Do no harm? PhD students target pollution from health-care sector

If it were a country, the global health-care sector would be the fifth-largest emitter of greenhouse gases – not a great look for a field that promises to “do no harm.”

That’s among the reasons PhD students Victoria Haldane, Anna Cooper Reed and Danielle Toccalino at the University of Toronto’s Institute for Health Policy, Management and Evaluation (IHPME) along with Dr. Colin Sue-Chue-Lam, are leading a grassroots organization called Emerging Leaders in Environmental Sustainability in Healthcare (ELESH).

The mission of ELESH is to foster interdisciplinary learning and action across the various disciplines and professions that deliver care.

“A lot of the work we do is advocacy-related,” says Cooper Reed, who notes that trainees in health services and policy research are rarely taught that health care is a major polluter.

In Canada, for example, the health sector accounts for 4.6 per cent of the country’s total greenhouse gas emissions, resulting in a staggering 23,000 years of life lost each year from disability or early death, according to a 2019 paper in the Canadian Medical Association Journal.

“This can be a newer area for many faculty and trainees – the nexus of climate change and health and health care. We want to build community and a movement and get students interested in this topic,” Cooper Reed says.

ELESH, which is supported by the Centre for Sustainable Health Systems (founded by IHPME professor Fiona Miller), has developed a framework for thinking about how to transform health systems so that they are more equitable, resilient and sustainable.

In October 2020, the group brought together 10 students from across Canada to form the Health Services and Policy Research Trainee Committee on Environmental Sustainability. The committee discusses how environmental sustainability can influence how research is carried out, what research is done and what students are taught.

The committee held a virtual town hall on Nov. 6 that was attended by representatives from the Institute of Health Services and Policy Research, part of the Canadian Institutes of Health Research (CIHR), to discuss recommendations that ultimately aim to better protect people and the planet.

“It laid out a framework and road map for what we as trainees are committed to doing to help embed [environmental sustainability] into our own practice and curricula, and outlining opportunities for CIHR to help facilitate this,” says Toccalino, who notes there will be another town hall with delegates from CIHR in the spring of 2021 to follow up on the ideas discussed.

The goal is to establish environmental sustainability as a way of looking at health services.

“The status quo is clearly harmful and we have to push towards better systems in whatever ways we can,” says Haldane. “Where there isn’t education, you try and build processes to get that awareness so that it becomes as common as applying a sex and gender lens to your research. We think about the impact of our research in terms of environmental sustainability. We’ve already shown it can be done with other lenses we apply to our work, so why not this lens?”

The group recently completed a virtual case challenge that drew participation from interdisciplinary teams across the country. The event, held jointly with trainees from Choosing Wisely Canada, had teams pitch solutions for single-use products in the Canadian health system, a major source of hospital waste with lasting impact on the environment.

The winning team was a trio of McGill University medical students. They were awarded the first prize of $1,000 for their proposal for equitable distribution and use of menstrual hygiene products in Montreal.

As part of their advocacy work, ELESH is committed to building capacity in environmental sustainability by educating trainees from diverse programs and faculties.

“As the health system is interdisciplinary, we must be, too, if we want to combat this problem,” says Cooper Reed. “I love learning from people from different disciplines like public health, medicine and nursing. It’s this collaborative effort that has been so central to ELESH.” The group holds book club meetings every other month to discuss climate and ecological issues more broadly, not just in relation to health care.

The group also represents trainees at the Sustainable Health Systems Community of Practice, a collaboration between hospitals in the Toronto Academic Health Sciences Network and U of T’s Council of Health Sciences.

Cooper Reed, Haldane, Sue-Chue-Lam and Toccalino are unanimous in their resolve to address the issue.

“I think IHPME training us to be health systems leaders asks us to step into big shoes and transform complicated and, in many ways, deeply flawed, institutions and systems,” says Haldane. “If, as emerging leaders, we want to think ahead to the health systems we will inherit, this is going to be one of the issues. It’s interconnected with equity, racism and with all of these public health crises that are already happening. We’re just trying to do our due diligence to be best equipped to deal with that.”

Sue-Chue-Lam, who is a general surgery resident, says he is optimistic because he sees opportunities for change.

“We are not without agency and health care has a parcel of emissions and ecological impacts that is under our institutional control,” Sue-Chue-Lam says. “Every tonne of carbon matters, so while I may have cynicism about the scale and pace of transformation of other systems that are outside of my control, I’m hopeful about our ability to transform health care and, hopefully, by mobilizing people within health care, that’s a mechanism for social transformation that pushes for bigger changes.”