Practising health care as if the planet matters

The Doctors for Planetary Health-West Coast rally was timed to coincide with the COP26, the United Nation’s climate change conference in Glasgow, where for the first time – and at the behest of the U.K. government – health was one of three science priority areas.

The World Health Organization (WHO) was at the centre of this work, offering an extensive set of events and initiatives. This included the release of an open letter signed by 600 organizations representing 46 million health professionals that identified the climate crisis as the single biggest health threat humanity faces; a Global Conference on Health and Climate Change; and the release of a WHO report on the health argument for climate action.

This report recognized, in the words of Tedros Adhanom Ghebreyesus, the director-general of the WHO, that in the face of climate change “protecting health requires action well beyond the health sector, in energy, transport, nature, food systems, finance and more.” But it also requires action by the health sector itself, which is a significant contributor to climate change, and more broadly to ecological harm.

When it comes to climate change, Health Care Without Harm – the leading international organization focused on making health care ecologically sustainable, and a co-lead with WHO on its global initiative – estimated in a 2019 report that “Health care’s climate footprint is equivalent to 4.4 per cent of global net emissions” of greenhouse gases. If it were a country, the report noted, the health sector “would be the fifth-largest emitter on the planet.”

Canada’s health-care system, noted the 2019 Lancet Countdown report for Canada, has the third highest greenhouse gas emissions per person in the world compared to 47 other countries where data was available. It also emits large amounts of other air and water pollutants, consumes considerable quantities of materials (especially because of its widespread use of disposables) and as a result generates large volumes of waste, including toxic waste. But those are just the direct emissions.

When we consider that health care is one of the largest economic sectors in Canada (almost 13 per cent of GDP, according to the Canadian Institute for Health Information), employs around the same proportion of the labour force and generates millions of kilometres of travel by staff, patients and suppliers, it is clear the system’s impact is even larger.

So it is exciting to hear the WHO announce that the governments of 50 countries had signed on to a commitment to develop climate-resilient and low-carbon health systems. Despite missing the original deadline, Canada did indeed sign on before the end of COP26, after being pressured by Canadian planetary health advocates in Glasgow and their colleagues across Canada. Thus, Canada has agreed to conduct climate change and health vulnerability assessments and to develop national adaptation plans for health.

It has also agreed to develop an action plan or roadmap to achieve sustainable, low-carbon health systems. Regrettably, however, Canada did not join 14 other countries, including Belgium, Spain and the U.K., in committing to creating a net-zero emissions health-care system.

The U.K. provides a useful example. In early 2020, the CEO of the National Health Service (NHS) commissioned a plan for the system to become “the world’s first ‘net zero’ national health service,” a plan it stuck with in spite of COVID. Launched in October 2020, the plan has two clear targets: For the emissions the NHS controls directly, achieve net zero by 2040; for the emissions the system can influence, achieve net zero by 2045.

The latter emissions include “indirect emissions from the generation of purchased energy, mostly electricity … and  … all other indirect emissions that occur in producing and transporting goods and services, including the full supply chain.” Achieving this by 2045 is ambitious.

Canada’s failure to sign on to a net-zero target is perhaps understandable. After all, health care is a provincial responsibility and not under federal control. So it is now up to our provincial governments to develop climate-resilient and low-carbon health systems and to achieve net-zero health-care systems.

This column was originally published in The Victoria Times Colonist Nov. 21.