Climate and health: applying All Our Health – GOV.UK

Climate and health: applying All Our Health – GOV.UK

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Published 18 May 2022

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This publication is available at https://www.gov.uk/government/publications/climate-change-applying-all-our-health/climate-and-health-applying-all-our-health
This guide is part of All Our Health, a resource which helps health and care professionals prevent ill health and promote wellbeing as part of their everyday practice. The information below will help frontline health and care professionals use their trusted relationships with patients, families and communities to reduce the contribution of the health and care system to the climate crisis.
We also recommend important actions that managers and staff holding strategic roles can take.
The health of the planet is inextricably linked to human health and wellbeing. A healthy planet provides us with our most basic needs:
The warming of the planet, known as climate change, is degrading our planet’s life-support system and threatens our ability to thrive and survive. Climate change is happening more quickly than previously feared and represents an urgent global crisis requiring a bold, united response.
Climate change has been identified as the most important health threat of the century, but it is also the “greatest opportunity to redefine the social and environmental determinants of health”. Everyone working in health and care needs to prepare for and be equipped to respond to the health impacts of the climate crisis.
The climate crisis has an important impact on health.
Global temperatures are rising at an unprecedented rate, driven by a build-up of greenhouse gases in the atmosphere. These gases, of which the most commonly known is carbon dioxide, are largely a result of burning fossil fuels. Global temperatures continue to rise and are expected to surpass the 1.5 to 2 degree threshold, triggering unprecedented changes to climate systems, with devastating impacts for human health and wellbeing.
The science is unequivocal; a global increase of 1.5°C above the pre-industrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse.
(The Lancet, 2021)
In the UK, average surface temperature has already risen by 1.2°C and the effects of climate change are already apparent. The UK is particularly at risk of drought, flooding and extreme weather events, all of which threaten the water, food, infrastructure and supply systems we depend on.
A warming climate affects health in 3 main ways:
The climate crisis affects our efforts to safeguard the health of the population and therefore tackling it as a determinant of health is a crucial aspect of our role as health and care professionals.
Reducing our contribution to the climate crisis and creating resilience to respond to the worst impacts of a warming climate is an opportunity to protect health. Importantly, much of what can be done is a ‘win-win’ for both the environment and for health.
The good news is that greenhouse gas emissions can be reduced in a way that addresses public health challenges; these are ‘win-win’ opportunities. We know that increasing physical activity through active travel, making nutritious and sustainable food readily available and improving air quality and housing will reduce the risk of obesity, cardiovascular and respiratory disease, certain cancers and diabetes. These actions will also help achieve national commitments to reduce our contribution to the climate crisis.
Transport is the largest greenhouse gas-emitting sector in the UK, accounting for 28% of total emissions. Our transport system is largely road-travel dependent, and this has been a major factor in reducing physical activity through active travel and increasing obesity-related morbidity and mortality in the UK. Physical inactivity directly contributes to 1 in 6 deaths in the UK and costs wider society £7.4 billion a year.
Transport is also a major cause of air pollution. Burning fossil fuels for vehicles and industrial processes fills the air we breathe with greenhouse gases that warm the atmosphere and are released with pollutants that directly impact human health. In the UK, air pollution is responsible for an estimated 28,000 to 36,000 excess deaths a year, with the health costs of air pollution estimated to be between £8.5 billion and £20.2 billion. Find out more about the health impacts of air pollution.
If we, as health and care professionals, can help people to increase the number of journeys taken on foot, by bicycle or public transport, we will see benefits for both health and the climate.
Homes that lack energy efficiency contribute to climate change and negatively impact our health. Home energy use accounts for 14% of UK greenhouse gas emissions, with the vast majority of energy consumption from coal, oil and gas. Inefficient energy use in homes, as well as rising energy prices, increases the risk of fuel poverty and cold homes. Fuel poverty affects 13.4% of households in the UK. Improving the energy efficiency of homes is the most effective way of tackling fuel poverty in the long term. It reduces the amount of energy required to heat the home and can therefore contribute to reduced energy bills and a warmer, safer home.
The burden of ill health from cold homes remains significant in the UK. Living in a cold home represents a considerable risk to health, wellbeing and inequalities. Cold homes are recognised as a source of both physical and mental ill health, increasing the risk of heart attack and stroke, respiratory illness, falls and accidents. Equally, with increasingly warmer temperatures due to global warming, there is also a significant risk to health, particularly for older people, very young children, and those with chronic health conditions of living in a home that is too hot. Ensuring homes are well ventilated can not only help to reduce temperatures on hot days but can also benefit health by improving indoor air quality.
If we, as health and care professionals, can help to encourage efficient energy usage in homes, as well as ensure that homes are not too hot or too cold, we will see benefits for both health and the climate.
Our current food system is a major contributor to global temperature rise, deforestation, biodiversity loss, freshwater overextraction, as well as air and plastic pollution. At the same time, the way we eat is causing significant morbidity and mortality, with poor diets increasing the risk of heart disease, high blood pressure, type 2 diabetes, obesity and certain cancers. Diet-related ill health is estimated to cost the NHS and wider UK society £5.1 billion per year, having a higher impact on the NHS budget than smoking, alcohol consumption and physical inactivity.
The foods most damaging to our health are often those with the highest emissions, pollution, land and water use. A diet rich in plant-based foods, and lower in animal source foods which have a significant environmental impact, has benefits for health and the environment. Adherence to the Eatwell Guide which encourages a high consumption of fruits, vegetables, wholegrains and plant-based protein, could contribute to a 7% reduction in mortality and a 30% reduction in greenhouse gas emissions.
If we, as health and care professionals, can encourage people to adopt a balanced, sustainable diet and promote wider changes to our food system, we would reduce the environmental impact of food production and supply, as well as reduce the risk of diet-related disease.
Our interaction with natural places can have a significant impact on our health. Protecting nature and biodiversity safeguards health and wellbeing. People who live in greener neighbourhoods have higher self-reported health and mental wellbeing. Exposure to green spaces has been shown to improve mood, reduce anxiety, and reduce the risk of type 2 diabetes and cardiovascular disease. ‘Green exercise’, or taking physical activity in green or natural environments, may also provide additional benefits to people’s overall wellbeing. It is estimated that £2.1 billion per year could be saved in health costs if everyone in England had good access to green space, due to the increased physical activity in these spaces.
Green spaces can also bring communities together, reduce loneliness and mitigate the negative effects of air pollution, excessive noise, heat and flooding. However, green space access is closely linked to health and social inequalities. The most affluent wards in England have 5 times the amount of parks and green space compared to the most deprived 10% (Public Health England, 2020).
If we, as health and care professionals, can promote the protection of green spaces, and implement nature-based interventions for health, such as green walking for mental health or green social prescribing, we can improve the health of people and the planet, while reducing health inequalities.
The climate crisis and the social justice crisis are closely related. Those most likely to suffer the worst consequences of climate change have contributed the least to it. Deprived areas have the poorest air quality while producing a much lower proportion of housing and travel emissions. The political and economic systems which drive the climate crisis also drive social injustice.
The climate crisis impacts people differently depending on their susceptibility, risk and ability to cope. For example, elderly populations, people living in care homes and those with underlying health conditions are more likely to suffer from the effects of extreme heat and cold. Fuel poverty and poor housing can exacerbate these effects.
People from deprived areas face disproportionately higher flood risk than those in wealthy areas, particularly in coastal and rural zones, which could mean they are more vulnerable to flood-related financial and livelihood loss.
If we, as health and care professionals, act on the climate crisis in a way that addresses social inequalities, we can ensure that the costs of climate action are not unfairly borne by those with lower incomes or other social disadvantages.
Policies and commitments at international and national levels require the health sector to take action on the climate crisis. At a global level, the UK has signed the Paris Agreement, a legal commitment to keep global temperatures below 2 degrees Celsius and reduce carbon emissions by 45% by 2030. Commitments made at the COP26 meeting in 2021 put us on track for 2.5 degrees of warming.
At a national level, the UK Climate Change Act 2008 requires the government to undertake 5-yearly assessments of climate risks and produce a National Adaptation Plan for responding to the identified risks, including the risks to health and wellbeing as a priority.
Within the health and care sector, the NHS in England became the first healthcare system in the world to commit to reduce the carbon emissions it can directly influence (for example, the amount of electricity used by hospitals) to net zero by 2040. Carbon emissions it cannot control but can influence (for example, emissions from manufacturers within the supply chain) will be reduced to net zero by 2045.
These commitments are essential because the health and care system in England accounts for approximately 5% of the country’s national greenhouse gas emissions. Particular carbon ‘hotspots’ include supply-chain derived items such as pharmaceuticals and medical equipment, as well as certain anaesthetic gases and patient or staff travel (see graph below). The health system also contributes to plastic and air pollution:
For a sector based on the principle of “First, do no harm,” the health and care sector must act quickly and collectively to mitigate its own climate damage.
Figure 1: Sources of carbon emissions by proportion of NHS Carbon Footprint Plus
Medicines, medical equipment and other supply chain:
NHS carbon footprint:
Personal travel:
Commissioned health services outside NHS: 4%
Source: NHS, Delivering a ‘Net Zero’ National Health Service.
Health and care professionals have an integral role to play in reducing the contribution of the health and care system to the climate crisis. Patient-facing health workers have a particularly important role given they are able to influence how many resources are used and how much healthcare activity is undertaken. Clinical care is responsible for the high-emitting consumption of pharmaceuticals, equipment and consumables, while clinical decisions determine how patients move through the system, for example whether they are admitted to hospital, or how often they need to make a journey to an outpatient clinic.
Reaching NHS Net Zero demands that the health and care system becomes environmental, socially and economically sustainable. This will require leadership and innovation from NHS staff.
A sustainable health system will:
help prevent illness
give greater control to patients in managing their health
be leaner by streamlining care systems to minimise wasteful activities
prioritise treatments and technologies with a lower carbon footprint
This All Our Health climate crisis information has been created to help all health and care professionals understand that the climate crisis is a problem for health, and how healthcare professionals need to prepare for and respond to it.
Health and care professionals are highly trusted and therefore well placed to advocate for action on the climate crisis and the health impacts it has. By acting on the climate crisis, we can safeguard population health against the worst effects of a warming climate.
Health and care professionals should recognise the climate crisis as a health crisis, and therefore climate action as a core part of their professional responsibilities. Delivering on this, they can:
Health and care professionals can implement these core principles by:
Ask colleagues whether they are willing to make positive changes together. See how to have a climate conversation.
Check whether your organisation has a Sustainability Action Plan or Green Plan for NHS Net Zero ambitions.
Encourage your professional networks and regulatory bodies to declare a climate emergency as a commitment to climate action.
Become a Climate Champion or Environmental Champion, join or start a Green Impact team. Find out how to join climate action and sustainability initiatives at work.
Using the Make Every Contact Count (MECC) approach – use every opportunity to talk to patients and their families about ways they can improve their health which also have a positive impact on the environment.
Encourage patients and staff to use active travel when appropriate for them, especially for short journeys.
Help patients and staff reduce their exposure to air pollution, and to the risk associated with high pollution episodes.
Identify patients most vulnerable to cold or hot weather (children, the elderly, those with chronic conditions), and ensure they know how to keep their homes at a reasonable temperature. Use this online training course to learn how to refer patients for support if they are living in cold homes.
Encourage patients and staff to increase their consumption of whole grains, nuts, seeds, plant-based protein, fruits and vegetables, whilst reducing red meat and processed food consumption.
Encourage patients and staff to increase their use of green spaces for both physical and mental health. You can make this part of your management plan using these green social prescribing resources.
Opt for low-carbon treatments and technologies where appropriate.
Use this National Institute for Clinical Excellence (NICE) patient decision aid to help you to discuss with your patient the benefits of switching to a lower-carbon inhaler for their respiratory disease.
Anaesthetists, A&E and maternity services staff can reduce the use of highly polluting anaesthetic gases like nitrous oxide or desflurane.
Reduce unnecessary resource use.
Replace single-use with recyclable or multi-use consumables where appropriate.
Reduce the waste associated with prescribing medicines.
Actively travel to or at work, using public transport where available, and avoid air travel wherever possible.
Use communication technology when appropriate to reduce staff and patient travel.
Switch off lights and computers when not in use, reduce paper use and optimise recycling.
Help transition towards low-carbon models of healthcare.
Use a sustainable quality improvement approach to redesign pathways, processes and services, by embedding sustainability into quality improvement projects.
Join a sustainable healthcare network.
If you’re an allied health professional (AHP), see this Greener AHP Hub for information and ideas on how your profession can contribute to NHS Net Zero.
If you’re a team leader or manager:
If you’re a senior or strategic leader:
Take action on the climate crisis while improving health and reducing social inequalities at a local level:
Measuring the impact of your work demonstrates its value and enables its spread:
This 2-minute video from the Lancet Countdown on Health and Climate change report, highlights how climate change is a critical public health issue.
Free e-learning modules on Environmentally Sustainable Healthcare e-LFH platform.
UK government report on the health effects of climate change in the UK.
WHO special report: The Health Argument for Climate Action.
A webinar series with lectures on climate change, COVID-19 and sustainability.
Intergovernmental Panel on Climate Change (IPCC) report on climate change.
This report by Medact outlines the public health case for Green New Deal and is an argument for social and economic structure changes to tackle climate change and social injustice.
This guide from the Clean Air Fund can be used to communicate the health impacts of air pollution.
Social prescribing for active travel toolkit
Use these resources to promote physical activity among patients:
NICE guideline on the health impacts of cold homes
Marmot Review on the health impacts of fuel poverty
This Citizens Advice resource can be provided to patients to help them make their homes more energy efficient.
This brief for healthcare professionals outlines specific interventions for promoting diets than are healthy for patients and good for the planet.
The Association of British Dieticians has published a toolkit to help you learn more about environmentally sustainable diets and how to discuss this with your patients.
Best practice examples of sustainable food for healthcare.
Circular economy for food in healthcare model.
Sustainable food and the NHS-recommendations from the King’s Fund.
Nature-based interventions, including green social prescribing, walking for health and green space for health.
Nature-based interventions for mental healthcare.
Green health routes.
London’s climate risk mapping training on how to consider at-risk populations.
Reducing health inequalities resources
WHO strategy on environmentally sustainable healthcare.
The Clean Air Hospitals Framework can be used to reduce the air pollution at hospital sites for the benefit of patients, staff and the wider community.
A list of actions local authorities can take to reduce emissions.
The UK Climate Impacts Programme toolkit to help local authorities prepare for the impacts of climate events on organisations and services.
Reduce the carbon footprint of inhaler prescribing using this guide developed by Greener Practice.
Easy wins for improving energy efficiency through behaviour change in your place of work.
Simple steps doctors can take to reduce pharmaceutical pollution
Green impact for health toolkit: resources and ideas for improving the sustainability of primary care services.
Case studies from the Royal Devon and Exeter NHS Foundation Trust Green Ward competition: these projects embedded sustainability into quality improvement to reduce waste, inappropriate prescribing and unnecessary cannulation across departments.
Sussex Community NHS Trust chose to support and promote active travel investing in e-bikes and electric and hybrid pool cares. See the pedal power for cleaner healthcare delivery scheme in action.
The ‘Gloves Off’ campaign at Great Ormond Street Hospital shows how simple changes to the way non-sterile gloves are used can significantly reduce the environmental impact of care while improving patient outcomes and experience.
The NHS Sheffield Clinical Commissioning Group shows how GP practices can use allotment gardening to provide healthy food to their communities and improve wellbeing.
Dorset Integrated Care System integrated climate action into their 5-year plan (2019 to 2024), improving the sustainability of their service and providing care in a way that both protects and recognises the health benefits of nature and the environment. They have made particular progress on leading a whole systems approach to increasing physical activity, a key component of increasing active travel and reducing transport-related climate impacts and ill health.
The Greater Manchester Health and Social Care Partnership manifesto uses the health voice to support a transport system which makes active travel the easy and accessible choice.
The Yorkshire and Humber Climate Commission brings public, private and third sector organisations together to prevent and prepare for the worst impacts of climate change whilst improving population wellbeing.
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