A sustainable future in health: ensuring as health professionals our own house is in order and leading by example

To the Editor: Congratulations to the Medical Journal of Australia for emphasising the role of health professionals in needing to lead by example towards a sustainable future. Talley's editorial1 encourages health care professionals to reduce health care's own carbon footprint and pollution, noting that, “With a concerted effort, the Australian health system could achieve zero net emissions and relatively soon, and we applaud all the ongoing state initiatives”.

Leading by example is vital but will alone not reduce the Australian health care's large carbon footprint — 7% of Australia's carbon dioxide equivalent (CO₂e) emissions. Many doctors, including ourselves, have collectively spent several decades and thousands of hours leading by example to reduce our workplaces’ (hospitals) carbon footprints. Individual efforts to date have had minimal effect at best. Even in Victoria, where a 2017 climate change act exists, “since 2005 [to 2018, Victorian public health care's] overall energy use has increased by 22 per cent and carbon emissions [rose] by 32 per cent”.2

Reducing Australian health care's CO₂e emissions requires multilevel system change, not only individual change. England's Sustainable Development Unit (SDU) has guided the National Health Service's (NHS) carbon reduction plan since 2008 with impressive results.3 The small (fewer than ten staff) NHS SDU has been integral to reducing carbon emissions by 11% from 2008 to 2018, despite activity increasing by 18%, and saving at least £90 million annually.3 This contrasts to increasing carbon emissions and increasing costs in Victoria and elsewhere. As doctors, we need to collectively demand and work towards a comparative national Healthcare SDU in Australia. The Australian Medical Association4 and Doctors for the Environment Australia have called for such a Unit to facilitate significant changes within our high carbon health care system.5

A national SDU leading and coordinating a clear roadmap would lead to more effective, efficient, resilient and sustainable health care. State‐based SDUs and primary (general practice) and preventive health care are integral, and there are potentially significant financial benefits as demonstrated by the NHS SDU. It is time for doctors to lead and insist on a national health care SDU to facilitate our urgent transformation to a low carbon health care system. We cannot afford not to do it.