www.carbonaddict.org

Carbon DependenceA healthcare challenge

• The carbon addict: health effects of a high carbon lifestyle

• Is the NHS addicted?

• Complications: adverse effects of a high carbon health service

• Detox: what can health professionals do about it?

• Health services for a low carbon future

The carbon addict: health effects of a high carbon lifestyle on

individuals

Carbon DependenceEpidemiology

• Early case reports date back to the 19th century, with prevalence rising exponentially in the last 50 years

• Now reached epidemic proportions in the UK – affecting almost 100% of the population

• Fears of global pandemic

Causes

• No genetic influences identified

• Environmental factors important – e.g. out-of-town shopping

Carbon DependenceSymptoms

• T-Shirt in winter

• Car journeys under 3 miles

• Vegetable intolerance / meat-bingeing

• New-variant Consumption (nvC)

A carbon-dependent society?…

…What’s wrong with that?

• Reduced exercise tolerance

• fossil fuel use is replacing physical activity in daily living negative impacts on cardiovascular health

• Anxiety, stress

• physical activity has psycho-protective effects, so doing less of it has negative impacts on mental health

• dissatisfaction

• Respiratory symptoms• asthma and allergies. Less air pollution and more time spent

in natural environments could reduce the risk of these complications.

Carbon DependenceEarly Complications

• Obesity and diabetes– due to high fat diet and inactivity

• Cardiovascular disease – high salt and fat diet, and inactivity

• Colorectal cancer – correlates with high meat intake

• Falls – inactivity low muscle mass, falls due to SE of medication

• Fuel poverty – using more fuel costs money

• Social isolation – interaction via facebook? TV entertainment?

Carbon DependenceLate Complications

Am J Prev Med 2004;27(2)

each hour in car per day: risk obesity by 6%

Circulation July 6, 1999

Walking <0.25 mile/day: risk CHD x2

Journal of the National Cancer Institute, Vol. 97, No. 12, June 15, 2005

Red/processed meat: risk colorectal cancer

• Obesity and diabetes– due to high fat diet and inactivity

• Cardiovascular disease – high salt and fat diet, and inactivity

• Colorectal cancer – correlates with high meat intake

• Falls – inactivity low muscle mass, falls due to SE of medication

• Fuel poverty – using more fuel costs money

• Social isolation – interaction via facebook? TV entertainment?

Carbon DependenceLate Complications

Carbon DependenceClimate Toxicity

2004: Hurricane Catarina – the first South Atlantic hurricane.

• Already responsible for many deaths worldwide: malnutrition, malaria, diarrhoeal disease (WHO)

• Severity not related to intensity of same individual’s carbon addiction

Carbon DependenceClimate Toxicity

“Sustainable Energy – without the hot air” 2008

David MacKay. www.withouthotair.com

CO2 concentrations

IPCC Fourth Assessment Report (2007)

Climate projections

Synthesis Report – Climate Change, Global Risks, Challenges & Decisions, Copenhagen 2009

What’s happening now?

Is the NHS addicted? Understanding the carbon footprint of NHS

England.

18 million tonnes CO2 in

2004

Carbon Footprint NHS England

Carbon Footprint NHS England – procurement

Complications: adverse effects of a high carbon health service.

“Is the NHS getting flabby…?”

• Elective surgery cancelled after last-minute anaesthetic review

• Blood tests repeated because not on system

• Hospital-acquired infections

• Post-operative pain

• Drugs to treat side-effects – of drugs

High Carbon Care

• Patients attending for appointments without knowing why they are there

• Drugs continued when no longer needed

• Related conditions managed on separate days by separate teams

• Hi-tech interventions preferred, even where alternatives exist 

High Carbon Care (2)

Activity ≠ outcome

High Carbon Care

Risk-benefit: can a move to single use instruments cause harm?

Health risks?

• lower quality surgical instruments > bleeding

• chemical exposure?

Environmental impacts?

• energy and carbon for manufacture

• transport

• pollution from waste disposal

Waste of NHS resources? 

Health risks?• infection, side effects, complications of invasive tests

Psychosocial factors?• perception of condition, stress

• time off work

Environmental impacts?• energy, transport - carbon emissions

• production of material resources: needles, forms, gloves

• pollution from waste disposal

Waste of NHS resources? 

Risk-benefit: can referral to a specialist cause harm?

Climate ToxicityHospitals in heatwaves (press stories)

• Nurses and administrative staff walked out in protest at high temperatures in brand-new PFI hospital "We can't work in this- we're suffering from heat exhaustion and everything“

• Angry relatives claimed hospital could not provide for its most vulnerable patients. People on strict nil by mouth diet were left to lie in pools of their own sweat without ice and proper air conditioning as their limbs swelled in the heat

• Hospital facing demands for an enquiry into how vital equipment was allowed to break down during recent heat-wave, forcing the cancellation of scores of operations

Climate ToxicityHospitals in heatwaves (press stories 2)

• Public Health (Pathology) Laboratory stopped work - machines failed in heat.

• Nurses on cardiac ward were in tears at their inability to keep patients as cool as they should have been

• Drugs may be vulnerable to extreme temperatures in summer

• Andy Williamson, Chair – GSTT Kidney Patients’ Association:

“As a kidney patient, I’m acutely aware of my own vulnerability to climate events, and my dependence on drugs and dialysis equipment which rely on cheap oil for their availability.”

Detox: what can health professionals do about carbon addiction?

In your patients?

What are the barriers..?

Discussion point

Medical Intervention• Medical interventions are carbon intensive

– risk of increasing carbon dependence

• How can health professionals reduce medical interventions by PREVENTING ill-health?

Active Travel• Cycling burns about 300 calories per hour (5 calories per minute)

• Regular cyclists enjoy a fitness level equal to that of a person ten years younger and a life expectancy 2 years above the average

• Cycling regularly to work is the most effective thing an individual can do to improve health and increase longevity.

• If one third of all short car journeys were made by bike, national heart disease rates would fall by between 5 and 10 percent  

• Only 28% of women in England and Scotland and 24% in Wales meet the government’s guidelines for physical activity levels.

• During rush hour a bicycle is about twice as fast as a car.

“Housing improvement programmes benefit almost all carbon addicts, but particularly the elderly, living alone, those with cardiovascular or respiratory disease”

• Referral systems from health services to fuel poverty schemes

• Educating patients on specific health benefits of housing improvements

Housing & energy

J Epidemiol Community Health 2008;62:793–797

BP 142/85 123/73

Detox: what can health professionals do about carbon addiction?

In the NHS?

Discussion point

What are the barriers..?

Health services for a low carbon future: designing clinical care

which is preventative, develops self-reliance, uses lean pathways

and low carbon technologies.

www.sdu.nhs.uk

NHS England CO2 baseline to 2020 with Climate Change targets

10% target from 2007

26% target from 1990 baseline

64% target from 1990 baseline

80% target from 1990 baseline

0.00

5.00

10.00

15.00

20.00

25.00

1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050

Year

Mt C

O2

NHS EnglandNHS England forecast2007 baselineCarbon Reduction Strategy Target10% target from 20071990 baselineClimate Change Act Target26% target from 1990 baseline64% target from 1990 baseline80% target from 1990 baseline

sustainable estates & facilities

+sustainable

clinical practice

sustainable healthcare =

Principles of Sustainable Clinical Practice

(The Campaign for Greener Healthcare)

• Prevention

• Patient partnership

• Lean systems

• Low carbon treatment choices

www.greenerhealthcare.org/clinical-transformation

• Recent advances have transformed outcome in what was previously a universally disabling disease.

• With help of multidisciplinary team, addicts may even achieve full recovery.

Carbon DependencePrognosis

www.carbonaddict.org

Carbon Addict is an opensource project of The Climate Connection and

The Campaign for Greener Healthcare.

The illustrations are by www.worldofinferiors.co.uk and are licensed

under a Creative Commons License.

www.CarbonAddict.org