These Irish doctors are on call for the environment

LAST month, the World Health Organisation declared climate change ‘the single biggest health threat facing humanity’. It warned that global warming would lead to escalating physical and mental health problems.

The signs are already there. A 2018 Belgian study  found a positive relationship between temperatures rising above 21ºC and admissions to emergency rooms. This reinforced the findings of a 2003 French study which examined data from 16 European countries and linked a continent-wide heatwave to 70,000 additional deaths over the summer.

The quality of our environment affects health in other ways too. A 2021 WHO report claims that air pollution kills 13 people every minute by exacerbating conditions like lung cancer, heart disease, and stroke.

The Environmental Protection Agency (EPA) has linked air pollution with an annual 1,300 premature deaths in Ireland.

In 2018, four doctors were so concerned about the effects of climate change on health that they founded Irish Doctors for the Environment (IDE). The organisation is now a charity with an active membership of almost 400 doctors, medical students, and healthcare professionals.

“We believe that climate change and human health are irrevocably linked,” says Dr Aoife Kirk. “We see it as our responsibility as doctors to raise awareness of this link, take action on environmental health issues, and encourage clinicians and patients to do the same.”

Kirk is a doctor of internal medicine at Dublin’s Mater Hospital. She and Dr Rachel MacCann, a specialist registrar in infectious diseases at St Vincent’s Hospital in Dublin, are two of IDE’s founding members.

“It might be easy to think that climate change doesn’t affect Ireland,” says MacCann. “But take Covid-19 as an example. It didn’t start here but our interconnected world meant it affected us and put huge pressure on our health system.”

Kirk lists ways in which Ireland could suffer: “We’ve long known about the impact of air quality on our respiratory and cardiovascular systems, but we’re now learning about its role in other health conditions.”

In 2019, for example, a reviewtarget=”_blank” rel=”noopener noreferrer”> by researchers from Australia and Britain showed that exposure to airborne pollutants increased the risk of dementia. In 2021, a global public health organisation Vital Strategies report found that air pollution caused stunting in children, resulting in permanent harm to their cognitive and physical development.

“Floods and other extreme weather events are another risk factor,” says Kirk. “They will become more common. Will the HSE be able to deal with that additional pressure?”

There is also the risk that viruses will increase in the heat. A 2021 London School of Hygiene and Tropical Medicine study concluded that an additional 4.7bn people could be at risk of mosquito-borne diseases like malaria by 2070.

Working from the bottom up

 Dr Rachel MacCann, at St Vincent's hospital . Photograph Moya Nolan
Dr Rachel MacCann, at St Vincent’s hospital . Photograph Moya Nolan

IDE is tackling these looming threats in a variety of ways. “We’re working from the bottom up to educate healthcare workers and the public on the health effects of the climate crisis,” says MacCann. “We’re also trying to impact policymaking from the top down. As doctors, we have made submissions to local councils, HSE working groups, and the Government on issues from introducing a climate action plan for healthcare to the ongoing discussions about the turf ban.”

Kirk highlights the IDE’s ongoing work to encourage towns and cities to promote active travel as an alternative to travelling by car. This included a 2020 campaign to create cycle lanes linking Cork University Hospital, Bon Secours Cork, and Mercy University Hospital.

She believes this campaign underlines just how linked planetary and human health can be. “Cutting back on motorised travel reduces carbon emissions and increases physical activity, lowering our risk of respiratory diseases, cardiovascular diseases, some cancers, diabetes, and obesity,” she says.

While they are waiting for government policies to be implemented, IDE members are already working at an individual level to affect change in their hospitals.

MacCann, for example, has set up a Green Network committee in St Vincent’s. These committees introduce sustainable practices into hospital settings. Her committee has set up an inhaler project to recycle the 4.4m inhalers used in Ireland every year and conducted an audit of the endoscopy unit, which found that 70% of the waste produced by the unit could be recycled.

Another strand of the IDE focuses on reducing the carbon emissions of the healthcare system itself. “A 2014 report by Healthcare without Harm found that healthcare accounts for 4.4% of global carbon emissions,” says Kirk. “In Ireland, it accounts for 9.7%.”

Ana Rakovac is a consultant chemical pathologist at Tallaght University Hospital and the chair of IDE’s sustainable healthcare working group, which is looking at ways to improve on this.

“According to NHS data, energy accounts for about 10% of that carbon footprint,” says Rakovac. “Hospitals and other healthcare facilities switching to renewable sources of electricity and healthcare will help.”

Procurement is an even more significant factor, accounting for 60% of the sector’s energy emissions. Rakovac would like to see the HSE use its considerable buying power to influence suppliers to adopt more sustainable policies.

“The HSE is currently setting up a national steering group on sustainability in healthcare and I hope it establishes national sustainability procurement criteria,” she says. “This will ensure that sustainability becomes a deciding factor whenever projects go out for tender.”

One of Rakovac’s main aims as chair of the sustainable healthcare working group is to establish a professional umbrella organisation to steer the healthcare sector in a more sustainable direction.

“We can’t continue asking medical professionals who are already extremely busy to voluntarily give more in their spare time,” she says. “This needs to be done at an official level.”

Rakovac has a particular interest in the impact of plastics on health. “I attended a meeting of the Endocrine Society in 2008 and was shocked to learn about the endocrine-disrupting chemicals used in plastic and their effects on health, from increasing the risk of breast and prostate cancers to obesity and reducing fertility,” she says.

This is the reason she joined IDE. “I wanted to use my medical knowledge to advance the argument to stop using plastic but as I’ve got more involved, I’ve realised that climate action is needed in all sorts of other ways too,” she says.

Anaesthesiology and carbon emissions

Dr. Ola Løkken Nordrum in Galway. Photo: Ray Ryan
Dr. Ola Løkken Nordrum in Galway. Photo: Ray Ryan

Dr Ola Løkken Nordrum is an anaesthesiology trainee at Galway University Hospital. As the lead of its sustainable anaesthesiology working group, he is driven by the desire to make environmental changes to his field of medicine.

“Anaesthesiology has a particular role to play in terms of healthcare’s carbon emissions,” says Nordrum. “The anaesthetic gases we use are potent, hundreds or thousands of times more potent than CO2 and our aim is to reduce the amount of them we release into the environment.”

He mentions a recent initiative in the NHS where they are collecting Entonox, administered as pain relief during labour. “It’s much better than the Irish policy of releasing it into the atmosphere,” he says.

Education is vital too. “Anaesthesiologists need to be aware that some gases contribute to greenhouse gas emissions more than others,” says Nordrum. “This should impact their choices.”

Progress is being made in this regard. Nordrum hails the recent establishment of a sustainability committee within the College of Anaesthesiology as “a massive step in the right direction”.

Nordrum is also involved in the IDE’s campaign to include climate change in the medical curriculum. “A 2020 study found that only 15% of medical schools internationally have incorporated the relationship between climate change and health into their curriculum,” he says. “We’re lobbying Irish medical schools and the Irish Medical Organisation to change this. A changing climate requires a changing medical curriculum.”

As well as its work in Ireland, IDE is collaborating with international groups to achieve change on a global scale. It has links with the Planetary Health Alliance, Healthcare Without Harm, Global Green and Healthy Hospitals, and the WONCA Working Party of Environment, which is a European society for GPs.

It’s gaining support from within the medical profession too.

“People didn’t know what to make of us at first,” says MacCann.

“Now, with Lancet Countdown Reports (which monitor the
health consequences of a changing climate) becoming more and more ominous, there’s a growing appetite for information about links between the environment and health and actions that can be taken to improve both.”

The pandemic posed an unforeseen challenge to medics. “We were so grateful to have PPE when so many of our colleagues worldwide did not, but so much of it was disposable,” says Kirk. “We need research and development into how to make it sustainable. There has to be another way to do things.”

Finding that other way is what IDE strive for in everything they do. “We work as a team to affect positive change,” says Kirk. “The environment is deteriorating, and so is human health. We aim to introduce and implement more sustainable ways to do things that will benefit the planet’s health and its people.”

Ways to reduce your carbon footprint 

Ana Rakovac is a consultant chemical pathologist at Tallaght University Hospital
Ana Rakovac is a consultant chemical pathologist at Tallaght University Hospital

Small changes to our daily lives can have positive effects on both our environment and our health. “Typically, what is good for you is good for the planet,” says Dr Ana Rakovac. Here are some tips from Irish Doctors for the Environment.

1. Choose walking or cycling over travelling by car when possible. It will cut your carbon emissions and help you burn more calories, with benefits for your physical and mental health.

2. Reduce your meat intake and eat more plants. A 2021 study published in Nature found that meat produced twice the amount of greenhouse gas emissions as plant-based foods while a 2019 study in the Journal
of the American Heart Foundation found that eating more plants and less meat reduced the risk of cardiovascular conditions such as stroke, heart attack, and heart failure by 16%.

3. Switch to a more sustainable energy provider.

4. Ask yourself if there is an alternative to burning solid fuel in your home. “Solid fuels introduce particle matter into the house and the outside environment, contributing to air pollution,” says Rakovac.

5. Cut back on your use of plastics. One simple way of doing this is by avoiding buying fruit, vegetables, meat, and fish that are packaged in plastic.

6. Choose quality, long-lasting items of clothing instead of fast fashion that you are likely to wear only a few times before it has to be thrown away.

7. Advocate for greener-based policies where you can. For example, if people use plastic or disposable cups in your workplace, suggest colleagues bring in their own cups from home instead.

8. Talk to family and friends. Dr Aoife Kirk’s parents weren’t interested in the environment until she started to discuss it over the dinner table. “Now they eat far less meat and recycle much more,” she says.

9. Put pressure on local politicians to prioritise the environment. “It’s the biggest issue of our time,” says Rakovac. “If we don’t do something, our grandchildren will have harsher lives than we do. So, ask candidates what they intend to do about it. This isn’t a question of party politics. It’s about survival.” 

10. Join a group or sign up to IDE’s monthly newsletter at www.ide.ie. It’s got tips for behavioural change as well as activities you can join nationwide. “It’s easy to feel paralysed with faced with a challenge like climate change,” says Kirk. “Working with others can help with this and so can making small changes. Such small changes can have a significant cumulative effect.”

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