Sustainable Healthcare PDF
Preview Sustainable Healthcare
Sustainable Healthcare Sustainable Healthcare Knut Schroeder GeneralPractitioner(FamilyPhysician),ConcordMedicalCentre HonorarySeniorClinicalLecturer CentreforAcademicPrimaryCare SchoolofSocialandCommunityMedicine UniversityofBristol Bristol,UK Trevor Thompson GeneralPractitioner(FamilyPhysician),WellspringHealthyLivingCentre ReaderinHealthcareEducation CentreforAcademicPrimaryCare SchoolofSocialandCommunityMedicine UniversityofBristol Bristol,UK Kathleen Frith President,GlynwoodandformerManagingDirector CenterforHealthandtheGlobalEnvironment HarvardMedicalSchool Boston,MA,USA David Pencheon Director NHSSustainableDevelopmentUnit EastofEnglandStrategicHealthAuthority Cambridge,UK A John Wiley & Sons, Ltd., Publication Thiseditionfirstpublished2013,2013byJohnWiley&SonsLtd. BMJBooksisanimprintofBMJPublishingGroupLimited,usedunderlicencebyBlackwellPublishingwhich wasacquiredbyJohnWiley&SonsinFebruary2007.Blackwell’spublishingprogrammehasbeenmergedwith Wiley’sglobalScientific,TechnicalandMedicalbusinesstoformWiley-Blackwell. Registeredoffice:JohnWiley&Sons,Ltd,TheAtrium,SouthernGate,Chichester,WestSussex, PO198SQ,UK Editorialoffices:9600GarsingtonRoad,Oxford,OX42DQ,UK TheAtrium,SouthernGate,Chichester,WestSussex,PO198SQ,UK 111RiverStreet,Hoboken,NJ07030-5774,USA Fordetailsofourglobaleditorialoffices,forcustomerservicesandforinformationabouthowtoapplyfor permissiontoreusethecopyrightmaterialinthisbookpleaseseeourwebsiteatwww.wiley.com/ wiley-blackwell TherightoftheauthortobeidentifiedastheauthorofthisworkhasbeenassertedinaccordancewiththeUK Copyright,DesignsandPatentsAct1988. Allrightsreserved.Nopartofthispublicationmaybereproduced,storedinaretrievalsystem,ortransmitted, inanyformorbyanymeans,electronic,mechanical,photocopying,recordingorotherwise,exceptaspermitted bytheUKCopyright,DesignsandPatentsAct1988,withoutthepriorpermissionofthepublisher. Designationsusedbycompaniestodistinguishtheirproductsareoftenclaimedastrademarks.Allbrandnames andproductnamesusedinthisbookaretradenames,servicemarks,trademarksorregisteredtrademarksof theirrespectiveowners.Thepublisherisnotassociatedwithanyproductorvendormentionedinthisbook. Thispublicationisdesignedtoprovideaccurateandauthoritativeinformationinregardtothesubjectmatter covered.Itissoldontheunderstandingthatthepublisherisnotengagedinrenderingprofessionalservices.If professionaladviceorotherexpertassistanceisrequired,theservicesofacompetentprofessionalshouldbe sought. Thecontentsofthisworkareintendedtofurthergeneralscientificresearch,understanding,anddiscussiononly andarenotintendedandshouldnotberelieduponasrecommendingorpromotingaspecificmethod, diagnosis,ortreatmentbyphysiciansforanyparticularpatient.Thepublisherandtheauthormakeno representationsorwarrantieswithrespecttotheaccuracyorcompletenessofthecontentsofthisworkand specificallydisclaimallwarranties,includingwithoutlimitationanyimpliedwarrantiesoffitnessforaparticular purpose.Inviewofongoingresearch,equipmentmodifications,changesingovernmentalregulations,andthe constantflowofinformationrelatingtotheuseofmedicines,equipment,anddevices,thereaderisurgedto reviewandevaluatetheinformationprovidedinthepackageinsertorinstructionsforeachmedicine, equipment,ordevicefor,amongotherthings,anychangesintheinstructionsorindicationofusageandfor addedwarningsandprecautions.Readersshouldconsultwithaspecialistwhereappropriate.Thefactthatan organisationorWebsiteisreferredtointhisworkasacitationand/orapotentialsourceoffurtherinformation doesnotmeanthattheauthororthepublisherendorsestheinformationtheorganisationorWebsitemay provideorrecommendationsitmaymake.Further,readersshouldbeawarethatInternetWebsiteslistedinthis workmayhavechangedordisappearedbetweenwhenthisworkwaswrittenandwhenitisread.Nowarranty maybecreatedorextendedbyanypromotionalstatementsforthiswork.Neitherthepublishernortheauthor shallbeliableforanydamagesarisingherefrom. LibraryofCongressCataloging-in-PublicationData Sustainablehealthcare/KnutSchroeder...[etal.]. p.;cm. Includesbibliographicalreferencesandindex. ISBN978-0-470-65671-6(pbk.) I.Schroeder,Knut. [DNLM:1.DeliveryofHealthCare.2.ClimateChange.3.ConservationofNaturalResources.W84.1] 362.1–dc23 2012030887 AcataloguerecordforthisbookisavailablefromtheBritishLibrary. Wileyalsopublishesitsbooksinavarietyofelectronicformats.Somecontentthatappearsinprintmaynotbe availableinelectronicbooks. Coverdesignby:RobSawkinsatOptaDesign.ImageadaptedfromiStockFile#:59775392008appleuzr Setin9.5/12ptMinionbyLaserwordsPrivateLimited,Chennai,India. 1 2013 Contents Preface,vii Acknowledgements,ix Abouttheauthors,x Chapter 1 Greeningthegaze,1 Chapter 2 Climatescienceincontext,26 Chapter 3 Engagingwithsustainability,50 Chapter 4 Avisionforsustainablehealthcare,72 Chapter 5 Low-carbonclinicalcare,92 Chapter 6 Foodforpeopleandplanet,112 Chapter 7 Travelandtransport:movingtobetterhealth,138 Chapter 8 Healthybuildings,healthyspaces,157 Chapter 9 Resourcestewardship,183 Chapter10 TheGreenDeath,206 Chapter11 TheGreenAcademy,223 Chapter12 Thejourneytowardssustainablehealthcare,244 Index,259 Preface Shouldpeopleworkinginthehealthsectorbeinterestedinsustainability?The answer,wethink,isaresounding‘yes’.We,anauthorialteamcomprisinga primarycareclinician(KS),amedicalteacher(TT),apublichealthspecialist (DP) and a science educationalist (KF), have been exploring the interface between medicine and sustainability for many years. In that time, general publicinterestinthisareahasincreasedalot,butwithinthehealthsector it has received relatively little attention. We have written this book as a synthesis of a growing, but disparate, body of expert knowledge, and also withthehopeofbringingsustainabilitytoitsrightfulplaceatthecentrestage ofhealthcarepolicyandpractice. Theearthsystemisawonderfulyetultimatelyvulnerablething.Itprovides uswithendlessbenefitsuponwhichweareentirelydependentandwhichwe caneasilycometotakeforgranted.These‘ecosystemsservices’includefresh water,cleanair,fertilesoils,carbon-basedandrenewableenergysourcesand a stable and relatively predictable climate. Less tangibly, we draw spiritual sustenance from nature in all its beauty and diversity. The science is now unequivocal–this planetary system is under stress due to human activity. Weunpackthesestresses,suchasclimatechangeandthelossofbiodiversity, andconsiderthevariousconsequencesforhumanhealthandthehealthcare system–asystemthatitselfstrugglestocontaincosts,dealwiththesoaring prevalenceofchronicillnessandbringhumanitytotechnologicalcare. This book describes a new paradigm to tackle these pressing predica- ments–acollectionofideasandperspectives(mostlydevelopedbyothers, butsomeofourown)thatfall,howeveruntidily,underthebannerofsus- tainablehealthcare.Thisbringstotheforegroundthepreventionofdisease andthecreationofindividualandcommunityresilience.Itchampionslean systemsofclinicalcarethatmaximiseefficiencyandcommonhumanityand minimiseresourceuseandthecreationofwasteproducts(includinggreen- housegasesandtoxicpollutants).Aconsistentandhearteningobservationis thatmanyinterventionsthatimproveindividualhealth(suchasfresh,local viii Preface andmainlyplant-basedfood)arealsogoodforthehealthoftheplanetary system–creatingwhataretermed‘virtuouscycles’. Wehavewrittenforareadershipbusywiththemyriadtasksofdelivering care. We have tried to keep the book concise and balance ‘need to know’ with‘usefultoknow’information.Wehavereadandappraisedmuchofthe science so you don’t have to, and tried to draw balanced conclusions in a fieldwherethereisconsiderableuncertainty.Attimeswehaveappliedthe precautionaryprinciple–advocatingactionwherethepriceofinactionseems incalculable.Wecutthroughsomeofthejargonandchallengetherhetoric ofbothfearanddenial,whichoftenpervadesthetopic.Andwefocusonthe essentialquestions,offeringasynopsisofthemainissueswhichwesupport withkeyreferencesandlinkstosourcesoffurtherinformation.Inshort,this isabookoffirstresort. Wewritewithawidereadershipinmindincludinghealthprofessionals, educationalists,healthservicemanagersandhealthcarestudentsforwhomit mightprovideanoutlinecurriculuminsustainablehealthcare.Wehopethisis apositivebookthatinspiresreflection,engagementand–crucially–action. Wethinkthattherearesmarter,safer,fairerandmoresustainablewaysof doing things in the health sector, which are well worth the effort for the benefitofcurrentandfuturegenerations.Whowouldhavethoughteven10 yearsagothatinmanycountriessmokingwouldbebannedinpublicplaces? Asimilarshiftinpublicpolicyandhumanbehaviour,involvinginnovative technology and better models of care, needs to happen to develop health systemsthatcansustainusthroughthechallengingdecadesahead. Forfeedback,commentsandsuggestionsforimprovementspleaseemail [email protected]. KnutSchroeder GeneralPractitioner(FamilyPhysician),ConcordMedicalCentre; HonorarySeniorClinicalLecturer,UniversityofBristol TrevorThompson GeneralPractitioner(FamilyPhysician),WellspringHealthyLivingCentre; ReaderinHealthcareEducation,UniversityofBristol KathleenFrith President,GlynwoodandformerManagingDirector,CenterforHealthand theGlobalEnvironment,HarvardMedicalSchool DavidPencheon Director,NHSSustainableDevelopmentUnit Acknowledgements We owe much gratitude to a number of people who helped tremendously with writing this book by providing us with key resources and materials and reading part or all of the manuscript. In alphabetical order, we are particularlygratefulto: Annie Anderson, Ari Bernstein, Stefi Barna, Jonathan Broad, Timmy Bouley, Peter Cawston, Adrian Davis, Bob Fox, Ian Fitzpatrick, Howard Frumkin, Lynn Gibbons, Michelle Gottlieb, Chris Johnstone, Phil Insall, Katy Mahood, Janet Maxwell, Frances Mortimer, Hubert Murray, Scott Murray,ChrisPayne,DavidPeters,IanRoberts,KatherineRusack,Marion Steiner,JeromeThomas,AshTierney,SarahWalpoleandSarahWebster. We would also like to thank Mary Banks, Adam Gilbert, Chrisma Ng, Jon Peacock,SangeethaParthasarathyandeveryone else at Wiley for their patience,gentleguidanceandtheirbeliefinthisproject.Manythanksalso toKevinDunnforexpertcopy-editing. Wewouldalsoliketoacknowledgetheindustryanddedicationthemany researchers,writers,cliniciansandactivistswhoseendeavourswehavedrawn oninthewritingofthisbook. About the authors Knut Schroeder works part-time as a Family Physician and is Honorary Senior Clinical Lecturer at the Centre for Academic Primary Care in the UniversityofBristol,UK.Hehadneverreallyconsideredthelinkbetween climatechangeandhealthuntilheattendedaconferenceon‘ClimateChange anditsImpactonHealth’in2008,hostedbytheRoyalCollegeofPhysicians. This instilled a growing interest in the relationship between health and sustainabilityandpromptedtheideaforwritingthisbook.KnutisaBoard MemberoftheUKSelfCareForum,whichaimstosupportpeopleinmaking better (as well as more sustainable) choices about their health. He also workswiththeNHSInstituteforInnovationandImprovementtohelpfamily practicesworkmoreefficientlyandmoresustainably.Knutenjoysspending timewithhisyoungfamily.Wheneverworkandfamilycommitmentsallow, heisoutandaboutrunningorcycling,orwritesabouttopicsthathefeels passionateabout. TrevorThompsonisaFamilyPhysicianattheWellspringHealthyLiving CentreinBristol,UK,whichsupportsadiverseinner-citypopulationwitha rangeofcommunity-basedandmedicalservices.Heisalsoaseniorteacher at the University of Bristol Medical School with responsibilities across the curriculum. Trevor has been reading on the theme of sustainability for manyyearsandsince2006hasrunanundergraduatecourseonthe‘Global Environment and Human Health’. Teaching is often the best way to learn and his writing here draws extensively on his educational practice which seeks to engage both hearts and minds. Trevor is clinical co-lead for the Sustainable Healthcare Education Network, supporting green educational initiativesacrosstheUK.Heisanactivecyclist,sailorandgrower. KathleenFrithisacreative,visionaryleaderworkingforasmarter,more sustainable world and President of Glynwood, one of the United States’ leadingsustainableagricultureandfoodorganisations.Withadeeppassion forthenaturalworld,KathleenstudiedmarinebiologyandreceivedaMaster’s degree in Science Journalism from Boston University. In 2001, she was recruitedtoHarvardbytheCenterforHealthandtheGlobalEnvironmentat Abouttheauthors xi HarvardMedicalSchool,whereshehelpedshapetheCenter’sprogrammesto educateandinformpeopleaboutthelinksbetweenhumanhealth,theocean, foodsystemsandtheenvironment,servingastheorganisation’sManaging Directorduringthelasttwoyearsofhertenure.In2009,Kathleenproduced the award-winning film Once Upon a Tide, a live action and animated educationalshortthatscreensaroundtheworld.In2010,Kathleenstarted theHarvardCommunityGarden,HarvardUniversity’sfirstgardendedicated solelytotheproductionoffood.OtherinitiativeswhileattheCenterincluded the creation of the Center’s Healthy Oceans, Healthy HumansProgram, the launch of Center’s Healthy and Sustainable Food Program and work with NationalGeographictohelprestoreahealthy,sustainableseafoodresource. Kathleenhasproducedanumberofaward-winningreportsandpublications and serves as an advisor for a number of environmental and community organisations. David Pencheon is a UK-trained public health doctor and is currently DirectoroftheNationalHealthService’sSustainableDevelopmentUnit for England.DavidwaspreviouslyDirectorofaPublicHealthObservatoryin Cambridge,England.HehasworkedasaclinicaldoctorintheNHS,ajoint DirectorofPublicHealth,aPublicHealthTrainingProgrammeDirectorin the East of England, with the NHS R&D programme, and lived in China in the early 1990s contributing to the work of Save the Children Fund (UK).Hismaininterestsandareasofresearchandpublicationare:sustain- able development, large scale transformational change, health and climate change, underpinning action and policy with good information and evi- dence,trainingandprofessionaldevelopment,organisationaldevelopment, medicalinformaticsanddecisionsupportforhealthprofessionals,carersand thepublic.HeblogsmainlyviatheBMJwebsite.HewasawardedanOBEin theNewYear’sHonoursList2012forservicestopublichealthandtheNHS. Chapter 1 Greening the gaze Healthprofessionalshavealotontheirminds:caringforpatients,managing teams, keeping up to date with clinical developments and responding to broader agendas of quality and cost containment. This book offers up a quietly revolutionary invitation to rethink this enterprise by considering medicineinitsrightfulplacewithinamuchbiggerplanetarysystem.Here, wecallthisnewwayofthinkingsustainablehealthcareandbelieveitcanhelp usdeliverservicesofbetterquality,atlowercostsandwithlessimpacton thesystemsthatsustainus.Tothispointintimethehealthsectorhastaken planetary health for granted, but now a body of evidence shows an earth systemunderstress.Halftherainforestisgone,extinctionratesaresoaring, theoceansareincreasinglyacidicandtheplanetisrunningafeveronedegree abovepre-industriallevels.Wearejuststartingtorealisehowtheseplanetary ailmentsimpactonhumanhealth,withclimatechangefamouslydescribed in the Lancet as ‘the biggest global health threat of the 21st century’ [1]. Though many health professionals are alive to these global issues, in the healthprofessions,asinsocietyatlarge,sustainabilitycompeteswithmany other pressing and more proximate concerns. Thus, there is a danger that wearecollectivelysleepwalkingintoapublichealthcatastrophe.Thisbook offersanewsynthesisofsustainabilityandhealth,leadinginlaterchaptersto manyideasforpracticalaction.Firstly,though,wewanttoexplainwhywe needarevolutioninourhealthsystems,whynothingshortofarevolution is going to be enough and what sort of a revolution we are talking about. Luckilyitisarevolutionfromwhichweallstandtobenefit. The revolutionary road Nineteenth century medicine witnessed the emergence of germ theory, which revolutionised our understanding of infectious disease. This new theorydispatchedthethenprevalentmiasmatic paradigm,whichheldthat diseasearosefrombadair.Inthetwentiethcentury,classicalmechanicswas SustainableHealthcare,FirstEdition.KnutSchroeder,TrevorThompson,KathleenFrith andDavidPencheon. 2013JohnWiley&Sons,Ltd.Published2013byJohnWiley&Sons,Ltd.
The list of books you might like
