Climate change and Australia’s healthcare systems

Climate change is a major risk to human health and also impacts healthcare systems, with many communities heavily impacted by devastating floods and bushfires. BehaviourWorks Australia was the lead organisation in a report commissioned by the Royal Australasian College of Physicians (RACP) to address the need for urgent action on climate change and provide Australia’s peak healthcare organisations with evidence-based recommendations for policymakers and the health sector to confront this threat.

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Healthcare: part of the problem and the solution

Health systems are uniquely placed as part of both the problem of climate change (Australia’s health system contributes approximately 7% of the nation’s CO2emissions) but also responsible for managing its health consequences.

Australia is seen as a climate laggard, and ‘uniquely placed to benefit economically from global decarbonisation’, according to the OECD, with abundant renewable resources. As carbon tariffs are being priced into international trade, we have an even greater obligation to take a steeper emissions path to get to Net Zero by 2040.

The RACP report has 4 research projects – a rapid literature review byBehaviourWorks Australia, policy and institutional analysis, economic analysis and a series of case studies that illustrate the breadth and complexity of climate impacts to health systems.

The seven key recommendations from these four projects are;

Implement and fund a coordinated national strategy on climate change and health
Commit to delivering net zero healthcare by 2040 (as per the UK’s NHS)
Invest in climate health vulnerability and capacity assessments with a focus on locally-led planning
Establish a dedicated climate health resilience research fund to support innovation and evidence-based action
Develop climate health capacity in the healthcare workforce and the wider health system
Embed Aboriginal and Torres Strait Islander knowledge and leadership in all climate health policy and action
Invest in prevention and early intervention as a key element of climate health action

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Climate change and Australia's healthcare systems; a review of literature, policy and practice

What did we do?

A rapid literature review approach was used to address the review question (co-developed in consultation with The RACP): “How are healthcare systems responding to the threat of climate change?”

A total of 4,409 citations were identified; 165 articles were reviewed in full-text and 17 reviews relevant to the review question were identified. Of these reviews, we found evidence to support a range of interventions that can reduce carbon footprint, save money, and improve healthcare outcomes, including;

● training healthcare workers in improved environmental outcomes and recycling,

● increased use of telemedicine,

● energy efficiency measures,

● waste reduction,

● reusable textiles, and

● changes to anaesthetic and surgical practices.

What did we find?

The key findings across the included reviews were;

● Research has demonstrated the effectiveness of a range of health system responses to climate change which have been reported in high quality review-level studies

● System-level responses have the most potential for impact, but very few published examples exist

● Policy and regulatory support is needed to drive system-level action

● More research into the effectiveness of health system interventions to address climate change is needed

This evidence from this overview of reviews is primarily at the level of individual hospitals, health services or communities; if the reported outcomes were achieved at scale, there is potential for substantial reductions in carbon footprint and costs associated with delivering healthcare. Achieving this system level transformation requires strong leadership at all levels, and ‘winning hearts and minds’ at the level of individuals.

What’s next?

Recommendation1 – that Australia implement a national climate health strategy – is currently underway, with consultation open for input towards this important step.

In addition to community pressures, healthcare entities and associations calling for action on climate change is critical to driving health system-level transformation. Two key groups promoting climate actions are Doctors for the Environment Australia and global Green and Healthy Hospitals network. Our review also found that more research is required, especially studies quantifying the effectiveness of climate change action strategies or performing environmental impact / life cycle assessments.

This would complement existing evidence on the impact of healthcare on emissions, which broadly mirrors the sectors in which there is most evidence for response strategies — surgery and anaesthetics in particular — but also highlights other areas including renal, pathology and asthma inhalers as having substantial carbon footprints.

Public sentiment is a key influence on policymakers and has been demonstrated to drive legislative change in a number of areas. Although beyond the scope of this review, some consideration of implementation and behaviour change challenges is warranted given the urgency of the climate change challenge.

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