Author: Dr Tom Downs
We now have an opportunity for a Healthy recovery coming out of lockdown for Wales, but what does this mean? And what sort of things should we be prioritising individually and collectively to ensure that not only do we maintain our own health but also create a healthy environment for us and for our future generations?
This pause (created by COVID-19) in many people’s day to day activities as-well as the business as usual approach has acted as a reset button. We now have an opportunity to re think the sort of things that are important and what we want to prioritise both individually and collectively. The sacrifices we have made during lockdown have not been easy and there may be a reluctance to make further sacrifices coming out of lockdown such as walking, rather than getting the car, eating less meat. However this may provide an opportunity to take advantage of, with many of the changes that have already been made not only have a positive impact on our own health but also have a positive impact on the health of the environment. These are what we call health co-benefits. Taking action on climate change and working to improve our environment in Wales has many health co-benefits.
A healthy recovery is one that considers the health of people by taking the opportunity to consider the interdependency of wider social, economic and environmental /planetary health for the benefit of our current and future generations. Prior to COVID-19 the effects of human caused climate change meant we may well have been on a path of at least 3degrees warming by the end of this century and potentially even 5degrees or more depending on the level of action or inaction (1). The health impacts of such runaway climate change would not protect our NHS and predictions are that by 2090 there would likely be an additional 2billion flood exposure events worldwide per year (2). This would undoubtedly overwhelm not only our health services but our public infrastructure, many think we would already have seen widespread societal breakdown with changing disease burden, global crop failures and extreme weather events (3,4). Prior to COVID-19 an estimated 40,000 people were dying prematurely a year due to air pollution in the UK - from heart attacks, strokes and lung disease and along that “business as usual” trajectory by 2030 was predicted to increase to 160,000 deaths due to air pollution per year in the UK (5,6).
Due to lockdown many of us are now breathing cleaner air we are seeing that the streams are cleaner and noticing and enjoying more wildlife. But the problems of climate change and biodiversity loss have not gone away with 17% of our species in Wales still at risk of extinction (7). Coronavirus has acted as wake up call for us, further connecting environmental impacts with global health. Most new infectious diseases and almost all recent pandemics have originated in wildlife, the growing pressure on the environment is thought to contribute to new disease emergence (8). A quarter of all death and disease burden is thought to be due to preventable environmental risks (9). It is clear that we must continue to change direction and continue to make sacrifices that will not only protect our NHS but will also save the lives of current and future generations.
Wales has been leading the way in this in some regards. We have legislation protecting the well-being of future generations and we have a Future Generations Commissioner whose role it is to do just that (10).
We also have the NHS with its roots in Wales, of which many have felt very proud particularly in recent months in dealing with the recent pandemic doing their best to save lives. As a health care sector we are not exempt from the broad lenses of planetary health. We also directly impact the environment which then impacts on our patients health and on their future generations. The pipeline of damage is considerable from the way we make and transport medicines, prescribing and taking medicines, waste in hospitals including energy consumption, food waste and procurement to transport and equipment such as crutches and other aides all of which impact on the environment. In terms of plastic waste the NHS is estimated to dispose of 133,000 tonnes each year (11).
For many countries this has meant that the health care sector has a very large carbon footprint. In England, Health and Social Care is responsible for 6.3% of its total emissions, that’s a big chunk 40% of public sector emissions (12). In Wales our NHS (not including social care) is responsible for around 2.6% of Wales’ total emissions. If the global health care sector was a country it would be the 5th biggest emitter of greenhouse gas emissions (13). It is not surprising that we may have been producing more waste in recent months as a result of all the PPE we have been using and some clinical waste has even been finding its way into the ocean. A conservationist on world ocean day was quoted as saying “there will be more masks than jellyfish” (14). Some countries have managed to de-couple their investment into the health care sector from further reliance on fossil fuels (15). The health care sector can act as a lever for change encouraging the rest of society to move away from harmful practices, by shifting it’s ethical, political and economic influence that can lead to healthier changes across the rest of society. We are hoping to achieve this and the health care sector in Wales ambition is to be carbon neutral by 2030 (16). As the UNs recently launched its race to zero for World Environment Day (17). Similarly globally health care professionals are mobilising in support of a healthy recovery and in support of planetary health, recently a letter by over 40million health professionals, over a half of the global healthcare workforce signed a letter to all G-20 leaders, demanding a healthy recovery (18). A similar letter was signed by Welsh health professionals calling for a Healthy Recovery to the Welsh Government (19).
To achieve this goal will require transformative actions from within the NHS and care sectors as well as across society as a whole. The health and care sector can also play an important role in helping to influence and engage others in such actions. We now have an opportunity for a more healthy recovery, that will become the ‘norm’ for generations to come. The fundamental use of the Prudent Healthcare principles form the bedrock for this and so we already have an advantage and taken alongside the following 7 principles this will help our healthy recovery in Wales. The Bevan Commission are supporting the One Health agenda in their work and calling for a Green Recovery Framework and Pathfinder for Wales. This will build upon the work of their Exemplars working on sustainable health and care, especially Ysbyty Gwynedd in North Wales and act as a template for the adoption and spread across the rest of Wales.
The following steps for a Healthy Recovery for Wales integrate the following;
Prudent healthcare principles,
WHOs manifesto for a healthy recovery,
Future Generation Commissions 5 ways of working,
UK Health Alliance on Climate Change recommendations to UK government,
Healthcare without Harm Health Care Climate Challenge,
Centre for Sustainable Healthcare’s principles of sustainable health care, recommendations from the next generation of health professionals, the Build Back Better campaign and some of the aims from Ysbyty Gwynedd Green Group (20-27).
Steps for a Healthy Recovery for Wales should:
Prioritise those with the greatest health need first- Those at the greatest risk of the health and economic impacts of coronavirus and climate change, those who have lost their homes to flooding, groups vulnerable to air pollution, marginalised communities, black and ethnic minorities, our young people and future generations.
Empower people, patients, NHS staff and key workers- recovery should empower people and give individuals the tools to look after their own health and well-being, empower them with the tools to live sustainable lifestyles, incentivise active travel, pedestrianisation, promote healthy, sustainable food systems and work with farmers locally to produce the healthy food we need for our hospitals and the people of Wales whilst also combating climate change.
Do only what is needed and do no harm- Short term needs must be balanced with long term needs, investment must be in essential services and prioritise low carbon and carbon reduction industries. Prioritising a rapid clean energy transition for the people of Wales, with jobs in a new green sector. Universal access to renewable energy must be at the heart of our stimulus plans. Prioritising what does no harm to nature and the environment as-well as people. And moving towards a more circular economy, that moves from growth to well-being as a measure of long term success. Using the triple bottom line of environmental, social as-well as financial costs.
Promote health of people and nature- Promote a one health/planetary health approach. Protect and preserve the source of human health: Nature. Continue to allow nature to re-generate and allow equal access to green space for the people of Wales, promote health and prevent disease by tackling the cause of illness and inequality.
Build resilience and sustainability by planning ahead- We must prepare for the impacts of extreme weather and shifting burdens of disease as result of our impact on the environment, including future pandemics and climate change. By having a robust health adaptation plan for Wales and to invest in surveillance, planetary health and early warning systems. Utilise key anchor institutes such as primary care and hospitals to secure resilience locally.
Work in equal partnership with people- Strategies and plans should be developed by working in equal partnership with the people of Wales. By working in collaboration and sharing evidence and best practice clearly and transparently. Sharing solutions, technology and finances where it is needed.
Be globally responsible- Our recovery should be globally responsible, aiming to end global injustices, conflict and environmental degradation. Promoting changes that end global power inequalities.
The Coronavirus crisis has shown us that people can work together, that our health is interdependent to that of people all over the world. We have also seen the impact that our collective actions can have on our health and that of our environment. We now must utilise what we have all learnt and done during the last few months to prioritise a healthy recovery to ensure the health and well-being of ourselves and all future generations of Wales.
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(6) British Heart Foundation. We’re full of it. Everyone is. Progress towards cleaner air and why we need to do more. (2020)
(7) World Wildlife Fund. State of Nature 2019, a Summary for Wales https://nbn.org.uk/wp-content/uploads/2019/09/State-of-Nature-2019-Wales-summary.pdf
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(10)The Future Generation Commission. The Future Generation Report 2020. https://futuregenerations.wales/wp-content/uploads/2020/05/FGC-Report-English.pdf
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(22)UK Health Alliance on Climate Change. UKHACC Principles for a healthy and green recovery. http://www.ukhealthalliance.org/wp-content/uploads/2020/06/UKHACC-Principles-Priorities-for-a-HealthyRecovery.pdf
(23)Health Care Without Harm. Health Care Climate Challenge. Forging a Future for Climate-smart Health Care. https://noharm-uscanada.org/sites/default/files/documents-files/5500/Health%20Care%20Climate%20Challenge%20Enrollment.pdf
(24)Centre for Sustainable Healthcare. 10 Year Impact Review. https://sustainablehealthcare.org.uk/sites/default/files/final_report.pdf
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(26)Build Back Better. What we want. https://www.buildbackbetteruk.org/what-we-want
(27)NHS Sustainability Impact Report 2020. https://www.nhssustainabilityday.co.uk/wp-content/uploads/2020/07/Sustainability-Impact-Report-2020.pdf