Practising planetary health care in BC

(Published as “Practising planetary health care in B.C. starts with hospital food waste)

Dr. Trevor Hancock

22 November 2021

701 words

It comes as a surprise to many people, including health care professionals, that the health care system has a large ecological footprint. But as I noted last week, if the global health care system were a country, then its carbon emissions would have made it the fifth-largest emitter on the planet, according to a 2019 report from Health Care Without Harm. 

But climate change caused by the health sector’s emissions results not only in environmental harm, but in harm to human health. And that is a direct contravention of one of the fundamental priciples of medicine, enshrined in the Hippocratic Oath, to do no harm; hence the need for health care without harm.

Of course, climate change is not the only environmental and health harm that the health care system creates. For example the Green Hospital Scorecard, a program of the Canadian Coalition for Green Health Care (founded 20 years ago), is used by hospitals to assess their policies and actions on energy and water use, pollution prevention and waste management, transportation, healthy food systems and climate change, as well as corporate leadership.

So now that Canada has signed on at COP26 to the global commitment to create sustainable low-carbon health care systems, we have to look to the provinces, who actually run the health care system, to step up and take action across this wide range of issues.

Here in B.C. some steps are already underway. The province’s July 2021 Mandate Letters to the health authorities makes fighting climate change one of five foundational principles that will inform their policies and programs. In particular, they are expected to reduce their building emissions by 50 percent and their fleet emissions by 40 percent by 2030, as part of the CleanBC Plan. But B.C. will need to go much further to identify and tackle the full range of environmentally responsible health care practices that are needed.

So I was delighted to learn recently that UBC has established a Planetary Healthcare Lab led by Dr. Andrea MacNeill, a cancer surgeon at Vancouver General Hospital who is passionately committed to reducing health care’s environmental and health impacts. She also holds the newly established position of Medical Director of Planetary Health for Vancouver Coastal Health (VCH). The Lab is an interdisciplinary research collaborative dedicated to creating health systems that promote both human and planetary health.

In an April press release, UBC noted the Lab “will tackle everything from hospital food-related pollution and unnecessary patient testing and treatment through to emissions stemming from the medical supply chain.” Over time, the Lab states, this will involve “embedding planetary healthcare in health system structures (e.g. hospital accreditation, quality reporting, supply chain)”, so it becomes just part of everyday practice.

One key area the Lab will be looking at is the health system’s food services, which account for a large part of the sector’s footprint and generate a lot of food waste, as is the case at the household level. A more ecologically sustainable diet will also have significant direct health benefits for patients and staff. Another area is the supply chain, which accounts for around 80 percent of health care’s carbon emissions. Requiring a ‘circular economy’ approach be adopted throughout the supply chain could thus substantially reduce the consumption and depletion of natural resources, as well as reducing emissions, waste and pollution. The Lab will also examine the environmental and health benefits of  ‘virtual care’, which already saves millions of kilometres of patient travel each year.

The new Planetary Health initiative at VCH is complemented by the work of VCH’s Energy and Environmental Sustainability team, which among other things works on active & clean transportation and minimizing energy and water consumption, carbon emissions, waste generation and toxic chemicals use. Then there is GreenCare, which unites efforts across the four Lower Mainland health organizations (VCH, Fraser Health, Providence Health and the Provincial Health Services Authority). Their 2020 Environmental Performance Dashboard highlights significant reductions in the intensity of greenhouse gas emissions, water use and waste generation across the four health authorities.

It’s a good start, now we need this to become provincial in scope, with Planetary Health Offices at the provincial level as well as in all the health authorities.

© Trevor Hancock, 2021

thancock@uvic.ca

Dr. Trevor Hancock is a retired professor and senior scholar at the

University of Victoria’s School of Public Health and Social Policy

Practising health care as if the planet matters

17 November 2021

Dr. Trevor Hancock

697 words

Last week I reported on the rally at the BC Legislature organised by Doctors for Planetary Health – West Coast. The rally was timed to coincide with the COP26, the UN’s climate change conference in Glasgow, where for the first time – and at the behest of the UK government – health was one of three science priority areas.

The World Health Organization (WHO) was at the centre of this work, offering an extensive set of events and initiatives. This included the release of an open letter signed by 600 organizations representing 46 million health professionals that identified the climate crisis as the single biggest health threat humanity faces; a Global Conference on Health and Climate Change; and the release of a WHO report on the health argument for climate action.

This report recognised, in the words of Dr. Ghebreyesus, the Director-General of the WHO, that in the face of climate change “protecting health requires action well beyond the health sector, in energy, transport, nature, food systems, finance and more.” But it also requires action by the health sector itself, which is a significant contributor to climate change, and more broadly to ecological harm.

When it comes to climate change, Health Care Without Harm – the leading international organisation focused on making health care ecologically sustainable, and a co-lead with WHO on its global initiative, estimated in a 2019 report that “Health care’s climate footprint is equivalent to 4.4% of global net emissions” of greenhouse gases. If it were a country, the report noted, the health sector “would be the fifth-largest emitter on the planet.”

Canada’s health care system, noted the 2019 Lancet Countdown report for Canada, has the third highest greenhouse gas emissions per person in the world, compared to 47 other countries where data was available. It also emits large amounts of other air and water pollutants, consumes considerable quantities of materials (especially because of its widespread use of disposables) and as a result generates large volumes of waste, including toxic waste. But those are just the direct emissions.

When we consider that healthcare is one of the largest economic sectors in Canada (almost 13 percent of GDP, according to the Canadian Institute for Health Information), employs around the same proportion of the labour force and generates millions of kilometres of travel by staff, patients and suppliers, it is clear the system’s impact is even larger.

So it is exciting to hear that the WHO announced that the governments of 50 countries had signed on to a commitment to develop climate-resilient and low-carbon health systems. Despite missing the original deadline, Canada did indeed sign on before the end of COP26, after being pressured by Canadian planetary health advocates in Glasgow and their colleagues across Canada. Thus Canada has agreed to conduct climate change and health vulnerability assessments and to develop national adaptation plans for health.

It has also agreed to develop an action plan or roadmap to achieve sustainable, low carbon health systems. Regretttably, however, Canada did not join 14 other countries, including Belgium, Spain and the UK, in committing to creating a net-zero emissions health care system.

The UK provides a useful example. In early 2020 the CEO of the National Health Service (NHS) commissioned a plan for the system to become “the world’s first ‘net zero’ national health service”, a plan they stuck to in spite of Covid. Launched in October 2020, the plan has two clear targets: For the emissions the NHS controls directly, achieve net zero by 2040, and for the emissions the system can influence, achieve net zero by 2045.

The latter emissions include “Indirect emissions from the generation of purchased energy, mostly electricity . . . and  . . . all other indirect emissions that occur in producing and transporting goods and services, including the full supply chain.” Achieving this by 2045 is ambitious.

Canada’s failure to sign on to a net-zero target is perhaps understandable. After all, health care is a provincial responsibility and not under federal control. So now we have to get our provincial governments to develop climate-resilient and low-carbon health systems and to achieve net-zero health care systems.

That will be the focus of next week’s column.

© Trevor Hancock, 2021

thancock@uvic.ca

Dr. Trevor Hancock is a retired professor and senior scholar at the

University of Victoria’s School of Public Health and Social Policy

Doctors and nurses declare a climate and ecological ‘Code Red’ for BC

9 November 2021

Dr. Trevor Hancock

700 words

In 1848, Dr. Rudolf Virchow presented his report to the Prussian government on the steps needed to address a typhus outbreak in Upper Silesia – an impoverished, largely Polish-speaking coal-mining area. To the surprise and consternation of the government, he called for a variety of social and economic reforms, including democratic self-government, making Polish an official language, separation of church and state, and the creation of grassroots agricultural cooperatives.

‘But Dr Virchow’, they said, ‘this is not a medical report, it’s a political report!’. To which he famously replied, “Gentlemen, medicine is a social science, and politics nothing else but medicine writ large.” His statement has been an inspirational force for public health action ever since, providing the rationale for the focus public health so often has on the hugely important health impacts of public policy beyond the health sector.

173 years later, Virchow’s spirit is alive and well and was on display at the BC Legislature on November 4th. Doctors for Planetary Health – West Coast brought together some 100 doctors, nurses and other health professionals for a rally at the BC Legislature, timed to coincide with the COP 26 meeting in Glasgow. (Full disclosure: I was a member of the organizing group, helped formulate the set of demands presented at the rally and write the background document, and spoke at the rally.)

Inspired in part by the UN Secretary General, Antonio Guterres, who had called the latest IPCC report on climate change a ‘Code Red for humanity’, we were there to declare a climate and ecological ‘Code Red’ for BC, noting: “The climate and ecological crisis is a health crisis. We stand in solidarity for a safe and equitable future for all living creatures and the planet.”

We were also motivated by an unprecedented editorial published in September in more than 200 leading medical journals that stated bluntly: “the greatest threat to global public health is the continued failure of world leaders to keep the amount of global temperature rise below 1.5°C and to restore nature.”

As was the case for Virchow all those years before, the focus of the action agenda we want the BC government to undertake is rooted in the recognition that politics is nothing else but health and wellbeing on a large scale. So in addition to asking the government to declare a climate and ecological emergency, we called for an emergency plan leading to transformative change that would improve the health and wellbeing of the people of BC – and the world beyond.

On the climate change front, we called not only for an end to fossil fuel supports, but the phasing out of fossil fuel production and exports. In addition, we called for an assessment of the health impacts of all energy use in BC and investment in a regenerative zero-emissions economy.

Recognising, as does the UN, that we also face both biodiversity loss and pollution crises, we called for the protection and restoration of nature. In particular, this means protecting natural ecosystems such as old growth forests, enacting a Species at Risk Act and recognizing the human right to a healthy environment, as well as the rights of nature.

Even more broadly, we called on the BC government to put human wellbeing in balance with nature at the heart of decision-making. This includes replacing the GDP as a measure of progress with an alternative such as the Genuine Progress Indicator and creating a Wellbeing budget, enacting a Wellbeing of Future Generations Act and establishing the role of a Commissioner for Future Generations. These are all steps that similar-sized jurisdictions such as Aotearoa New Zealand and Wales have taken.

Finally, recognizing that we must protect and improve the health of the most disadvantaged and least healthy groups in society, as well as those who will be most affected by the shift to a more healthy and sustainable society, we called for a Just Transition. It is important, we emphasized, that any action on these ecological crises be undertaken in conjunction with BC’s First Nations and Indigenous people, with a particular focus on addressing social and ecological injustice in BC and around the world.

I like to think Rudolf Virchow would have been proud of us.

© Trevor Hancock, 2021

thancock@uvic.ca

Dr. Trevor Hancock is a retired professor and senior scholar at the

University of Victoria’s School of Public Health and Social Policy

Becoming a One Planet Region: Where to begin

Published as “Becoming a One Planet region starts with food

Dr. Trevor Hancock

2 November 2021

700 words

Last week I noted that Saanich – which has an ecological footprint of around 3-4 planets – has taken the first step to becoming a One Planet municipality by adopting a resolution to that effect; staff will report back on next steps. But while Saanich is almost 30 percent of the Greater Victoria Region, that still leaves 12 other municipalities, the CRD and more than 70 percent of the population to follow suit.

The good news is that most if not all of our local municipalities have declared a climate emergency and created a climate action plan, as has the CRD. Since carbon emissions are an important part of the ecological footprint of the region – about 60 percent in Saanich, which is likely the same for the whole region – this is an important start. But our footprint also includes the land and water area we need to provide food and resources such as timber and minerals, to build our communities and their supporting infrastucture and to dispose of wastes.

Moreover, the ecological footprint is an underestimate of our full impact, since it does not include the impacts of many pollutants, especially the persistent organic pollutants we have created that permeate our food chains. Nor does it include species extinctions and the loss of biodiversity. And yet, as the UN has noted, we face a triple ecological crisis: Climate change, biodiversity loss and pollution.

So becoming a One Planet Region – one with a footprint equivalent to our fair share of the Earth’s biocapacity and resources – means addressing this triple crisis while reducing our footprint around 65 – 75 percent. What would that mean and how would it be achieved?

First, we need to recognise the scale of the problem. So we need to measure the ecological footprint of the Greater Victoria Region as well as the level of locally generated pollution and local biodiversity loss. More challengingly, this must include pollution and biodiversity loss elsewhere in the world created in both in the production of the resources we then import and use and the damage from any wastes we export.

This is quite similar to the appraoch needed to undertake the ecological assessment of the Region in a Doughnut Economics city portrait (see my column “True prosperity is doughnut-shaped,” 31 January 2021, and related columns on 7 and 14 March 2021) so we might be able to achieve both together.

Then we need the CRD and all the other municipalities to adopt a One Planet strategy or action plan, as they have done for the climate emergency. Fortunately, the team of Dr. Jennie Moore at the BC Institute of Technology and Cora Hallsworth that assessed Saanich’s ecological footprint in 2018 also identified some key actions to reduce the footprint.

They identfied four broad areas of work: Food (49 percent of Saanich’s footprint), transportation (27 percent), buildings (15 percent), and consumable products and wastes (9 percent). Of these, municipal governments have a fair degree of control over transportation, buildings and waste management, but much less control over the food and agricultural systems and the production, sale and purchasing of consumables. Clearly, becoming a One Planet Region also needs the engagement and support of the citizenry as a whole, the private sector and higher levels of government.

Moore and Hallsworth suggested a number of specific actions that we need to undertake. The two with the greatest benefit in terms of reducing our ecological footprint are related to food. Since more than 70 percent of the food footprint is due to animal-based foods – meat, fish, eggs and dairy – they recommend we should reduce beef and dairy consumption by 50 percent (substituting chicken for the beef) and reduce post-purchase food waste by 25 percent – both being a task for households and the retail and food services industries.

The next largest benefits come from converting half the private vehicle fleet to electric power, reducing the number of kilometers travelled in private vehicles by one quarter, eliminating heating oil and reducing natural gas and propane consumption by two-thirds.

In a future column in this series, I will explore specifically what our local governments can do in these areas to help us become a One Planet Region.

© Trevor Hancock, 2021

thancock@uvic.ca

Dr. Trevor Hancock is a retired professor and senior scholar at the

University of Victoria’s School of Public Health and Social Policy

Working towards a One Planet Saanich

26 October 2021

Dr. Trevor Hancock

701 words

UN Secretary General Antonio Guterres stated almost a year ago “Making peace with nature is the defining task of the 21st century. It must be the top, top priority for everyone, everywhere.” In my view, this can only happen if we recognize, as Barbara Ward and Rene Dubos’ 1972 book put it, that there is ‘Only One Earth’ and we have to learn to live within and not beyond its bounds.

We are a long way from that. According to the Global Footprint Network our ecological footprint, globally, was 1.7 planets in 2017, with 61 percent of that due to carbon emissions. Here in Canada, it was 5 planets, of which almost 65 percent was due to our carbon emissions – and that ignores the emissions from Canada’s exported fossil fuels. So to become a One Planet Canada, we need to reduce our ecological footprint by 80 percent – and we have to do so quite rapidly.

In this region our footprint is a bit less, according to the footprint of both Saanich and Victoria as calculated by Dr. Jennie Moore at the B.C. Institute of Technology and Victoria-based environmental consultant Cora Hallsworth. (This is largely because 90 percent of our electricity is from hydro, not fossil fuels, and we have a more temperate climate year-round than most of Canada). Nonetheless, with a footprint of around 3 – 4 planets, we still need to reduce it by 65 – 75 percent, a massive task that should be “the top, top priority for everyone, everywhere” in the Region. 

In fact Saanich – which we tend to forget is the largest municipality by population in the region – has been hosting and supporting a One Planet Saanich initiative since 2018 and Mayor Fred Haynes has been an enthusiastic supporter. The initiative came to Saanich from a UK-based organization, Bioregional, as part of a small international project.

Coordinated by Cora Hallsworth (with Vancouver-based non-profit OneEarth) and funding first from Bioregional and now from Vancity Credit Union and the District of Saanich, the project engages local community organisations, schools and businesses in developing their own One Planet Action Plans and reporting on their progress in reducing their ecological footprint. You can find a number of their plans published in the Stakeholders page on the One Planet Saanich website.

But Saanich itself does not yet have an overarching strategy to become a One Planet municipality, although it does use the One Planet framework as a ‘lens’ within its Climate Action Plan. In addition it is now developing a Resilient Saanich initiative (an environmental policy framework that will integrate sustainability and the natural environment) and has other relevant initiatives such as its Active Transportation Plan.

So I was glad to see Saanich Council, on October 18th, become the first municipality in the Region – and as far as I know, the first in BC and indeed in Canada – to start down the path to becoming a One Planet municipality. This followed a presentation I made earlier in the summer to the Council’s Healthy Saanich Advisory Committee, in my capacity as founder and President of Conversations for a One Planet Region. The Committee adopted a resolution asking Council to develop a One Planet Action Plan. Council adopted the resolution and referred it to staff to report back on next steps.

One way forward would be to create a One Planet Strategy to embed the ten One Planet principles into all other plans and strategies at the municipality. Saanich could then report its progress using the same One Planet metrics that are currently being developed to create a standard reporting framework for all the One Planet Saanich stakeholders.

What makes these One Planet principles particularly interesting is that they are focused first on people and community. In fact the first three principles are about health and happiness, equity and local economy, and community and culture. Only then do the principles address the ‘usual suspects’ of environmental sustainability, including of course both zero waste and zero-carbon energy.

Saanich is the regional and indeed provincial leader in heeding Mr. Guterres’ call to make peace with nature. Now we just need the rest of the region to get on the same page; more on that next week.

© Trevor Hancock, 2021

thancock@uvic.ca

Dr. Trevor Hancock is a retired professor and senior scholar at the

University of Victoria’s School of Public Health and Social Policy