Combatting climate change as a healthcare organisation involves more than simply reducing its carbon footprint, writes David Galler. It means seeing climate change and wellbeing as intertwined – and that what’s good for the environment is always good for health.

This pandemic, as overwhelming as it is, will eventually pass. But before too long there will be another, and another after that. This global bombshell has exposed many of the vulnerabilities inherent in our society, the precarious nature of our existence and how we have chosen to live so out of sync with the planet.

Now that New Zealand has returned to level one, will anything change? Will our leaders learn from this experience and make the country more resilient to future global shocks by designing and building a better, fairer, more sustainable and inclusive future for all New Zealanders? Or will it be more of the same?

The film 2040, by Melbourne-based Damon Gameau (director of That Sugar Film), considers what the world could look like when Gameau’s daughter is his age in 2040, at a time when the existential threats of climate change have been curtailed – using only technologies that already exist today.

The film showcases five simple interventions, in current use and of proven value, that if adopted worldwide would radically alter the trajectory of global warming:

• The establishment of solar-powered microgrids connecting households in rural Asia, allowing the storage and sharing of power between them.
• Ocean permaculture: the farming of edible seaweed that refreshes and cools the ocean and absorbs carbon.
• Regenerative farming practices.
• The education of girls.
• Providing dashboards in school classrooms tracking real-time use of resources, teaching children from an early age how what they do affects resource utilisation and access for others.

As optimistic as this film is, it begs the question: why have governments chosen not to do these things already? And despite knowing the science, why have they not acted effectively to reduce CO2 emissions? The answer is the same each time. It is because of vested interests and their power in opposing change, aided and abetted by their inability (and unwillingness) to consistently present a compelling vision of a better future.

But post-Covid, things could really be different. As numerous commentators have pointed out, now is the opportunity to do what has not been done in the past. It is time for civil society to organise, be strategic in our thinking and planning, and doggedly consistent in our messaging and expectations. This is particularly important when addressing our elected officials because, more often than not, governments tend to underestimate the support for change and overestimate opposition to it. If there are any takeaway messages from this short korero, it’s that we need focused leadership, advocacy and action to build the future we want for our children and theirs that follow.

I work in South Auckland, for Counties Manukau Health, a DHB that serves a population of well over 600,000 of our most vulnerable people. It is a place that is enormously rich in many ways, with outstanding communities who do extraordinary things, but to my mind it has for too long been abandoned to the fast food chains, liquor stores and pokie machines. South Auckland is home to a high proportion of young people; many there move from one overcrowded house to the next, from one GP to another, and as a consequence, the kids from school to school.

It is also a place where many suffer from the South Auckland full house – a six carded hand that includes obesity, diabetes, renal impairment, ischaemic heart disease, high blood pressure and gout, at rates far higher than the general population. From a pure healthcare point of view, the population of South Auckland is the most complex in the country and its access to services is far less than that in smaller, more affluent, more Pākehā cities like Christchurch, Dunedin and Wellington.

It is this issue of inequity – and poor value – that in the last five years has become the focus of our Middlemore based carbon-reduction group. Our story started in 2011, with a small group of hospital staff who understood the great threat climate change poses to human health. Years later, in fact, the Lancet billed climate change as the greatest threat to human health in the 21st century

In 2011, Counties Manukau Health was the first healthcare organisation in Australasia to join Enviromark’s Certified Emissions Measurement And Reduction Scheme, now known as Toitū EnviroCare. At our last audit in September 2019 we had reduced our carbon foot print by 26% despite significant growth in both the volume of our work and staff. Many more DHBs are now members and together our advocacy through the Sustainable Health Sector National Network (SHSNN) has grown; so too have our savings in carbon, largely through picking off the low hanging fruit in the fields of energy, waste and travel.

Healthcare contributes between 3-10% of a nation’s greenhouse gas emissions, with 60% of that directly attributable to the life cycle carbon costs of the devices and pharmaceuticals that health professionals like me use and prescribe every day. So, despite all our good work, and even if we had a totally energy-neutral facility, healthcare’s footprint would still be substantial. The best way to reduce it is to do less work and the only way to do that is to invest significantly more into keeping people well.

Health and wellbeing are not created in doctors’ offices or in hospitals but where and how people live. I am an intensive care doctor, and I know that most people who end up with me do so because of an embedded series of failures beforehand. Many of these are structural in nature and are called the social determinants of health. Together they account for over 80% of our overall population health status and it is that which has become the focus for our carbon reduction group.

We understand and know that what’s good for the environment is always good for health. And what’s good for health is good for the environment because the trajectory of planetary health and population health are tightly linked; in the end, they rise or fall together. As a result, our group at Middlemore Hospital has redefined our carbon reduction work as health and wellbeing initiatives. We’re turning our sights on a more regenerative approach, looking to improve functional ecosystems and build stronger social networks, while at the same time creating economic opportunity.

This approach to wellbeing is not new. Mason Durie’s model of the Māori view of health and wellness, Te Whare Tapa Wha, paints a holistic picture of health and wellbeing that is comprised of more than just physical health; it includes the wellbeing of the whānau, the mind and the spirit.

But health and wellness are not ends in themselves. For indigenous groups like the members of the First Nations’ Health Authority from the Canadian province of British Columbia, health and wellness are an enabler that sits alongside others, like safe housing, effective social policies, good education, decent employment and more, to create a foundation for their people to reach their potential for themselves and for their nation. There is a sense of overall purpose that allows them to align their efforts across a wide range of activities to create a future for themselves that they actually want.

This overarching sense of purpose is at the core of our work at Middlemore too, but because of the power of the status quo and the way we have always done things, realising purpose is never easy. We have started with a call to redefine value. Traditionally seen as outcomes divided by costs, the value equation here in New Zealand has for too long been simplified to value for money, which in turn has become “getting as much as you can for as little as possible”. That’s been our world and now we are paying the price for that. Value for money has delivered us $40bn worth of leaky homes, mouldy buildings at Middlemore Hospital and elsewhere, and many other short term outcomes that come with long term liabilities. Climate change groups like ours see value differently, in terms of social, environmental and health costs as well as opportunities, and have advocated for an investment approach in public spending, with some success.

Helped by associate health minister Julie Anne Genter, whose unique responsibilities include the health impacts of built environments and climate change, our collective efforts have seen some significant changes in how DHBs view and protect the environment and a real step up in support from the Ministry of Health. The wheels of the public sector turn slowly, and we have needed to fight every step of the way, but that is the nature of change. We also know that if more of us in society were to agree on our purpose and priorities, combine forces, be more strategic and play a tougher game, we would make faster progress to a better, more equitable and sustainable future for New Zealand.