We can all easily appreciate the necessity of sustainability in healthcare. Doing our jobs in a manner that allows long term viability is a sensible pragmatic approach that should make sense to us all as clinicians. We can also easily appreciate the need to consider our own environmental footprint within the sphere of sustainability, recognising that while we increasingly need to treat the health impacts of our changing climate, we are contributing to them due to the emissions of our healthcare system.

The tricky bit is getting our governments, our institutions and ourselves to make the changes we need to have a truly sustainable healthcare system that works in the best interests of the communities we serve. Given the seriousness of the climate health emergency, we all have a responsibility to be part of this change. As the World Health Organisation’s Director-General Dr Tedros Adhanom Ghebreyesus states: “The climate crisis is a health crisis…We need transformative solutions to wean the world off its addiction to fossil fuels, to reimagine economies and societies focused on well-being, and to safeguard the health of the planet on which human health depends.”¹ Our ethical duty of nonmaleficence² dictates that we must do everything in our power to not contribute to, nor aggravate, this global health crisis. This includes getting our own house in order.

Healthcare is a carbon intensive industry, accounting for 4.4% of total global emissions,³ meaning that if we were a country we would be the fifth largest emitter in the world.⁴ In Australia, we emit more than the global average. Our healthcare system is estimated to cause between 5.3 and 7% of our country’s carbon footprint^5,6, with the hospital system being the largest emitting sector. These calculations include our direct and indirect emissions, i.e. those occurring on site in our hospitals and medical practices, and those occurring upstream and downstream of our workplaces.⁵ Looking at these different sources allows us to enable different avenues to reduce emissions, but before we do that, let’s take a moment to reflect on how global heating and climate change is impacting patient outcomes in obstetrics and gynaecology.

The 2023 MJA–Lancet Countdown report on health and climate change, states that the “Excess Heat Factor” in Australia has risen by 35% in the last 20 years,⁷ increasing the incidence of heat-related illness. Mounting evidence indicates that heat exposure during pregnancy places women at greater risk of complications including prematurity, low-birth weight and stillbirth,⁸ pre-eclampsia⁹ and maternal morbidity.¹⁰ Bushfires, also increasing as our planet heats,¹¹ are linked with low-birth weight, prematurity, gestational diabetes and gestational hypertension.¹² Both heat and bushfires aggravate mental illness. Heatwaves increase suicidal ideation and hospital attendance for mental health presentations¹³ and it is far from surprising that anxiety, depression and PTSD are associated with bushfires.⁷ Coupling this with the high mental health incidence in our postpartum populations raises significant concerns regarding climate change and health for mothers of newborns.

These are just three examples where climate change is relevant to the disciplines of obstetrics and gynaecology, illustrating why we have an obligation as clinicians to reduce emissions and advocate for sustainable healthcare.

Regarding our clinical practice, the essence of reducing emissions is recognising that everything carries a carbon footprint and adding a consideration of this in our clinical decision making. Take imaging as an example, MRIs are the most carbon intensive and ultrasounds the least intensive forms,¹⁴ so let’s avoid ordering them unnecessarily and choose the lower emitting option when we can.

The same applies to pharmaceuticals, where we can tackle their impact via avoiding overprescribing, using lifestyle prescriptions and addressing non-adherence and routine prescriptions.¹⁵ Big carbon savings comes from practising preventative medicine, keeping people well with healthy diets, exercise and immunisations,⁵ and thereby reducing the need for expensive high carbon hospital-based care.⁶

We can all take these opportunities to make a difference as practitioners. However, none of us practice in total isolation, and to achieve meaningful reduction in emissions we need to look at the bigger picture.

Doctors for the Environment Australia (DEA) and the Australian Medical Association (AMA) are jointly calling for the healthcare sector to achieve net zero emissions by 2040, with an 80% interim reduction target by 2030.¹⁶ Eighteen medical organisations, including the Australian and New Zealand College of Anaesthetists (ANZCA) and the Royal Australian College of Surgeons (RACS) have joined our call, accepting their responsibility to work towards sustainable health care. DEA’s “Net Zero Emissions: Responsibilities, pathways and opportunities for Australia’s healthcare sector report,”¹⁷ written in 2020, provides guidance on how to achieve these targets.

Pathways include:

As doctors, we can all advocate at the hospitals and medical practices in which we work to achieve these pathways. We are a powerful voice within these institutions, and the experience of DEA members is that much can be achieved through internal advocacy. Having conversations with our colleagues and hospital administrators, highlighting the ethical need for action as well as the financial savings that can be made, makes a material difference. My personal experience at my suburban general practice means we have solar panels, an EV charging station, sensible tree planting and improved waste management.

DEA has long advocated for a National Health and Climate Strategy (NHCS) and an accompanying Sustainable Healthcare Unit¹⁸ and we are very pleased that in December 2023 the federal government released the National Health and Climate Strategy,⁵ with its supporting National Health, Sustainability and Climate Unit (NHSCu). This high-level policy document’s vision is for ‘Healthy, climate-resilient communities, and a sustainable, resilient, high-quality, net zero health system’. It outlines a sensible, responsible pathway for our industry to achieve this vision and names workforce mobilisation as a key precondition for its success.

Currently DEA is advocating for budgetary support of the NHCS.¹⁹ While there is a small allocation for support of the NHSCu ($3.7 million over 3 years) and $5 million for research,²⁰ considering the annual health budget of $105.8 billion,²¹ this is a drop in the ocean for what has been described as the greatest health issue facing humanity.²²

As I said, recognising the need for sustainability is easy. Unfortunately, making a sustainable healthcare system is a complex and wicked problem requiring the input of federal and state governments, health departments, the hospital system and community care. As workers within that system we can make a difference, not only by the way we practise medicine but also by accepting our ethical responsibility to advocate for change. None of us can solve this problem individually, but if we all play our part, collectively we can. At least, we need to try.

2023 was the hottest year in recorded history.²³ People’s health and wellbeing are suffering due to climate change now;²² and this suffering will only get worse as our planet continues to heat. We doctors must exercise our duty of care to advocate for climate action, ensuring that people’s needs are at the heart of decision making by our governments and health institutions, because fundamentally the climate crisis is a health crisis, and we need to treat it.

Dr Kate Wylie is a GP and the Executive Director of Doctors for the Environment Australia.