Momentum is building, so let’s keep going: Extending our efforts in sustainable healthcare
'The clear message to everyone working for a green, healthy, and liveable future: keep going, momentum is building' (The Lancet Planetary Health, 2021)
These words in a recent editorial to the Lancet Planetary Health (2021) are both highly encouraging and deeply resonant with my experience of what is happening in the world of healthcare at the moment. Across the professions, people are recognizing that human health depends on our planetary ecosystem, and taking this insight as part and parcel of what it means to think and act as a healthcare professional today. Healthcare research, education and practice are increasingly influenced by an understanding of this relationships between health, environment and society. What feels as though it has been a slow wave building under the surface now seems a veritable planetary health tsunami.
How can we best keep going with so much more to be done? First, we need to embed teaching about all of the ways in which human health is inseparably intertwined with our planetary ecosystem into all aspects of healthcare education. Some of the key dimensions of environmental literacy for healthcare professionals identified in the recently published Planetary Health Education Framework by the Planetary Health Alliance include understanding of our biological, psychological, social and spiritual interconnection within and dependence on nature, knowledge of today’s social and environmental crises and their grave health impacts, and the contribution that healthcare professions and systems make to them (Guzmán, et al., 2021).
Second, we must change how we do healthcare to reduce today’s social and environmental problems and, with that, advance better health for present and future generations. This includes reducing the overall environmental footprint of healthcare services and systems as championed by the Greener NHS and the Centre for Sustainable Healthcare. For allied health professionals, the Greener AHP Hub will facilitate our contribution to reducing the carbon and overall environmental footprint of the NHS, and blaze a trail for healthcare systems around the world to follow suit. There are more parts to this process than I can comment on here, but it is an incredible effort that must be advanced and involve all healthcare professions, personnel and, in fact, those we wish to serve.
In addition to reducing our environmental footprint, healthcare professionals must recognise that racism, colonialism, extractive industrialism, and our current economic system are major drivers of today’s social, environmental and health problems. We can no longer turn a blind eye to these causes of the causes. As health is largely determined outside of the clinical spaces we have traditionally associated with our work, we have an opportunity and responsibility to reimagine healthcare in a much bigger way. Social justice and equity must be advanced as an equally core dimension of planetary health research, practice and education if we are to deliver a healthcare that seeks to be sustainable in the broader sense of the term (United Nations, 2015).
Healthcare professionals have a history of getting involved beyond patient’s bedsides and even beyond healthcare systems (Williamson, 2020). Already in 1992, we have known that ‘the primary determinants of disease are mainly economic and social, therefore its remedies must also be economic and social. Medicine and politics cannot and should not be kept apart’ (Rose, 1992). Because of the complex nature of the problems we are facing today, we must finally follow up on this 30-year-old insight much more deliberately, extending healthcare practice even further into advocacy, activism, and even politics.
And finally, as if reducing our environmental footprint and deliberately integrating a socio-political mandate were not difficult enough, learning about interconnections within our planetary ecosystems also teaches us that the social and political are, by no means, reduced to the human. As anthropologist Anna Tsing and colleagues recently put it, ‘attention to social inequalities requires an acknowledgment of the “much more” out there’ (Tsing, Mathews, & Bubandt, 2019). Indigenous cultures have long understood that we are deeply related to and intertwined with all sorts of existences we share this planet with. The ongoing COVID-19 pandemic is teaching us much the same, if we care to listen (Gibb, Franklinos, Redding & Jones, 2020). Rather than shy away from such complexity and the diverse responsibilities that come with it, we should recognize the opportunities it presents and the significant work already underway to which we can contribute. Momentum is building, so let’s keep going.
Filip Maric (PhD)
UiT The Arctic University of Norway; Founder and Executive Chair of the Environmental Physiotherapy Association
Gibb, R., Franklinos, L.H.V., Redding, D.W., Jones, K.E. (2020). Ecosystem perspectives are needed to manage zoonotic risks in changing climate. BMJ, 371:m3389. doi:10.1136/bmj.m3389
Guzmán, C.A.F., Aguirre, A.A., Astle, B., Barros, E., Bayles, B., Chimbari, M., . . . Zylstra, M. (2021). A framework to guide planetary health education. The Lancet Planetary Health. doi:10.1016/s2542-5196(21)00110-8
Rose, G. (1992). The strategy of preventive medicine. Oxford: Oxford University Press.
The Lancet Planetary Health (2021). Charting the climate straight and narrow. The Lancet Planetary Health, 5(6), e324. doi:10.1016/s2542-5196(21)00147-9
Tsing, A. L., Mathews, A. S., & Bubandt, N. (2019). Patchy Anthropocene: Landscape Structure, Multispecies History, and the Retooling of Anthropology: An Introduction to Supplement 20. Current Anthropology, 60(S20), S186-S197. doi:10.1086/703391
United Nations (2015). Transforming Our World, the 2030 Agenda for Sustainable Development. General Assembly Resolution. A/RES/70/1. New York: United Nations Publishing.
Williamson, J., 2020. Nuclear war, climate change, and medical activism. The Lancet Planetary Health 4, e221–e222.. doi:10.1016/s2542-5196(20)30127-3