Climate Change and the Health Sector

Healing the World

Alexander Thomas, K. Srinath Reddy, Divya Alexander, Poornima Prabhakaran, Alexander Thomas, K. Srinath Reddy, Divya Alexander, Poornima Prabhakaran

• Publisher: Routledge India
• Year: 2021
• ISBN:
  9781000511833
• Edition: 1
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

The health sector is known to be one of the major contributors towards the greenhouse gas emissions causing the climate crisis, the greatest health threat of the 21st century. This volume positions the health sector as a leader in the fight against climate change and explores the role of the health system in climate policy action. It delivers an overview of the linkages between climate change and the health sector, with chapters on the impact of climate change on health, its connection to pandemics, and its effects on food, nutrition and air quality, while examining gendered and other vulnerabilities. It delves into the different operational aspects of the health sector in India and details how each one can become climate-smart to reduce the health sector's overall carbon footprint, by looking at sustainable procurement, green and resilient healthcare infrastructure, and the management of transportation, energy, water, waste, chemicals, pharmaceuticals and plastics in healthcare.

Well supplemented with rigorous case studies, the book will be indispensable for students, teachers, and researchers of environmental studies, health sciences and climate change. It will be useful for healthcare workers, public health officials, healthcare leaders, policy planners and those interested in climate resilience and preparedness in the health sector.

The Open Access version of this book, available at http://www.taylorfrancis.com, has been made available under a Creative Commons Attribution-Non Commercial-No Derivatives 4.0 license.

Section 1 Climate action by the health sector

1 Health sector leadership to combat climate change

Alexander Thomas, Divya Alexander and Girdhar Gyani

DOI: 10.4324/9781003190516-3

Introduction

The health of a community is inextricably linked with the climate of the region. Climate change threatens human health by affecting the social and environmental determinants of health – clean air, safe drinking water, sufficient food and secure shelter (WHO Fact Sheet, 2018).

When climate change has an adverse effect on the health of a population, people seek healthcare services from hospitals and other healthcare providers. Hospitals themselves are known to produce significant amounts of greenhouse gas (GHG) emissions by running 24×7 on fossil fuel consumption and purchased energy sources, as well as a carbon-intensive supply chain, thereby contributing to climate change both directly and indirectly. They also generate one of the most diverse and difficult-to-manage waste streams, generated in close proximity to human beings and posing a serious threat to the safety of hospital staff, patients, their associates and the community at large. Healthcare firmly sits among the “large-emitting” sectors: in 2019, the global healthcare sector had a climate footprint of the equivalent of 2.0 gigatons of carbon dioxide (GtCO₂e), equivalent to 4.4% of global net emissions (HCWH and Arup, 2019). Hence, it is crucial for hospitals and healthcare organizations to address these concerns.

The health sector is widely seen as a trusted and well-respected segment of society, as well as being a major employer in the economy. It is uniquely positioned in the community to lead by example in reducing its carbon footprint and raising awareness about climate change among the public. The sector, therefore, has both a duty and a window of opportunity to achieve climate neutrality, efficiency and cost reduction all at the same time (Neira, Bertollini et al., 2008). For this to be achieved, effective and transformative leadership is required at all levels. This chapter will look at health sector leadership in three contexts:

• The leadership of the healthcare sector in reversing global warming at a sectoral and policy level.
• The thought leadership of healthcare institutions and providers in a community, mobilised for public advocacy to raise awareness on climate change.
• The leadership and engagement required within an individual healthcare facility to make it carbon-neutral, climate-resilient and more aware of population vulnerabilities with regard to climate change.

Leadership of the health sector at the policy and sectoral level

Globally, the voice of the healthcare sector is beginning to be heard. In a 2018 Call to Action on Climate and Health, organizations representing more than six million doctors, nurses and public health professionals and 17,000 hospitals in over 125 countries made commitments to accelerate climate change mitigation and adaptation (Global Climate and Health Forum, 2018). With its diverse supply chains and significant purchasing power, the sector has the ability to trigger climate mitigation initiatives across other sectors including plastics, chemicals, pharmaceuticals, clinical waste disposal, e-waste recycling, energy, food sourcing and preserving biodiversity.

In India, healthcare is a driving component of the economy, representing a little over 5% of the country’s total expenditure (Department of Economic Affairs, Ministry of Finance, Govt. of India, 2020). The Indian healthcare sector is the fourth-largest employer in the country and runs 24×7 all year, giving it substantial economic clout. As the only sector with a duty of care as its mission, it also has significant ethical and political influence. With this size and influence in India, the healthcare sector must create the driving leadership required to slow and then reverse global warming.

The healthcare sector, already battling against the casualties of climate change on the frontlines, can lead by example in reducing its own carbon footprint. There are many examples of efficient and effective healthcare delivery with a reduced carbon footprint. If health systems across the country whole-heartedly embraced the changes required for decarbonising, the total impact of the investments would not only be massive but also rouse other sectors into realising the benefits of such an initiative. Policymakers should promote an inter-sectoral approach with the relevant government agencies to identify carbon reduction targets and set goals for GHG emissions.

Apart from reducing its own carbon footprint, strengthening its own health systems and advocating for change in climate change policy using health information, the health sector can address climate change at the policy level by collaborating with other health-determining authorities in sectors such as water, environment, agriculture and disaster management to include health in their climate adaptation plans (WHO Framework, 2017).

As a signatory to the Paris Agreement, India has committed to cut its emission intensity of GDP by 33–35% of 2005 levels by 2030 (Aggarwal, 2015). As called for by the World Health Organization, healthcare should be integrated into climate policy, and climate policy should be integrated into health policy at all levels – state, national and international. In India, the government has instituted a National Expert Group on Climate Change and Human Health with experts from ministries, institutions and non-governmental organizations. The National and State Climate Action Plans should develop a specific roadmap for the health sector. The national objectives for health, economic growth and environmental sustainability should complement each other, rather than stand as individual goals.

One way of achieving this is by using existing platforms to raise a collective voice for climate advocacy (Box 1.1). The Association of Healthcare Providers – India (AHPI), for example, which represents the vast majority of healthcare providers in India, advocates with the government, regulatory bodies and other stakeholders on issues affecting the health sector, including climate change. The Health and Environmental Leadership Platform (HELP), of the Public Health Foundation of India (PHFI), which has over 7300 healthcare institutions (both government and private) is another platform to share best practices and showcase leadership in the adoption of climate-smart strategies.

Box 1.1 Case study The health sector leading policy action: National Health Conclave 2019

The Association of Healthcare Providers – India (AHPI) and the Centre for Environmental Health (CEH), a centre of excellence set up by the Public Health Foundation of India (PHFI), organised the National Health Conclave 2019, where participants deliberated on the health impacts of climate change, risk mitigation and adaptation strategies focused in the health sector (EH News Bureau, 2019). The conclave brought together health professionals, research groups, academic experts, policymakers, government officials, international agencies and civil society to deliberate on how to make the health sector climate-smart and climate-resilient, developing an agenda and roadmap for action.

The recommendations from the conclave were compiled in a white paper and presented to Dr. Harsh Vardhan, the Minister for Health and Family Welfare, Government of India, on 23 November 2019. One of the recommendations was to bring in the missing component of environmental health and associated health impacts into the medical curriculum. Subsequently, in December 2019, the National Centre of Disease Control (NCDC), an institute under the Ministry, constituted an Expert Committee on the Inclusion of Health Impacts of Climate Change in the Medical and Allied Health Curriculum. The Ministry also directed the National Board of Examinations (NBE) to implement the inclusion of health and climate change into the postgraduate medical curriculum. The NBE has already facilitated the introduction of this topic into selected postgraduate courses.

The complete white paper titled Climate Change and Health: Role of the Health Sector (AHPI and CEH, 2019) can be accessed at: https://www.ceh.org.in/publication/white-paper-on-climate-change-and-health-role-of-health-sector/

Leadership in the community

If hospitals and healthcare centres in a community bring in clean, renewable energy and invest in conservation strategies, they become a model of leadership for the rest of the community. As major energy consumers and highly respected anchor institutions in their communities, health systems have a unique opportunity to bring about change and contribute to green local economies. By significantly ramping up investment in energy efficiency, clean energy generation and water conservation projects, health systems can initiate ideas and actions that will spread quickly into the wider economy. On seeing hospitals responding proactively to the threat of global warming, the immediate community can gain a sense of the urgency surrounding the issue.

Healthcare institutions and their employees are often considered “thought leaders” of their community. This means that any messaging around climate change that comes from health professionals contains an added value for the general public, policymakers, local leaders and media. Health sector voices can thus be used for advocacy and mass sensitisation to play a big role in policy changes. This impact must be mobilised for public advocacy to educate the general public about climate change, and in turn pressure governments to take urgent action to combat this crisis.

Health professionals need to understand how the destruction of ecosystems, decline in crop yields, and acidification of the oceans could reverse recent advances in global health, with special attention to vulnerable populations, especially those in low-income countries (Ramanathan and Haines, 2016). For all this to take place effectively, the healthcare community itself needs to be empowered through appropriate capacity-building initiatives. These initiatives should be promoted and facilitated by climate leaders from within the healthcare community (Box 1.2). During this process, it is important to involve government, academia and the private sector so that they can jointly review, identify and fill the capacity-building needs and gaps in order to achieve collective climate action.

Box 1.2 Case study Healthcare professionals leading change in their community: Doctors for clean air initiative

The Lung Care Foundation, in partnership with Health Care Without Harm and Every Breath Matters, launched an initiative called Doctors for Clean Air in India, which is a collective of pulmonologists, paediatricians, cardiologists, surgeons, radiologists, etc., who are Clean Air Champions representing every state in India (HCWH Global, 2020). Having seen the alarming increase in poor health as an impact of air pollution, these medical professionals have come together to educate and advocate for better air quality in their communities. The movement describes doctors as “motivated motivators” because they see first-hand the effect of air pollution on the public, and have the ability to influence and educate their patients as they come from a position of strength.

The World Health Organization has exhorted the health community across the world to show strong leadership in tackling climate change (WHO Conference on Climate Change and Health, 2016). Healthcare providers need to be prepared on how to respond to climatic heal...

Table of contents

• Cover
• Endorsement Page
• Half Title
• Title Page
• Copyright Page
• Contents
• List of figures
• List of tables
• Foreword by K. Kasturirangan
• Preface
• Acknowledgements
• Introduction First, do no harm: Climate change and the health sector
• Section 1 Climate action by the health sector
• Section 2 The impact of climate change on health
• Section 3 Reducing the climate footprint of the health sector
• Section 4 Climate action by allied sectors
• Editors
• About the Contributors
• Index