ANALYSIS
THE BMJ COMMISSION ON THE FUTURE OF THE NHS Sustainability is critical for future proofing the NHS
For numbered affiliations see end of article. Correspondence to: R Issa r.issa@uea.ac.uk Cite this as: BMJ 2024;385:e079259 http://dx.doi.org/10.1136/bmj-2024-079259
Interventions that consider climate change, sustainability, and nature should be integral to health system functioning. Placing sustainability at the core of the NHS ’ s future offers opportunities to deliver better services, support healthier populations, and save costs. Rita Issa, 1, 2, 3 Callum Forbes, 4 Catherine Baker, 5 Matt Morgan, 6, 7, 8 Kate Womersley, 9, 10 Bob Klaber, 11, 12 Elaine Mulcahy, 13 Rachel Stancliffe 14 The combined threats of climate change and
co-creating the healthier society that can be achieved when we centre on sustainability. Why we need a sustainable NHS A multitude of environmental determinants individually and together shape human health, including geography, access to green space, exposure to air pollution and extreme heat, employment conditions, and food and water quality. Often these determinants intersect and correlate with pre-existing vulnerabilities, such as socioeconomic status, income and education levels, disability, gender, and age. 5 -8 The climate emergency is a “ threat multiplier ” that will exacerbate existing health inequalities, in part through its interaction with these wider environmental determinants. 9 This interplay between environmental determinants and social vulnerabilities requires wider reaching interventions across sectors, such as housing, transport, energy, and green spaces. Trans-sectoral actions are often beneficial for climate mitigation and human health, with the resultant “ health co-benefits ” 10 leading to substantial health gains and reduced health risks. 11 For example, promoting active transport such as cycling or walking helps reduce air pollution caused by fossil fuel combustion vehicles while improving cardiovascular health, and retrofitting housing helps to reduce heating needs and expenditure, while managing the health harms of cold spells and fuel poverty. Within the health sector, action to reduce the footprint of clinical care has strong support from the general public and NHS staff: 92% of the general public believe it is important for the healthcare service to be sustainable, and 87% of NHS staff support the ambition for the NHS to reach net zero. 12 13 The NHS has already made a substantial commitment to climate mitigation, as the first health system to embed net zero into legislation in 2022, 14 and through the formation of the Greener NHS programme, which is driving the goal of net zero by 2040 for scope 1 emissions — those that the NHS controls directly, such as from NHS facilities, the NHS fleet, and anaesthetic gases; and 2045 for scope 2 and 3 emissions — those that the NHS can influence (fig 1).
biodiversity loss are a global public health emergency requiring urgent attention. 1 2 The health impacts of these crises are far reaching, spanning the direct effects of changing weather patterns, such as heat waves causing cardiovascular events or severe dehydration; damage to health infrastructure through extreme weather events; system disruptions to the upstream determinants of health, such as reduced crop viability affecting nutritional status; and the direct health effects of fossil fuel combustion, such as respiratory diseases from air pollution. 3 TheNHS contributes about 5% of UK fossil fuel emissions and generates substantial waste, 4 which feeds into a cycle where health systems experience the impacts of climate risks while simultaneously contributing to the processes that drive them. Sustainability must be at the heart of the NHS as we look to the future, both to improve the health system today and to make it resilient to future shocks. As an anchor institution that touches the lives of every person in the UK, the NHS must be a powerful advocate and driver for the societal changes needed to respond to the climate and biodiversity crises. The interventions required are mitigation — reducing contributions to global warming by reducing greenhouse gas emissions and other waste; and adaptation — adjusting to current or expected climate change and its effects, with the aim of minimising harm and exploiting beneficial opportunities. Beyond reducing carbon emissions, sustainable healthcare must also consider the sector ’ s consumption and waste practices, alongside a shift in values related to the human-nature association that reduces inequalities and promotes health and wellbeing for all. Responsibility for driving this agenda forward is multifaceted. There are roles, responsibilities, and expectations for political leaders to support and invest in salutogenic (ie, factors that promote health and wellbeing) and sustainable environments. Those working in the NHS and healthcare must consider their position as a means to seek and deliver positive action for health and climate. The wider public needs to meaningfully expect, demand, and participate in
the bmj |BMJ 2024;385:e079259 | doi: 10.1136/bmj-2024-079259
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