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2023 OHE Annual Report to the Charity Commission
Green Healthcare: Are We Asking the Right Questions?
The climate-health crisis is a growing global concern, and identifying the right starting points is crucial.
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This OHE webinar featured interviews with three global panellists representing government, healthcare, and academia to identify the most pressing challenges and gaps in our understanding. OHE responded with how health economics can offer the toolkit to begin to answer some of the most pressing unanswered questions and catalyse some of the most urgently needed changes. This article captures the key insights that the panel shared during the webinar.
KEY GAPS IN UNDERSTANDING
Our panellists explored the dual challenges of managing the impact of climate change on healthcare systems whilst reducing healthcare’s own environmental footprint. Some of the most significant barriers to a sustainable healthcare landscape include:
Overlooked impacts
As climate change accelerates, the extent of the effects on health and healthcare systems are becoming increasingly acknowledged. However, there are still areas where a significant lack of understanding persists. One such example is the impact on mental health, including the psychological toll of disasters and displacement, as well as the emotional effects of prolonged exposure to environmental stressors. These effects require deeper exploration and consideration of strategies for integrating adequate support into climate adaptation strategies.
Agency and headspace
Beyond awareness of the issue, it is often unclear how individual clinicians and healthcare workers can mitigate this. Healthcare systems do not always empower individuals to make meaningful sustainable decisions, due to systemic constraints such as resource limitations and time pressures. Unfortunately, this leads to missed opportunities for small changes that could have significant cumulative effects on carbon footprint as well as healthcare outcomes. The panel shared an optimism for the healthcare sector, noting that there is not a lack of willpower, but rather a chronic lack of headspace for people to prioritise sustainability.
Comprehensive data
The panel agreed that comprehensive data needs to explicitly link healthcare interventions with environmental factors as well as patient health outcomes to facilitate our ability to monitor and respond to vulnerabilities in the system. Importantly, this would enable effective tracking of trends of disease prevalence across regional and geographic area, allowing us to tailor interventions and target treatments accordingly.
WHAT IS MOST URGENTLY NEEDED?
Creating a sense of urgency
To drive large-scale commitment to change, the economic and social costs of inaction need to be clearer. An existing example of this is the loss of 4.2 million lives annually resulting from ambient pollution-related disease (WHO).
Integrating financial and environmental returns into decision making can help reconcile the often-debated trade-offs between economic growth and sustainability.
Leadership with a clear intention to foster change is key to facilitating this. In practice, this includes amplifying the voices of those most affected by climate change and health disparities, ensuring that policies and actions are done in the best interest of equity. This is key to engaging communities to establish a shared motivation to take accountability and drive change.
The panel also discussed the need for quantifying the impact and cost of decisions, noting how the carbon budget curve shows that if current emission rates continue, remaining carbon budgets will be exhausted faster. This curve can help to visualise the urgency of reducing emissions.
Whilst some trade-offs might need to be sacrificed in the short term, health economics can evidence why it is worth investing longer term. Importantly, analyses can quantify the cost of action as well as inaction, driving policy makers to take urgent action.
Policy changes and effective implementation
Developing our understanding of the issues is not enough on its own, as seen by the lack of policies in Sub-Saharan Africa addressing climate concerns despite knowledge of elevated vulnerability in this region. This disparity between the current situation and the action plan represents a significant obstacle to progress. Policies need to be devised to pragmatically respond to the issues at hand. Unfortunately, the implementation of such policies is a huge barrier in itself due to the long and complicated processes. The panel stressed the value of support and examples of critical success factors when making systemic policy transitions. Whilst research and policy formulation are important for this top-down change, understanding behavioural change is key to understanding what motivates all levels of society to embrace transformation.
At the heart of economics is a study of designing incentives to enhance systems and promote a willingness to pay for change. Through quantifying health burdens, and by demonstrating the economic benefits of interventions that improve the health of people and the planet, this research can attract funding and investment for service improvements.
Health economics can also help incentivise industry by ascertaining what the most effective combination of incentives is to drive impactful change.
Incentives can include:
- Financial incentives (e.g. tax credits, subsidies, carbon pricing mechanisms)
- Competition and Markets Authority incentives (e.g. non-appreciable environmental sustainability agreements to help encourage businesses)
- Reputational incentives (e.g. company ESG ratings impacting investor behaviour)
- Regulatory incentives (e.g. emission reduction targets, environmental standards and certifications)
OHE is dedicated to fostering critical thinking in the policy sphere through the Innovation Policy Prize, which offers a platform for ideas to improve knowledge surrounding policies for the health and life sciences sector. This year’s question specifically focuses on the nexus between climate change and health.
Building a culture of sustainability
The panel discussed the benefits of fostering a culture that values sustainability and encourages individual decision-making in line with these values. In practice, this could look like allocating protected time for healthcare workers to prioritise this amongst their daily activities, or by embedding sustainable practices in education programmes and initiatives such as those offered by Healthcare Without Harm. We must recognise that sustainability does not sit by itself, but rather alongside other issues like health inequity and patient safety. Developing our knowledge of how sustainable practices have positive outcomes on other areas of society is key for driving motivation for change.
Convening high impact actors
Efforts should focus on engaging major global actors and investing in innovations to reduce greenhouse gas emissions. Countries and systems with successful sustainable healthcare trials should share best practice so that these strategies can be adapted and scaled. Examples include Thailand’s attempts to learn from Singapore’s success in improved access and reduced delays following the adoption of decentralised care. Transparency and knowledge sharing is crucial for fostering accountability and driving further innovation. The panel agreed that partnership is a powerful tool for unlocking the sustainable and adaptable healthcare system of the future.
OHE is leveraging health economics to champion cross-sectorial partnership through the launch of the Change Initiative, which convenes diverse organisations to approach equitable solutions collaboratively. The power of health economic research is more impactful when combined with insights across sectors and geographies.
Preparedness and systemic adaptation
Healthcare systems must integrate environmental health practices, innovative technologies and sustainable supply chains. This requires a holistic approach, emphasising preventive and curative care through community programs, telemedicine and continual monitoring. An adaptive healthcare system requires flexible delivery to be prepared to respond to emerging threats and supported by interdisciplinary cooperation and equitable policies.
Setting clear milestones is a useful way to lay the roadmap for transitioning into this improved system of the future. We can begin with implementing low-cost but high impact sustainable practices across the system; and by building awareness and education into our culture. In the mid-term, we need cross-sectoral collaboration to begin necessary infrastructure changes for supporting sustainable practices to persist in the long term.
Harnessing data to identify signals and predictors can guide us in altering the trajectory of climate-related health impacts, preventing the need for care and easing the burden on the healthcare system. The most sustainable care is that which does not need to be delivered, as outlined in the OHE report: Reimagining Prevention. Health economics has already made a compelling case for prevention, even before considering the environmental benefits.
Health economics can offer innovative economic solutions to achieve environmental sustainability goals without necessarily compromising on financial sustainability. Paired with the insights shared across the panel, this will facilitate the systemic transformation needed to establish a healthcare system that meets the needs of both patients and planet.
You can find out more about OHE’s Change Initiative here.
