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Earlier this year, The Lancet and University College London published a report highlighting the potential impacts of climate change on health. It concluded with a wake-up call: “Climate change is potentially the biggest global health threat in the 21st century.”
This conclusion has reached many leading health experts and organisations, including the BMJ, who have warned that a failure to act on climate change is likely to result in devastating health impacts that will affect us all. Climate change is a major environmental issue – but it is also a major health issue.
In the UK, it is predicted that climate change will produce a wide range of direct health impacts, including increases in heat related health problems, and flooding related illnesses and injuries. And on the global scale, climate change could produce major social problems – such as food and water insecurity, mass migration and conflict.
Climate change is one of a wide range of serious problems that we now face as a result of the impact of unsustainable human activity. Others include loss of habitat and biodiversity (and all the food, medicines and other products they provide), air pollution, land degradation, ocean acidification and water shortages. All of these pose significant potential health risks.
A powerful organisation
As the organisation charged with safeguarding the nation’s health, the NHS needs to take these issues seriously and has a responsibility to act and use its influence to reduce these impacts. The NHS has enormous power to do good, or harm, to human health and the natural environment, not just by providing health services, but also by deploying its vast corporate resources.
The NHS employs 1.4 million people, and has an annual budget of over £100 billion. It spends £20 billion a year on products and services. Its buildings consume over £410 million worth of energy every year and in 2007-8, the NHS consumed an estimated 38.8 million cubic metres of water. More broadly, the NHS has the largest property portfolio in Europe, it accounts for five per cent of all road traffic in the UK, and it interacts with over a million patients and their families every day.
How the NHS operates – as an employer, purchaser, manager of transport, energy, waste and water, as a landholder and commissioner of building work, and as an influential partner in many communities – can make a huge difference in limiting carbon emissions and other environmental impacts. By making decisions that take into account environmental, social and economic considerations, NHS organisations can meet their business needs and achieve a wide range of additional benefits – saving money, and helping to builder stronger, healthier communities.
Good Corporate Citizenship
This is at the heart of Good Corporate Citizenship – the term used to describe how NHS organisations can contribute to sustainable development and a reduction in health inequalities through their day-to-day activities. The term Good Corporate Citizenship first appeared in Choosing Health: Making Healthy Choices Easier (2004) as one of five priorities for the following ten years. Good Corporate Citizenship follows the five principles of the UK Sustainable Development Strategy, Securing the Future (2005):
By acting as good corporate citizens, NHS organisations can not only limit their carbon emissions and other environmental impacts, but can also realise a wide range of co-benefits. For example, by encouraging low carbon active travel (travel by foot or by bicycle), NHS organisations can reduce carbon emissions and air pollution, and also help to tackle lifestyle diseases such as obesity. Over time, integrating this approach in all areas of business can help move the provision of healthcare from treatment to prevention, save money required to treat illness, and reduce demand on the NHS. More immediately, with fuel costs rising and budgets under strain, any reduction in energy costs makes good business sense.
In 2006, the Sustainable Development Commission produced the Good Corporate Citizenship Assessment Model (www.corporatecitizen.nhs.uk), funded by the Department of Health. This online tool can be used to help organisations assess their progress on good corporate citizenship in six key areas of business – procurement, travel, workforce, facilities management, community engagement and buildings. Organisations can register with the model, and answer a series of questions in each key area to determine where they are performing well on good corporate citizenship, and where there is room for improvement.
The tool allows organisations to compare their performance with others, and monitor progress over time. It also contains information, resources and case studies to provide ideas on how to improve performance, and a forum to allow exchange of ideas.
In its first three years, almost 60 per cent of NHS trusts registered with the Good Corporate Citizenship Assessment Model. The model has been revised and updated in 2009, in cooperation with the NHS Sustainable Development Unit, and now has a new, more strategic set of self-assessment questions. It also contains guidance on how to introduce good corporate citizenship effectively within organisations, and guidelines on how organisations should be performing by 2012, 2015 and 2020.
The NHS can use the Good Corporate Citizenship Assessment Model to help it reduce and minimise its carbon footprint and other impacts by modifying its decisions about what it buys, what it builds and how it manages its affairs. By acting as Good Corporate Citizens, NHS organisations can also use their influence to encourage patients, visitors, staff and suppliers to behave in more sustainable ways.
For example, through the vast scale of its commissioning and procurement, the NHS can drive innovation and shift markets towards more sustainable modes of operation. This is an approach now being taken by NHS Manchester, which commissions extensive healthcare services and is committed to supporting the UK sustainable development agenda by contributing to environmental improvements, regeneration and reduction in health inequalities.
NHS Manchester has developed questions on sustainable development that are now included in all of their tendering documents during the commissioning of services. Short listed providers must show that they have considered sustainable development in their bids – demonstrating that they are developing employment opportunities for local people, minimising energy use and waste production, promoting sustainable travel and opening up procurement contracts to local suppliers. By making sustainable development a requirement in the commissioning process, Manchester PCT is giving a clear signal that sustainable development is a key element of its core business.
Meeting government targets
The NHS as a whole has begun to demonstrate its commitment to carbon reduction. In January of this year, the NHS chief executive David Nicholson launched the NHS Carbon Reduction Strategy: Saving Carbon, Improving Health, which sets out how the NHS carbon footprint is made up and how it can be reduced. The NHS is currently responsible for more than 25 per cent of the public sector carbon footprint – equivalent to over three per cent of the UK’s total carbon emissions.
The NHS Carbon Reduction Strategy contains a pledge to become one of Europe’s leading sustainable and low carbon organisations, and to meet the government’s target of an eighty per cent reduction in carbon emissions by 2050. As a start, the NHS has set itself a target of achieving a 10 per cent reduction in its 2007 carbon footprint by 2015. The strategy recommends that NHS organisations use the Good Corporate Citizenship Assessment Model to help reduce carbon emissions and become more sustainable.
Many organisations are already doing this – and making great progress on Good Corporate Citizenship. For example, in 2005, Nottingham University Hospitals NHS Trust, in partnership with Nottingham City Council, introduced the Medilink Service, a free bus service that links separate sites, with transportation links into the city centre. Following expansion of the service in 2007, it now carries over one million passengers a year. The service has significantly reduced traffic in Nottingham, taking around 600,000 cars off the inner ring road annually. The scheme has also contributed to a reduction in CO2 emissions and travel expenses.
Nottingham University Hospitals NHS Trust supports a number of other initiatives to promote carbon reduction and sustainable development, and as a result has won the 2007 and 2008 Health Service Journal Awards for Corporate Citizenship.
The NHS is one of the most loved, respected and trusted organisations in the country, and is in a prime position to demonstrate leadership on carbon reduction and sustainable development. This is not a matter of altruism. It is a matter of dealing with the key threat to health of the 21st century. Now is the time to act.
For more information
To register with the Good Corporate Citizenship Assessment Model, go to www.corporatecitizen.nhs.uk
James Feindt, Marck Aghnatios and Alistair Fleming look at the opportunities of migrating care from hospital to the home environment, as well as the challenges it creates