The very system we rely on to keep us healthy is also making us sick.

It seems logical that the climate crisis would pose a threat to our health, but how the health sector, put in place to protect our health, would be a threat to it, seems paradoxical.

But according to the Health and Climate Network policy brief and Health Care’s Climate Footprint our current healthcare systems account for 4.4% of global greenhouse gas emissions. Put differently, if global healthcare were a country, it would be the fifth-largest climate polluter on the planet and would produce the equivalent of what 514 large coal-fired power plants produce in CO2.

Senior lecturer in the University of Cape Town’s (UCT) Faculty of Health Sciences lecturer James Irlam helped develop the policy brief for COP26 on sustainable and climate resilient health systems in 2021. He teaches evidence-based healthcare and environmental health and also chairs the climate energy and health special interest group of the Public Health Association of South Africa which advocates for healthy energy policy in South Africa. 

Irlam and Dr Louis Reynolds, a retired paediatric ICU and lung specialist, a member of the People’s Health Movement and of the advocacy committee in the Department of Paediatrics and Child Health at UCT, highlighted this paradox at a recent webinar held by groundWork to discuss the relationship between health systems and the global ecological crisis.

According to the policy brief, the source of the huge emissions varies, but most comes from the healthcare supply chain – production, transport and disposal of goods and services. The rest is from direct emissions from healthcare facilities and vehicles and indirect emissions from buying electricity, steam, cooling and heating.

Reynolds argues that health systems are endangering our health by aggravating climate change, about which Fiona Godlee, editor of the British Medical Journal, said in 2011: “The greatest threat to human health is neither communicable nor non-communicable disease. It is climate change.”

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How does climate change affect our health?

Reynolds said climate change affects our health indirectly and directly: directly by causing things such as rising sea levels and increased CO2 levels in the atmosphere, which not only increases the temperature but has knock-on effects on air and water quality and changes in vectors (insects that carry diseases being forced to move to different areas).

“And it particularly affects people who are vulnerable because of biological, social, economic or political influences.”

The indirect impacts include mental health, injuries, interpersonal violence, heat-related illness and death, forced migrations, civil conflicts and malnutrition and diarrhoea (from bad water).

We don’t have to look far for an example of malnutrition – Reynolds cites the massive food security crisis unfolding in Somalia where 7.1-million people are facing food insecurity and malnutrition and many are forced to migrate.

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Irlam highlighted in the policy brief that since the climate crisis and public health are interlinked, they have many of the same solutions, one of the most important being strengthening health systems.

Climate change and extreme weather patterns are making basic healthcare provision worse, as illustrated by the recent KwaZulu-Natal flood disaster, he said.

“We saw the floods that killed more than 400 people, made thousands homeless, robbed people of food and drinking water, making more people at risk of disease. People lost their medications because they couldn’t get access to the health facility [in addition to] personal insecurity [and] loss of work.”

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Reducing health system impacts

Irlam’s policy brief recommended sustainable, climate-resilient health systems to limit the health impacts of a changing climate without adding further damage.

An example of this is Global Green and Healthy Hospitals (GGHH), which GGHH’s African regional coordinator and webinar host Azeeza Rangunwala describes as an “international community of hospitals, health facilities, health systems [and] health organisations that are working to achieve measurable outcomes, improving sustainability at their facilities, while promoting environmental health in the communities”.

GGHH membership provides resources and access to tools and experts to help hospitals become more sustainable. Its goal is to deploy onsite renewable energy, source sustainably grown food for local communities, use water recycling and minimise waste. 

The policy brief Irlam helped develop has specific recommended actions related to policies, including building the resilience of health facilities to be able to anticipate and respond to climate change, building the resilience of vulnerable communities to be able to cope with the impacts of climate change (such as clean water, clean energy, nutritious diets, sustainable diet), and decarbonising health systems (reaching targets such as those in line with the COP26 health programme and regulating emissions from the production of medicines and medical supplies).

Reynolds suggested moving primary healthcare out of the hospital and into the community, making it more accessible and decreasing transport emissions, and argues for more multidisciplinary and less hierarchical team-based approaches.

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“Moving healthcare out of hospitals and into community means respect and support for community health,” he said, explaining that from there patients can be referred to more central hospitals and secondary and tertiary levels of care.

Reynolds also suggested that, to cut transport emissions, common and routine laboratory tests should be done at community facilities instead of sending them to central laboratories. He cites a recent Swiss study which found that an increase in transport distance from 5.5km to 15km raises the footprint of an average consultation by 56%.

Finally, an intersectoral approach would help tackle social issues that affected health.

“To reduce the burden of disease and the burden on the health system, it’s essential to get state sectors to work together to break out of their silos and work collaboratively to address the social determinants of health.” This would include addressing living conditions, unemployment, water and sanitation, and education. DM/OBP

This story first appeared in our weekly Daily Maverick 168 newspaper, which is available countrywide for R25.