April 7 is World Health Day and each year the World Health Organization (WHO) highlights an area of priority concern. This year’s theme is “Our Planet, Our Health” to draw attention on urgent actions needed to keep humans and the planet healthy and foster a movement to create societies focused on well-being.
Canadian health care contributes 4.6% of the national greenhouse gas emissions so while there is much to do, this is also a moment to reflect on the important work already underway.
In Fraser Health, Dr. Kevin Liang is working with Population and Public Health to introduce greener alternatives to family physicians across our region.
As a family medicine resident with Fraser Health, he is especially interested in how his work can engage other health professionals in addressing – and combatting – the current climate emergency.
“I have long held a strong passion for planetary health, specifically examining the role of health care in the climate emergency,” says Dr. Liang. “This passion only intensifies every year, as I see the escalating health effects of climate change on the patients I care for.”
As part of his final residency project, Dr. Liang is working with Fraser Health Population and Public Health, looking at the environmental impact of inhalers across our region.
“Propellants used in metered-dose inhalers (MDIs) for asthma and chronic obstructive pulmonary disease (COPD) have an outsized climate footprint,” explains Dr. Liang. For instance, one blue inhaler of Salbutamol has the equivalent climate footprint of a 290 kilometer car journey.”
His goal is to first examine how many MDIs are being used across Fraser Health, and then engage prescribers – including family physicians – to consider greener alternatives, whenever possible.
“There are climate-friendly options that can provide even better asthma and COPD control,” he continues,
When physicians find out the climate impact of MDIs, I find that they are all more than eager and excited to work with their patients and switch to greener alternatives.”
Staff can read more about this project on The Beat here (need to be connected to health authority computer network).
At BC Cancer, there is important work underway to address the climate emergency through the newly created BC Cancer Planetary Health Unit.
Led by diagnostic radiologist Dr. Maura Brown, radiation oncologist Dr. Shilo Lefresne, and medical oncologist Dr. Caroline Mariano, the BC Cancer Planetary Health Unit is an exciting step forward in establishing low waste, low carbon health care across cancer centres.
This clinician-led initiative will provide education and resources to engage and inspire clinicians to help establish low waste, low carbon health care throughout BC Cancer. They will work to promote new initiatives and support climate resilient sustainable health systems through knowledge-mobilization and networking.
The project started with informal conversations among BC Cancer staff about the climate crisis and accompanying health crisis. It became apparent that others across the province had similar concerns and that many had ideas for improvement and / or a wish to learn and do more to reduce waste and mitigate emissions arising from the provision of health care.
As clinicians, our responsibility to our patients and communities necessitates urgent attention to reducing emissions and harmful pollution arising from health care services through reducing overuse, matching supply to demand, and ensuring resource stewardship,” says Dr. Brown.
The BC Cancer Planetary Health Care Unit is currently working on a variety of projects, which include:
- Eliminating the routine use of exam table paper in outpatient clinics
- Working with Diagnostic Imaging to lower the power use of CT scanners, and reduce emissions from waste heat in CT. Subsequent similar projects may include MRI and CT PET.
- Collaborating with GreenCare to improve recycling and clinical waste management
Staff can read more about this initiative on the POD here (need to be connected to health authority computer network).
Taking a bite out of food waste in health care
Food waste is an issue that’s not new for institutions, says Dr. Eileen Wong, and one that she’s sought to address in long term care at Holy Family Hospital (Providence Health Care), by looking at it from the perspective of resident quality of life and enjoyment.
Recognizing how often enjoyment of food – or lack thereof – came up in family meetings with staff at Holy Family Hospital’s long-term care, in early 2018, she started a quality improvement project measuring the amount of food that long-term care residents weren’t finishing and to understand why, as it was a consistent cause of concern for families. “We want the best possible food experience for the residents,” Eileen explains.
“The idea came from idea of ‘food is medicine’ for the soul. We all eat food, we all need food, make it the best we can especially for people who are vulnerable. It’s important that we take that extra time and effort to make the food experience better.”
By making some simple changes, such as reducing portion sizes while retaining needed calories, food waste from cognitively intact residents dropped by half from December 2018 to September 2019. “Producing, distributing and preparing food all takes resources and energy – water, fertilizer, fossil fuel – so health care institutions have a responsibility to consider how this impacts planetary health, and what we can do to make improvement,” explains Eileen.
In Vancouver Coastal Health, Dr. Annie Lalande, a resident physician working in Dr. Andrea MacNeill’s Planetary Health Lab, led a similar study of 100 surgical patients at Vancouver General Hospital. Over the 12 weeks of the study, which weighed the amount of unconsumed food at each meal served to the patients, more than 565 kilos of food were wasted. It’s not uncommon, she says. On average in Canadian hospitals, about 50 percent of food served to patients is thrown out.
“When you consider this in the context of the thousands of admissions we have at VGH alone every year, it’s striking,” Annie says. “We have seen even more clearly over the last year how the planetary climate and ecological crisis is a health crisis as well. Food systems are major drivers in this, and malnourished patients have much higher health-care demands.
“We are in a loop where food drives illness and ecological crises, which then leads to more health issues, which then drives the ecological crisis further. We have a vested interest in increasing health on all these levels.”