Climate change, Health and Sustainability: A brief survey of Primary Care Trusts in
the South West of England.
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Introduction
There is little doubt that climate change will present real challenges to the health of
human populations, particularly those who are already vulnerable1,2. In the United
Kingdom (UK), an increase in mean annual temperature of 2.5 – 3 degrees
centigrade by the end of this century is likely to have a number of consequences
including increased risks of flooding, water contamination, drought and disruption to
water supplies, air pollution, skin cancers, and a rising incidence of food-borne
diseases3. Efforts are being made to reduce the risks of climate change and to work
towards sustainable development through the publication of a number of strategic
documents and action plans. For example the UK Public Health Association4 has
outlined strategies for promoting health and sustainable development, and the UK
Faculty of Public Health5 has published guidance on actions that can be taken at
both organisational and individual levels.
Similarly, the UK Department of Health
have published a Guidance Document on Promoting Sustainable Communities6.
However urgent action is required to limit the amount of carbon used by the UK
National Health Service (NHS), and reduce dependence of fossil fuel. The current
contribution of the NHS estate to carbon emissions is estimated at 18 million tonnes
CO2
per year7, and the NHS Sustainable Development Unit Carbon Reduction
Strategy7 details the origins of NHS carbon emissions, and practical actions aimed
at reducing the 2007 NHS carbon footprint by 10% by 2015. Such actions can be
directly linked to the UK Sustainable Development Commission NHS Good
Corporate Citizenship guidance8. This suggests ways in which NHS organisations
such as Primary Care Trusts can adopt sustainable development and tackle health
inequalities through their day-to-day activities such as transport, procurement,
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facilities, management and new buildings. Examples of action might include sourcing
locally produced food, and the development of Park and Ride schemes.
Whilst it appears that the potential impacts of climate change and sustainability upon
health care are being considered by central government in the UK and at national
level by a number of UK public health organisations, little is known about efforts to
plan for and manage these effects at a local level. Primary Care Trusts (PCT’s) are
arguably well positioned to provide direction on sustainability and promote efforts to
mitigate and adapt to the effects of climate change. However, previous research
indicated that where evidence of sustainable development amongst PCT’s was
found it was predominantly restricted to policy statements and strategic aims, with
examples of substantive, concrete action and implementation of policies being very
limited9.
Methods
In 2009, a questionnaire building upon our previous research9 and consisting of ten
questions examining topics relevant to climate change, sustainability and health was
emailed to fourteen Directors of Public Health based within south west England
PCT’s. The aim of this questionnaire was to gain a more detailed understanding of
knowledge and action on climate change and health amongst PCT’s in the south
west of England, and to illustrate this action though examples of good practice.
Correspondence with the National Research Ethics Service (NRES) confirmed that
this project was considered to be a service evaluation, therefore it did not require
ethical review by a NHS Research Ethics Committee.
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Seven questionnaires were completed and returned (a 50% response rate).
Completed questionnaire analysis and coding of data was carried out by two
researchers. A coding system for data extraction and analysis was constructed
based on an initial thematic analysis of responses within the completed
questionnaires. This coding system identified three main themes within the
questionnaire responses:
1) Strategy - where evidence of policies, procedures, guidelines in regard to
climate change/sustainability and health and/or staff tasked with the
development and implementation of climate change/sustainability and health
related strategy was discovered.
2) Intention - where evidence of some preparation or goal in relation to climate
change/sustainability and health was identified.
3) Action - where evidence of substantive acts in regard to climate
change/sustainability and health was found.
Evidence related to each of these themes is presented below. The anonymity of
PCTs discussed in this paper has been maintained, each PCT is indentified by an
allocated number only.
Data coding was carried out independently by two
researchers, and reliability was achieved by both researchers independently
reviewing and recoding material previously coded by their colleague. This enabled
the authors to extract relevant details which were then used to inform a discussion
and analysis of the data.
Results
All seven of the PCT’s that returned completed questionnaires claimed to have some
form of sustainability strategy. These strategies were either in the form of policies or
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plans. PCT3 provided good examples of policies available on sustainable building
including policy on, for example, low energy design, waste management, recycling
and emissions. PCT1 also provided evidence of robust and inclusive strategies such
as their Sustainable Development and Carbon Reduction Strategy which included
policies and plans for the management of waste, water, procurement and local
sourcing of food and supplies.
Evidence of PCT’s achieving a successful implementation of these strategies,
policies and plans was patchy, but indications were gained of the PCT’s continuing
intentions to further develop and put into practice their existing strategies. All
participating PCT’s provided evidence of some preparation, development or intent to
achieve some organisational goal in relation to climate change, sustainability and
health. For example, PCT6 was clear in its aim to negotiate with providers in an
attempt to procure a source of “green energy”. PCT4 and PCT2 described their
intention to implement “green travel” policies. The intention of PCT3 was apparent in
its endeavour to achieve specific aims in regard to procurement, waste management
and the reduction of packaging in products purchased. PCT1 was also seen to be
making efforts to successfully implement policies that intended to enable the
sourcing of local, sustainable produce. In their Carbon Reduction Strategy, PCT7
was able to provide evidence of its intention to achieve targets in energy use, travel,
procurement and waste management. This PCT also made it clear that designated
executive directors and other appropriate PCT staff were appointed to oversee the
implementation of plans and actions contained within the Carbon Reduction
Strategy, thus recognising the need for commitment at a senior level.
Some evidence of successful implementation of PCT plans and strategies in the
form of tangible action was found.
PCT5 and PCT3 were found to have been
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successful in implementing travel plans, with PCT3 including a cycle to work scheme
which had a particularly high rate of initial adoption compared to other similar
schemes within the NHS. Evidence of action in waste management was also offered
by, for example, PCT6 and PCT3.
These PCT’s were found to have been
particularly active in implementing plans to reduce, re-use and recycle waste. Other
examples of substantive action were provided by PCT4 and PCT1 and their activities
in sourcing renewable energy and local suppliers of sustainable produce.
Conclusions
This short paper draws attention to the health threats provided by climate change
and has outlined responses from UK public health organisations. The NHS will need
to respond quickly to the carbon reduction challenge if it is to meet the carbon
reduction targets set by the NHS Sustainable Development Unit. PCT’s are well
placed to provide direction on sustainability and promote efforts to mitigate and
adapt to the effects of climate change. This survey was undertaken in order to gain
further knowledge of action on climate change, sustainability and health amongst
PCTs in the south west of England and where possible, to illustrate this action
though examples of good practice.
The survey results indicate that, for those responding, PCT’s within south west
England were aware of the challenges posed by climate change and sustainability.
Based upon this awareness they had formulated appropriate strategies and made
clear their intent to implement these strategies. Although sporadic, some evidence
of successful implementation of PCT plans and strategies in the form of substantive
action was found. Further efforts should be made to build upon the good examples
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found in some PCT’s, and move towards implementation of strategies and policies
through practical action. This could be achieved by developing relationships between
stakeholders, such as public health specialists, pressure/community groups and
academics, to work collaboratively towards addressing the challenges of climate
change, sustainability and health.
Furthermore, successful implementation of
carbon reduction strategies and adaptation requires executive leadership at a high
level and Board level responsibility.
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References
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