Environmental impacts of Australia's largest health system

Transitioning to Environmentally Sustainable, Climate-Smart Radiation Oncology Care

<scp>AORN</scp> Position Statement on Environmental Responsibility

Integrating planetary health into clinical guidelines to sustainably transform health care

Health Care and Climate Change: Challenges and Pathways to Sustainable Health Care.

The Greenhouse Gas Emissions Associated With Cardiothoracic Surgery

BackgroundThe COVID-19 pandemic disrupted health systems around the globe. Lessons from health systems responses to these challenges may help design effective and sustainable health system responses for future challenges. This study aimed to 1/ identify the broad types of health system challenges faced during the pandemic and 2/ develop a typology of health system response to these challenges.MethodsSemi-structured one-on-one online interviews explored the experience of 19 health professionals during COVID-19 in a large state health system in Australia. Data were analysed using constant comparative analysis utilising a sociotechnical system lens.ResultsParticipants described four overarching challenges: 1/ System overload, 2/ Barriers to decision-making, 3/ Education or training gaps, and 4/ Limitations of existing services. The limited time often available to respond meant that specific and well-designed strategies were often not possible, and more generic strategies that relied on the workforce to modify solutions and repair unexpected gaps were common. For example, generic responses to system overload included working longer hours, whilst specific strategies utilised pre-existing technical resources (e.g. converting non-emergency wards into COVID-19 wards).ConclusionDuring the pandemic, it was often not possible to rely on mature strategies to frame responses, and more generic, emergent approaches were commonly required when urgent responses were needed. The degree to which specific strategies were ready-to-hand appeared to dictate how much a strategy relied on such generic approaches. The workforce played a pivotal role in enabling emergent responses that required dealing with uncertainties.

Assessing waste and carbon impacts of health system at a regional level

The Negative Bidirectional Interaction Between Climate Change and the Prevalence and Care of Liver Disease: A Joint BSG, BASL, EASL, and AASLD Commentary

Climate Change and Children Australian children are uniquely situated in a vast landscape that varies drastically across locations. Spanning multiple climatic zones—from cool temperate Tasmania to the tropical North—Australia is home to flora and fauna specific to diverse regions, including arid desert and rainforests, mountainous woodlands, and unique mangrove estuaries and coastal regions. Many of Australia’s endemic species—about 85%—are found nowhere else in the world, and in 2020 alone, 763 new species of flora and fauna were catalogued in Australia (Creswell et al). As a country, Australia is experiencing the full gamut of climate-related devastation, including rising land and sea temperatures, coral bleaching and loss of marine life, extreme bushfires and prolonged periods of drought, flooding, and relocation of communities. These extreme climate related events threaten human livelihoods and wellbeing in diverse ways, and disproportionately affect children. It is well documented that children around the world are experiencing anxiety, grief, anger, and despair about the damage climate change is causing to the planet, and the lack of action being taken to reverse this damage (Arnot et al.; Antronico et al.; Galway et al.; Hickman et al.; Ojala et al.). Today’s children will inherit a myriad of critical environmental, health, and socio-economic issues that will shape their future. Awareness of these impending challenges can invoke extreme distress from a very young age (Lee et al.; Halstead). Despite their feelings of powerlessness (Hickman et al.; Galway) and the disproportionate impact on their generation, children and young people are effective agents of change (Treichel; Haltstead; Trott). Climate change research is demonstrating that “children are effective communicators”, they “possess unique perceptions of risks” and “have distinctive knowledge and experiences and are capable of identifying and implementing viable, locally appropriate adaptation responses” (Treichel 27). The specific climate-related effects that children face vary based on their geographic location and socioeconomic difference. While global narratives and imagery about climate change and its impacts often utilise widely recognised phenomena such as melting sea-ice, deforestation, coral bleaching, and the great pacific garbage patch, the specific challenges faced by Australian children in their local suburbs look quite different. To explore the specific climate-related experiences and concerns of some Australian youth, creative and participatory workshops were conducted with children and young people in three geographically diverse regions of New South Wales (NSW). During the month of July 2023, 49 children and young people aged between 10 and 18 years participated in climate change workshops run by the Young and Resilient Research Centre at Western Sydney University. The workshops formed part of the research project in partnership with UNICEF Australia, who also co-facilitated some workshops. Participants were recruited from three regions of NSW, including Western Sydney (WS; 34 participants), the Upper Hunter (UH; 2 participants), and the Northern Rivers (NR; 13 participants). The purpose of the workshops was to explore children’s perceptions and experiences of climate change, as well as their aspirations for the future, which were then used to develop a child-centred indicator framework for climate change (Third et al.) During our workshops we discovered that children communicate specific climate-related challenges and fears based on the unique landscape in which they live, and these location-based issues are the subject of this article Children from Three Climate-Affected Areas Most workshop participants (86%) shared feelings of sadness, anger, and worry about climate change. These feelings reflect a state of solastalgia: a sense of loss and pain for the land that they love and call home (Albrecht). Participants expressed feeling a disproportionate “sense of responsibility/burden … to create change and solve [a] climate crisis that they did not start” (F, 15, WS). This responsibility “puts pressure on us to fix the mistakes of the older generation”, asserted one participant (F, 15, WS). And the burden of advocating for climate action, with its ongoing and cumulative impact on mental health, was recognised by another participant as increasing levels of “depression [and] anxiety about the future” (F, 18, WS). Throughout the workshops, one of the greatest fears expressed by participants was the prospect of climate change disrupting access to the natural world. Recognising the many benefits of spending time outdoors, participants expressed concern that climate change induced temperatures and events will trap them indoors, impacting on their wellbeing. They fear a future where “weather conditions will be unfit to go outside” (M, 15, WS), where “air pollution” and “overheating” (F, 15, WS) lead to adverse health effects and more time indoors. They also fear losing “access to education in times of bushfires, droughts, floods” (F, 17, WS), resulting in prolonged periods of remote learning (learning from home). As one child said, “we will be stuck inside or living underground” (M, 15, WS). In addition to losing access to natural spaces, children also fear destruction of the landscape. They fear a future where “waterways and landscapes are covered in rubbish and sewerage” (small group, 13-15, NR), where animals lose their natural “habitats due to deforestation” and become extinct (F, 15, NR). The Australian children and young people who contributed to this research demonstrate an acute awareness that connections with the land mediate connections within and between ourselves. They recognise the critical role that land plays in our construction of identity and community. For tens of thousands of years, Australian lands have been tended in interdependent relationship with Indigenous Australian communities (Malaspinas et al.)—cultures that represent a capacity for deep listening to the rhythms and needs of the land in all its diversity. Our participants fear a separation from land and urge all Australian citizens to act as stewards of our country. One group of children was eager to promote “an equal society that contributes to taking care of the society and land equally” (small group, 12-15, WS), while another emphasised that future action should involve following “First Nation’s environmental practices” (small group, 12-16, WS). The specific location-based experiences, challenges, and fears that emerged in engagement with these young people are explored below. Western Sydney Located in the geographical centre of the Sydney basin, Western Sydney is a dynamic, culturally diverse urban region. It has a rapidly growing population (About GWS) and is currently experiencing significant temperature rises related to its geographical location and urban heat island effects (Bubathi et al). Despite commencing only 30 kilometres from central Sydney, the Greater Western Sydney area experiences summer temperatures that can top Sydney’s maxima by 10°C (Bubathi et al). In early 2020, the city of Penrith in Greater Western Sydney was the hottest place on earth, hitting 48.9°C (Sydney’s Penrith). If carbon emissions are not significantly curbed, recent predictions suggest that, by 2090, Western Sydney could face up to 46 days each year of temperatures over 35°C (Melville-Rea and Verschuer). The economic impacts of rising temperatures—not to mention environmental and wellbeing impacts—will pervade society, from the individual ability to access necessary healthcare, utilities, food, and other necessities, to a whole nation’s capacity to provide for itself and engage meaningfully in the global economy (see Wood et al.; Steffen et al.; Australian Government). The Western Sydney region workshops took place in the suburb of Liverpool, a rapidly growing residential and multicultural area, with a population predicted to double by 2041 (Liverpool City Council). The ever-increasing demand for housing, coupled with rising interest rates and cost-of-living concerns, is putting considerable strain on families across the region, affecting household structures (Shaweesh). Western Sydney features a large culturally and linguistically diverse community, in which large family sizes and intergenerational living are common (Dockery et al.; Shaweesh). Many households in Western Sydney, including in the Liverpool region, are multigenerational or multi-family, reflecting a growing number of such households in the Western world (Lane and Gorman-Murray). Cultural values play an important role in shaping household makeup, but so do issues of housing affordability, rapid population growth, and migration—all of which contribute to housing density in the suburbs surrounding major Australian cities such as Sydney (Daley et al.; Shaweesh). While family structures and household compositions continue to change in response to social and cultural values and economic needs, physical dwellings and suburban structures tend to stay stagnant (Judd). This can lead to overcrowding (Dockery et al.). As Maram Shaweesh writes, “given that housing affordability is an obstacle to accessing adequate housing in Australia, larger nuclear families can end up living in housing that is too small for their needs (in terms of amenities), leading them to experience house crowding (Dockery et al.)” (140). Liverpool participants expressed significant concern about overcrowding in households and local communities. Although one child expressed concern that overpopulation in homes due to the cost-of-living crisis could affect “the upbringing of children” (F, 15, WS), most children were concerned about the impact of overcrowding on their access to essential resources. As one young person wrote, “overcrowding in cities is leading to hardships to access basic facilities such as schools, hospitals, etc.” (F, 18, WS). In addition to the housing affordability crisis in Sydney, participants also fear that “overcrowding in urban sprawls/cities” (M, 15, WS) will decrease their access to essential resources and facilities. One participant explained that “accessibility and cost of facilities would greatly affect young adults and children” because "the costs for these facilities would go up”, making them "less accessible for people in lower class areas” (M, 15, WS). Children in this region fear a future in which “food prices skyrocket due to food insecurity” (M, 15, WS); where families face “higher prices” and risk “losing jobs” (M, 16, WS); where the “cost of travel will increase (petrol and gas)” and “[public] transport costs will rise” (M, 16, WS) to the extent that people lose their mobility, “making it harder for them to travel” for work (M, 15, WS). Children and young people in Western Sydney were particularly sensitive to socio-economic inequality, and the disproportionate effect climate change has on vulnerable members of the community. Climate change “can impact certain communities more (for example, regional/rural, disabled, chronically ill etc.)” (F, 15, WS), one young person explained, while another observed that climate change “impacts people in lower socioeconomic conditions significantly” (F, 17, WS). Children in Western Sydney fear that climate change will worsen the economic prospects of people in their region. “Those who have grown up in a poor household will never be able to escape poverty due to the worsening of the economy [due to climate change]” (F, 15, WS). Some children also expressed concern that the rising cost of living, overcrowding, and limited access to resources will lead to increased levels of crime. There is evidence elsewhere in the world that climate-related events, such as agricultural crop devastation, can lead to famine and local and regional conflict (Akresh). Western Sydney children intuit this in their concerns. They fear that the rising “cost of living” and “food insecurity” (F, 15, WS) will lead to “increases in crime” (M, 15, WS) as well as “riots, fights for rights and action, [and a] lack of safety” (F, 15, WS). Upper Hunter Spanning a large region located 150km north of Sydney, the Hunter Valley comprises a river valley which extends 200km inland from the coast. The region boasts coastal beaches and estuaries, river wetlands, densely forested hills, and rich soils (Geary et al.). Traditionally a mining community, the Hunter Valley is Australia’s largest single source of coal and largest single source of carbon dioxide emissions (Evans). Extensive mining in the region has caused “profound changes to the landscape and long-term impacts on ecosystem and health” (Albrecht et al. 96). Residents of the Hunter frequently face air pollution levels which reportedly breach international standards (Fowler). In 2018, a mining facility in the Hunter was listed as one of the top 5 most polluting facilities in Australia (Australian Conservation Foundation). Families in the region are affected by coal dust and poor air quality due to the proximity of coal mines in the region, and many people have previously expressed distress about the ways this destruction of land threatens their identity and wellbeing (Albrecht; Albrecht et al.). Young people in all workshop locations expressed concerns about air quality and the detrimental effects of pollution on human health and the environment. But responses from the two participants in the Upper Hunter were particularly focussed on this issue, reflecting concerns about, and experiences of, coal mining impacts in their region. These young people hoped for a future where “mining has stopped near heavily populated towns” and where “coal mines [have] moved further away” (F, 12, UH). Coal mining was seen as a matter of environmental ethics. One participant expressed the desire for “a clean and better future”, in which “gasses that can and will pollute the air” are no longer used, and where “we stop cutting down trees” (F, 12, UH). Another asserted that “we need to move away from coal and gas, [and] move towards clean energy” (M, 13, UH). Research conducted by the Australian Conservation Foundation shows that air pollution tends to have a disproportionate effect on low- and middle-income households (Australian Conservation Foundation). While the Upper Hunter is currently undergoing a process of transition—from mining to renewable energy—participants were mindful that this must be a just transition that prioritises “decent work and quality jobs” (UNFCC) for the 14,000 workers employed by coal mines in the region (3 Local Solutions). Northern Rivers The Northern Rivers region of New South Wales is one of the state’s most biologically diverse regions (North Coast). Life is shaped by the lay of the land; but while the geography of the Northern Rivers—its plains and many river catchments—have historically made flooding a regular occurrence, the floods of 2022 were a “catastrophic disaster”, and were some of the worst in Australia’s written history (Royal Far West; McNaught et al.). These floods were preceded by the COVID-19 pandemic, the Black Summer bushfires of 2019, and by serious floods in 2017 (Royal Far West; McNaught et al.). Over one metre of rain fell in a single week during February and March 2022, and “whole roads and houses were pummelled by hundreds of landslides and boulders” (McNaught et al.). In the town of Lismore, floods rose “more than 2 m higher than the previous [2017] records” and damaged over 10, 000 homes (McNaught et al.; NSW Reconstruction Authority; Headspace). “The broader population”, McNaught et al. explain, “experienced periods of no or limited access to cash, petrol, communications, food, schools, carer services and medical assistance”. These were the sorts of scenarios in their region that young participants were exposed to. The 2022 floods had significant impacts on children's and young people’s education, physical and mental health, and safety (Royal Far West). A 2023 study highlighted the prevalence of eco-anxiety amongst the region’s flood-impacted young people (Headspace). The study found that more than half their participants felt fearful about the future, while one in five said climate change affects their daily lives. Describing the impact of the floods on the local community, one local young adult said, “I think that the general feeling in the community was one of gut-wrenching pain. Not on just a physical and mental level, but also on a spiritual level. It was our whole community—tens of thousands of people—impacted” (Zanuso in Headspace). During the 2022 floods, 331 schools in NSW were forced to temporarily close, and many students had to relocate for extended periods—as did many residents whose homes were destroyed or damaged (Royal Far West). These experiences were powerfully reflected in young people’s input at workshops, where they expressed a very real sense of the imminent threats of climate change. The workshop responses from Northern Rivers young people were “profoundly shaped” by their recent experiences of extreme weather events (Third et al. 25). Many responses were especially focussed on climate-related disruptions to education and resourcing, showing the ways in which participants value their education and the future opportunities it brings. Participants demonstrated concern about the ongoing impacts of climate disasters on their schooling: “schools won’t be useable because of the constant flooding”, one small group of 14–17-year-olds explained; “the school will have to be constantly rebuilt which would cost lots of money”. And, where the over-population of schools due to relocation of displaced students occurred, this could “lead to [a] lack of quality education and opportunities” (small group, 13–15, NR). “[Having a] bigger school affects education equality”, one student observed (15, F, NR), while another explained that in such scenarios, “schools won’t have the right materials to teach” (14, M, NR). The long-term effect of climate-related displacement is a huge concern expressed by Northern Rivers participants, many of whom are still feeling the impact of the 2022 floods in their community. “Even today in 2023, there are houses that are empty, and it plays on your mind. There were people living in those homes once, and there are no longer people there. It hits very close to home” (Zanuso in Headspace). Children and young people demonstrate serious concern about the longevity of their community. “By doing nothing about climate change”, said one group of 14–17-year-olds, “downtown Lismore will be uninhabitable due to regular flooding”. “Twenty years into the future”, another group declared, “[climate change will have] flooded Lismore out of existence” (small group, 13–15, NR). For these young people, the possibility of having to leave their homes and communities permanently because of the impacts of climate change is already a reality. Conclusion The imagery associated with climate change globally—ice caps melting, coral bleaching, the increasing threat to natural flora and fauna, and so on—can often feel distant and removed from everyday life in the suburbs. The reality is, however, that climate change poses a very real threat to our daily lives, and this threat is felt keenly by the young participants of this study. Australian children and young people face the effects of climate change every day in their local suburbs and communities. Importantly, climate change affects them differently according to the landscape in which they live. Within the same state of New South Wales, at three separate locations within a 740km distance, children express specific climate-related challenges and concerns which differ greatly according to location. In Western Sydney, children fear rising temperatures, overcrowding, and losing access to essential resources. In the Hunter Valley, children fear destruction of the natural landscape, poor air quality, and uncertainty at a time of just transition. In the Northern Rivers region, children fear the ongoing impacts of devastating floods, including the destruction of infrastructure and the relocation and loss of their community. Australian children experience climate change differently according to the landscape in which they live, but they share a sense of despair about the destruction of land and loss of wellbeing. In addition to a commitment to global and national climate action, concrete location-based action that addresses specific local challenges will be essential to bolstering resilience to future climate change events.

Measuring the environmental sustainability performance of global supply chains: A multi-regional input-output analysis for carbon, sulphur oxide and water footprints

Climate change is a complex and contentious public issue, but the risk-management options available to us are straightforward and have well-characterized strengths and weaknesses.

Climate And Health.

The real estate sector and its supply chains, i.e. up- and downstream processes, are responsible for a significant share of the greenhouse gas (GHG) emissions in most countries. The GHG emissions from the Swiss building stock are quantified and the hotspots identified along its supply chain using the multiregional, environmentally extended input–output tables Exiobase v3. Biodiversity impacts caused by land use, water stress due to water consumption, air pollution and eutrophication impacts are also quantified. The environmental impact-reduction requirements were estimated based on global planetary boundaries assuming that each economic sector will reduce its impacts according to the required global reduction. The Swiss real estate sector causes more than 24 Mt CO2e/year, which is 480 ppm of global emissions, while its gross value-added share is 200 ppm. Hence, the GHG emissions per US dollar gross value added of the Swiss real estate sector are above average. Two-thirds of the emissions are caused during the use stage of buildings, whereas 30% are caused by the supply chains. A reduction to net zero is needed within the next two to three decades to comply with the 1.5°C limit. The real estate sector must address its supply chains, but also must its tenants and users. Policy relevance The Swiss real estate sector building-related GHG emissions are analysed, taking into account the full building life cycle. The requirements for environmental impact reduction are estimated based on global planetary boundaries, assuming that each economic sector reduces its impacts with the same global percentage. The Swiss real estate sector is found to be environmentally inefficient: it causes more GHG emissions compared with its gross value-added share. Two-thirds of the emissions are caused during the use phase of buildings, with the remainder caused by the supply chain. A reduction to net zero is needed at the latest by 2050 in order to comply with the 1.5°C limit. The real estate sector should thus further increase the energy efficiency of buildings, phase out the use of fossil fuels and address its supply chains (particularly the construction materials and products) to develop zero emission products.

BackgroundHealth systems underwent substantial changes to respond to COVID-19. Learning from the successes and failures of health system COVID-19 responses may help us understand how future health service responses can be designed to be both effective and sustainable. This study aims to identify the role that innovation played in crafting health service responses during the COVID-19 pandemic.MethodsSemi-structured interviews were conducted online, exploring 19 health professionals’ experiences in responding to COVID-19 in a large State health system in Australia. The data were collected from April to September 2022 and analysed utilising constant comparative analysis. The degree of innovation in health service responses was assessed by comparing them to pre-pandemic services using 5 categories adopted from the IMPISCO (Investigators, Methods, Population, Intervention, Setting, Comparators and Outcomes) framework, which classifies interventional fidelity as: 1/ Identical: No differences are found between health services; 2/ Substitution with alternatives that perform the same function, 3/ In-class replacement with elements that delivers roughly the same functionality, 4/ Augmentation with new functions, 5/ Creation of new elements. Services were decomposed into bundles and fidelity labels were assigned to individual bundle elements.ResultsNew services were typically created by reconfiguring existing ones rather than being created de novo. The presence of pre-existing infrastructure (foundational technologies) was seen as critical in mounting fast health service responses. Absence of infrastructure was associated with delays and impaired system responses.ConclusionsThe need to reconfigure rapidly and use infrastructure to support this suggests we reconceive health services as a platform (a general-purpose service upon which other elements can be added for specific functions), where a common core service (such as a primary care practice) can be extended by adding specialised functions using mediators which facilitate the connection (such as virtual service capabilities). Innovation can be costly and time consuming in crises, and during the COVID-19 pandemic, innovations were typically patched together from pre-existing services. The notion of platforms seems a promising way to prepare the health system for future shocks.

Pitched battles are a regular occurrence in northern Alberta, Canada, as development of the province’s oil sands continues to expand. One ongoing battle—with another salvo launched in February 2011 with the leak of a European Commission report1—concerns how dirty oil sands are, relative to other fuels. Another concerns the influence of the oil sands industry in monitoring its own activity.2 In an effort to cut through the rhetoric of health advocates, industry representatives, environmentalists, government officials, and local residents, the Royal Society of Canada (RSC) selected and covered expenses for an expert panel to winnow out the facts. In a report issued 15 December 20103 the panel cited substantial evidence that efforts to extract oil from the Alberta deposits have degraded air, land, and water quality to varying degrees. The extent of the degradation is sometimes controversial; water quality data, in particular, are subject to differing interpretations and attributions of causality. However, the panel says that, based on publicly available evidence, there appear to be no significant human health threats to the general population either now or from development anticipated in the next decade or so. But the panel also warns that their conclusions come with a major caveat: there are major gaps in health and environmental data, risk assessments, government oversight, information transparency, industry efforts, and disaster preparedness. The health of the region could hinge on these gaps being addressed, particularly since, according to Travis Davies, a spokesman for the Canadian Association of Petroleum Producers, 97% of projected oil extraction and processing is still to come. After the RSC panel reviewed reams of publicly available information on factors such as health status, air and water pollution, greenhouse gas emissions, land disturbance, and energy and water consumption, it concluded that “[t]he claim by some critics of the oil sands industry that it is the most environmentally destructive project on earth is not supported by the evidence. However, for Canada and Alberta, the oil sands industry involves major environmental issues on many fronts which must be addressed as a high priority.”3p293