Measuring the environmental cost of health-related travel from rural and remote Australia

To the Editor: The environmental impact of Australia’s health system needs to be assessed. Estimates from the United Kingdom indicate that travel is responsible for 13% of health care-related carbon emissions, with patient travel contributing 6%.1 Australia’s total emissions for the year to September 2012 were estimated to be 24.1 tonnes of carbon dioxide equivalent gas (tCO2e) per capita, with 16% of all emissions being transport-related.2 In a recent study, we sought to estimate the carbon cost associated with health-related travel from rural and remote Australia.

We conducted a population survey of residents of King Island, located in Bass Strait between Victoria and Tasmania. Of the island’s 1553 residents, 625 (40%) responded. Participants reported 511 health care travel events for a 12-month period in 2011–2012, spending 2298 nights away from the island. Excluding escorts and family members who accompanied the patients, their travel to health services generated emissions of 130.87 tCO2e (0.22 tCO2e per capita per year). In terms of carbon offsets, these emissions represent growing 20 trees for 30 years.3 The carbon emissions attributable to a single person on a commercial flight were equivalent to using a medium or large petrol- or diesel-powered vehicle over the same distance.

We found that perceived time away from farming and seasonal businesses influenced whether participants would seek treatment for non-urgent problems or attend follow-up appointments. Rural general practitioners need to take this into consideration when arranging referrals. When travel was inevitable, participants preferred to go to places where they had personal networks to assist with accommodation, transport and emotional support, or where all of their health care needs could be met in the shortest time.

Telehealth is one solution that can allow rural and remote patients to access specialist care and follow-up closer to home. Many studies have aimed to establish its effectiveness for a broad range of specialties. The Australian College of Rural and Remote Medicine and the Royal Australian College of General Practitioners promote telehealth solutions and provide specialist provider directories on their websites.

Given the extensive use of large petrol- and diesel-powered cars in remote areas, these emissions data are relevant to all remote communities. Based on Australian Bureau of Statistics data in 2010,4 if all Australians in remote areas accessed health care similarly to our King Island sample, this could equate to 109 560 tCO2e per year, or offsets totalling 16 743 trees grown for 30 years.