Sustainability, health and politics: what can you do?

Many of you are fantastic clinicians, educators, academics, or quality improvement and patient safety advocates. Perhaps you never fitted neatly into any of those descriptions, but amongst the vast range of interests within medicine most of us find a home. In 2018 one of us (FB) became curious about the field of sustainable healthcare, a subject that aligned professional with personal ones. Increasing knowledge gave empowerment to focus attention on sustainability issues within healthcare but recognition that to affect the status quo at management level, more political drive would be required.

What can you do?

Fascinating research has been undertaken by political scientists into how to make the participation of ordinary people possible, probable and powerful [1]. Action can happen when motivation and authority align. Start by paying attention to the political, social and environmental context in which you are living and working. There are a plethora of resources available about planetary health [2], sustainable healthcare, sustainability in quality improvement (susQI) [3], and carbon literacy. The great news is that many of these topics overlap, so it takes just a little curiosity to translate knowledge into practice. Knowledge empowers and enables individuals and teams to enact transformational change within the clinical or political sphere.

Find strength in numbers; recognise that sustainable healthcare needs dedicated time and resources. In 2019, FB met Dan Morris, a local ophthalmologist, who had been working to reduce the carbon footprint of cataract surgery since 2012. They wrote a proposal and secured funding for a Sustainable Healthcare Leadership Fellow, utilising Health Education Improvement Wales leadership programme. This was ‘clearing stones’ so that others can lead the way. AF-W was the first fellow in 2020, SH the current incumbent. They have worked on reform of the undergraduate curriculum, health board sustainability action planning, the Nitrous Oxide Project, and susQI education.

Make friends

Tom Downs, in his Foundation years, undertook a Bevan Commission Exemplar project, harnessing the Well-being of Future Generations Act (Wales) 2015 [4] to explore the connections required to create a sustainable hospital, resulting in the inspiring Ysbyty Gwynedd Green Group.

Learn about the structure of the system in which you work to uncover how to align authority with motivation. Reach out to senior leaders to discuss pressing issues relevant to your healthcare setting.

Raise awareness of the climate and health crisis amongst those around you.

Embrace the opportunity to talk on the subject and encourage curiosity and interest. For example, FB and team presented at public health sessions, engaging health board executives and established the Welsh Environmental Anaesthesia Network (WEAN).

Advertise your successes. In 2019, a senior figure on a hospital visit spotted a curious poster describing WEAN’s Project Drawdown: our volatile agent reduction initiative. The environmental impact of healthcare was new to him. He and FB now sit on the same NHS Wales Decarbonisation Programme Board.

In 2021 NHS Wales published its strategic decarbonisation plan [5]. The net zero NHS Policies and our Future Generation Act were helping to align authority with our own personal motivation. With support from the Centre for Sustainable Healthcare, the Bevan Commission, and fledgling green groups, we launched Green Health Wales, a network for sustainable healthcare in Wales with three aims: ’Learn, Connect, Transform’, aiming to break down traditional silos within the healthcare sector to develop collective action through distributed networks underpinned by compassionate leadership [6].

Every anaesthetist has authority and support from their organisations (Association of Anaesthetists and RCoA) who have published sustainability strategies, the NHS decarbonisation policy, and COP26. Seize the moment, create opportunities, and follow every connection that comes your way.

Fiona Brennan
Consultant Anaesthetist
Cardiff & Vale UHB 

Amarantha Fennell-Wells
Welsh Clinical Leadership Trainee Fellow in Sustainable Healthcare 2020-21
Chief Fellow at the Office of the Chief Dental Officer, England 

Stacey Harris
Welsh Clinical Leadership Trainee Fellow in Sustainable Healthcare
ST5 Paediatrics, Cardiff & Vale UHB

Twitter: @brennan_fiona; @DrStaceyHarris; @amaranthafw

References 

1. The P3 Lab at Johns Hopkins. Welcome, 2021. https://www.p3researchlab.org/ (accessed 01/12/2021). 
2. Planetary Health Alliance. Home, 2021. https://www.planetaryhealthalliance.org/planetary-health https://www.p3researchlab.org/ (accessed 01/12/2021). 
3. Centre for Sustainable Healthcare. Home, 2021. https://sustainablehealthcare.org.uk/ (accessed 01/12/2021). 
4. Welsh Government. The well-being of future generations, 2021. https://gov.wales/well-being-of-future-generations-wales (accessed 01/12/2021). 
5. Welsh Government. NHS Wales decarbonisation strategic delivery plan, 2021. https://gov.wales/nhs-wales-decarbonisation-strategic-delivery-plan (accessed 01/12/2021). 
6. West MA. Compassionate leadership: sustaining wisdom, humanity and presence in health and social care. London: Swirling Leaf Press, 2021.

The Association of Anaesthetists recognise that our actions have an impact on the environment, and we see sustainability and climate change as key strategic issues. Find out more about what we do, and get advice and information on green anaesthesia.