less tangibly, we draw spiritual
sustenance from nature in all its beauty and diversity. The science is now
unequivocal–this planetary system is under stress due to human activity.
Weunpackthesestresses,suchasclimatechangeandthelossofbiodiversity,
andconsiderthevariousconsequencesforhumanhealthandthehealthcare
system–asystemthatitselfstrugglestocontaincosts,dealwiththesoaring
prevalenceofchronicillnessandbringhumanitytotechnologicalcare.
This book describes a new paradigm to tackle these pressing predica-
ments–acollectionofideasandperspectives(mostlydevelopedbyothers,
butsomeofourown)thatfall,howeveruntidily,underthebannerofsus-
tainablehealthcare.Thisbringstotheforegroundthepreventionofdisease
andthecreationofindividualandcommunityresilience.Itchampionslean
systemsofclinicalcarethatmaximiseefficiencyandcommonhumanityand
minimiseresourceuseandthecreationofwasteproducts(includinggreen-
housegasesandtoxicpollutants).Aconsistentandhearteningobservationis
thatmanyinterventionsthatimproveindividualhealth(suchasfresh,local
viii Preface
andmainlyplant-basedfood)arealsogoodforthehealthoftheplanetary
system–creatingwhataretermed‘virtuouscycles’.
Wehavewrittenforareadershipbusywiththemyriadtasksofdelivering
care. We have tried to keep the book concise and balance ‘need to know’
with‘usefultoknow’information.Wehavereadandappraisedmuchofthe
science so you don’t have to, and tried to draw balanced conclusions in a
fieldwherethereisconsiderableuncertainty.Attimeswehaveappliedthe
precautionaryprinciple–advocatingactionwherethepriceofinactionseems
incalculable.Wecutthroughsomeofthejargonandchallengetherhetoric
ofbothfearanddenial,whichoftenpervadesthetopic.Andwefocusonthe
essentialquestions,offeringasynopsisofthemainissueswhichwesupport
withkeyreferencesandlinkstosourcesoffurtherinformation.Inshort,this
isabookoffirstresort.
Wewritewithawidereadershipinmindincludinghealthprofessionals,
educationalists,healthservicemanagersandhealthcarestudentsforwhomit
mightprovideanoutlinecurriculuminsustainablehealthcare.Wehopethisis
apositivebookthatinspiresreflection,engagementand–crucially–action.
Wethinkthattherearesmarter,safer,fairerandmoresustainablewaysof
doing things in the health sector, which are well worth the effort for the
benefitofcurrentandfuturegenerations.Whowouldhavethoughteven10
yearsagothatinmanycountriessmokingwouldbebannedinpublicplaces?
Asimilarshiftinpublicpolicyandhumanbehaviour,involvinginnovative
technology and better models of care, needs to happen to develop health
systemsthatcansustainusthroughthechallengingdecadesahead.
Forfeedback,commentsandsuggestionsforimprovementspleaseemail
[email protected].
KnutSchroeder
GeneralPractitioner(FamilyPhysician),ConcordMedicalCentre;
HonorarySeniorClinicalLecturer,UniversityofBristol
TrevorThompson
GeneralPractitioner(FamilyPhysician),WellspringHealthyLivingCentre;
ReaderinHealthcareEducation,UniversityofBristol
KathleenFrith
President,GlynwoodandformerManagingDirector,CenterforHealthand
theGlobalEnvironment,HarvardMedicalSchool
DavidPencheon
Director,NHSSustainableDevelopmentUnit
Acknowledgements
We owe much gratitude to a number of people who helped tremendously
with writing this book by providing us with key resources and materials
and reading part or all of the manuscript. In alphabetical order, we are
particularlygratefulto:
Annie Anderson, Ari Bernstein, Stefi Barna, Jonathan Broad, Timmy
Bouley, Peter Cawston, Adrian Davis, Bob Fox, Ian Fitzpatrick, Howard
Frumkin, Lynn Gibbons, Michelle Gottlieb, Chris Johnstone, Phil Insall,
Katy Mahood, Janet Maxwell, Frances Mortimer, Hubert Murray, Scott
Murray,ChrisPayne,DavidPeters,IanRoberts,KatherineRusack,Marion
Steiner,JeromeThomas,AshTierney,SarahWalpoleandSarahWebster.
We would also like to thank Mary Banks, Adam Gilbert, Chrisma Ng,
Jon Peacock,SangeethaParthasarathyandeveryone else at Wiley for their
patience,gentleguidanceandtheirbeliefinthisproject.Manythanksalso
toKevinDunnforexpertcopy-editing.
Wewouldalsoliketoacknowledgetheindustryanddedicationthemany
researchers,writers,cliniciansandactivistswhoseendeavourswehavedrawn
oninthewritingofthisbook.
About the authors
Knut Schroeder works part-time as a Family Physician and is Honorary
Senior Clinical Lecturer at the Centre for Academic Primary Care in the
UniversityofBristol,UK.Hehadneverreallyconsideredthelinkbetween
climatechangeandhealthuntilheattendedaconferenceon‘ClimateChange
anditsImpactonHealth’in2008,hostedbytheRoyalCollegeofPhysicians.
This instilled a growing interest in the relationship between health and
sustainabilityandpromptedtheideaforwritingthisbook.KnutisaBoard
MemberoftheUKSelfCareForum,whichaimstosupportpeopleinmaking
better (as well as more sustainable) choices about their health. He also
workswiththeNHSInstituteforInnovationandImprovementtohelpfamily
practicesworkmoreefficientlyandmoresustainably.Knutenjoysspending
timewithhisyoungfamily.Wheneverworkandfamilycommitmentsallow,
heisoutandaboutrunningorcycling,orwritesabouttopicsthathefeels
passionateabout.
TrevorThompsonisaFamilyPhysicianattheWellspringHealthyLiving
CentreinBristol,UK,whichsupportsadiverseinner-citypopulationwitha
rangeofcommunity-basedandmedicalservices.Heisalsoaseniorteacher
at the University of Bristol Medical School with responsibilities across the
curriculum. Trevor has been reading on the theme of sustainability for
manyyearsandsince2006hasrunanundergraduatecourseonthe‘Global
Environment and Human Health’. Teaching is often the best way to learn
and his writing here draws extensively on his educational practice which
seeks to engage both hearts and minds. Trevor is clinical co-lead for the
Sustainable Healthcare Education Network, supporting green educational
initiativesacrosstheUK.Heisanactivecyclist,sailorandgrower.
KathleenFrithisacreative,visionaryleaderworkingforasmarter,more
sustainable world and President of Glynwood, one of the United States’
leadingsustainableagricultureandfoodorganisations.Withadeeppassion
forthenaturalworld,KathleenstudiedmarinebiologyandreceivedaMaster’s
degree in Science Journalism from Boston University. In 2001, she was
recruitedtoHarvardbytheCenterforHealthandtheGlobalEnvironmentat
Abouttheauthors xi
HarvardMedicalSchool,whereshehelpedshapetheCenter’sprogrammesto
educateandinformpeopleaboutthelinksbetweenhumanhealth,theocean,
foodsystemsandtheenvironment,servingastheorganisation’sManaging
Directorduringthelasttwoyearsofhertenure.In2009,Kathleenproduced
the award-winning film Once Upon a Tide, a live action and animated
educationalshortthatscreensaroundtheworld.In2010,Kathleenstarted
theHarvardCommunityGarden,HarvardUniversity’sfirstgardendedicated
solelytotheproductionoffood.OtherinitiativeswhileattheCenterincluded
the creation of the Center’s Healthy Oceans, Healthy HumansProgram, the
launch of Center’s Healthy and Sustainable Food Program and work with
NationalGeographictohelprestoreahealthy,sustainableseafoodresource.
Kathleenhasproducedanumberofaward-winningreportsandpublications
and serves as an advisor for a number of environmental and community
organisations.
David Pencheon is a UK-trained public health doctor and is currently
DirectoroftheNationalHealthService’sSustainableDevelopmentUnit for
England.DavidwaspreviouslyDirectorofaPublicHealthObservatoryin
Cambridge,England.HehasworkedasaclinicaldoctorintheNHS,ajoint
DirectorofPublicHealth,aPublicHealthTrainingProgrammeDirectorin
the East of England, with the NHS R&D programme, and lived in China
in the early 1990s contributing to the work of Save the Children Fund
(UK).Hismaininterestsandareasofresearchandpublicationare:sustain-
able development, large scale transformational change, health and climate
change, underpinning action and policy with good information and evi-
dence,trainingandprofessionaldevelopment,organisationaldevelopment,
medicalinformaticsanddecisionsupportforhealthprofessionals,carersand
thepublic.HeblogsmainlyviatheBMJwebsite.HewasawardedanOBEin
theNewYear’sHonoursList2012forservicestopublichealthandtheNHS.
Chapter 1 Greening the gaze
Healthprofessionalshavealotontheirminds:caringforpatients,managing
teams, keeping up to date with clinical developments and responding to
broader agendas of quality and cost containment. This book offers up a
quietly revolutionary invitation to rethink this enterprise by considering
medicineinitsrightfulplacewithinamuchbiggerplanetarysystem.Here,
wecallthisnewwayofthinkingsustainablehealthcareandbelieveitcanhelp
usdeliverservicesofbetterquality,atlowercostsandwithlessimpacton
thesystemsthatsustainus.Tothispointintimethehealthsectorhastaken
planetary health for granted, but now a body of evidence shows an earth
systemunderstress.Halftherainforestisgone,extinctionratesaresoaring,
theoceansareincreasinglyacidicandtheplanetisrunningafeveronedegree
abovepre-industriallevels.Wearejuststartingtorealisehowtheseplanetary
ailmentsimpactonhumanhealth,withclimatechangefamouslydescribed
in the Lancet as ‘the biggest global health threat of the 21st century’ [1].
Though many health professionals are alive to these global issues, in the
healthprofessions,asinsocietyatlarge,sustainabilitycompeteswithmany
other pressing and more proximate concerns. Thus, there is a danger that
wearecollectivelysleepwalkingintoapublichealthcatastrophe.Thisbook
offersanewsynthesisofsustainabilityandhealth,leadinginlaterchaptersto
manyideasforpracticalaction.Firstly,though,wewanttoexplainwhywe
needarevolutioninourhealthsystems,whynothingshortofarevolution
is going to be enough and what sort of a revolution we are talking about.
Luckilyitisarevolutionfromwhichweallstandtobenefit.
The revolutionary road
Nineteenth century medicine witnessed the emergence of germ theory,
which revolutionised our understanding of infectious disease. This new
theorydispatchedthethenprevalentmiasmatic paradigm,whichheldthat
diseasearosefrombadair.Inthetwentiethcentury,classicalmechanicswas
SustainableHealthcare,FirstEdition.KnutSchroeder,TrevorThompson,KathleenFrith
andDavidPencheon.
2013JohnWiley&Sons,Ltd.Published2013byJohnWiley&Sons,Ltd.
