Professor Yvonne Zurynski, Dr K-lynn Smith, Professor Jeffrey Braithwaite – Australian Institute for Health Innovation, Macquarie University
We prosecuted the case, in our Handbook of Climate Change and Health System Sustainability [1], that healthcare systems face a formidable, bi-directional challenge. Healthcare contributes ~5% of global greenhouse gas (GHG) emissions, and if healthcare was a country, it would be the fifth largest emitter in the world [2]. On the other hand, healthcare systems are on the front lines of dealing with the health impacts of climate change on people. Of course, health professionals are people too, and the impacts of climate change disasters on them, are already being amplified by the ongoing global health workforce shortages [3].
The health workforce faces these significant challenges, with ever-more frequent climate events: e.g., cyclones, bush fires, floods and heatwaves. Tropical, vector borne diseases are on the march, too. During disasters, health professionals are often uncomplainingly prepared to work long-hours under sometimes unsafe circumstances as they deal with increasing numbers of patients seeking urgent treatment for heat-exhaustion, respiratory distress, injuries, complications of pre-existing chronic conditions, or require emergency medicines.
The resilience and resourcefulness of health workers in times like these cannot be over-stated. However, evidence shows that there are long-term mental health impacts from these and other stressors on health professionals and their families [4]. Importantly, system recovery times are impacted by high workforce attrition and low retention rates.
As researchers, we have witnessed difficult experiences among health professionals. For example, while interviewing a specialist nurse from a flood affected area about the structure of her clinic, we heard that ‘…in the floods we lost all our paper notes… We couldn’t use any of them and they were just all covered in mud. Umm, so we lost a lot of information. We had to move 8 times, over about 18 months… [the patients] are confused about which building are you in now…’.
Support is needed not just before and during, but long after the disaster to maintain mental health and wellbeing of the health workforce, to optimise system recovery, increase workforce retention and value the people who need to get up and do it again, next disaster.
Aligned to this supportive culture, robust, data-driven, multi-professional workforce planning processes would go a long way to address the global shortage of healthcare workers, which is increasingly amplified by the consequences of climate change. Disconcertingly, the most recent national health workforce strategy Medical Workforce 2021-2031 takes a uni-professional focus concentrating on the doctor workforce. But what about the core role of nurses and allied health staff? The strategy fails to leverage the multi-professional frameworks and data-driven approaches described in the older strategy Health Workforce -2025 and neither strategy factors in the impact of climate change as a potential driver of workforce retention.
Training the workforce for the future it faces is essential, but evidence about the Australian workforce’s knowledge and training about climate change is scarce. Although embedding modules on climate change in medical curricula is an admirable step taken by many medical schools, we need to train the entire workforce to bolster the preparedness of all clinicians on the frontlines of care.
In a clear step in the right direction, the International Society for Quality and Safety in Health Care (ISQua) published ‘Green Care is High Quality Care’ which empowers clinicians to reduce Greenhouse gas emissions. In addition, a module on Sustainability in Healthcare is offered under the ISQua Fellowship course. It is heartening to see that ~160 Australian hospitals and other healthcare services have joined Global Green and Healthy Hospitals. The Climate and Health Alliance and the Healthy Environments and Lives Network provide support advice, advocacy and resources. At the Australian Institute of Health Innovation, we established the Observatory on the Future of Healthcare over five years ago to provide much needed evidence on mitigation and adaptation [5].
Looking to the future, investment is needed in research, evidence-based policy, and training to sustain the health workforce, health systems, the health of the nation and planet. We must act now. The clock is ticking.
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[1] Routledge Handbook of climate change and health system sustainability. J. Braithwaite, Y. Zurynski, & C. K. Smith (Eds.) Routledge, Taylor and Francis Group, 2024.
[2] Kluge H, Forman R, Muscat NA, Berdzuli N, Mossialos E. (2023) Environmental sustainability of health systems: time to act. Lancet, 401(10388):1552-1554.
[3] World Health Organization. Health Workforce: World Health Organization; 2023. https://www.who.int/health-topics/health-workforce#tab=tab_1
[4] Zurynski, Y., Fisher, G., Wijekulasuriya, S., Leask, E., Dharmayani, P. N. A., Ellis, L., Smith, C. L., & Braithwaite, J.(2024). Bolstering health systems to cope with the impacts of climate change events: a review of the evidence on workforce planning, upskilling, and capacity building. International Journal of Health Policy and Management,39(3), 781-805.
[5] Smith, C. L., Zurynski, Y., Braithwaite, J. (2022). We can’t mitigate what we don’t monitor: using informatics to measure and improve healthcare systems’ climate impact and environmental footprint. Journal of the American Medical Informatics Association, 29(12), 2168-2173.
