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Brighton & Sussex Medical School

The BSMS Sustainable healthcare group

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BSMS Sustainable Healthcare group

The BSMS Sustainable Healthcare Group is a leading group in research and education relating to environmental, social and financial elements of sustainability in health and healthcare.

Our core functions are to:

  • Research and influence policy, knowledge, attitudes, and behaviour relating to sustainability in health and healthcare
  • Evaluate the environmental and social (including labour rights) impacts of healthcare and develop responses to mitigate these 
  • Collaborate in development of lean health service design
  • Build capacity in teaching and learning on sustainable health and sustainable healthcare
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BSMS at COP26

BSMS hosted a virtual panel discussion at the COP26 World Health Organisation Health Pavilion.The event, held on Friday 5 November 2021, brought together key international voices from the field of sustainable healthcare to discuss how the environmental impact of healthcare can be mitigated: exploring the interplay of research, clinical leadership, institutions, and industry. 

Speakers included Dr Chantelle Rizan (BSMS, UK), Dr Forbes McGain (Western Health, Australia); Dr Cassandra Thiel (New York University, US); Dr Rengaraj Venkatesh (Aravind Eye Hospital, India); Dr Fiona Adshead (Sustainable Healthcare Coalition, UK); Dr Frances Mortimer (Centre for Sustainable Healthcare, UK); and Dr Richard Smith (UK Health and Climate Change Alliance). The event was chaired by Professor Mahmood Bhutta, co-founder of the Sustainable Healthcare Group at BSMS, and Green Lead for University Hospitals Sussex (UK). 

Watch a full recording of this webinar below.

 

Another of our team, Dr Lisa Page, spoke at an event from the WHO Pavilion on 10th November entitled "The future of healthcare if we do nothing".  The event included short talks on air pollution and the impact of climate change on children's and refugee health; Lisa then spoke on the 'Implications of the Climate Emergency on Mental Health'. The event can be viewed below.

View the event here >

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surgeon in an operating theatre

What is sustainable healthcare?

We use a triple bottom line definition of sustainability, taking into account environmental, social and financial elements. Healthcare systems and processes can only be considered sustainable where all three elements (also termed ‘People, Planet and Profits’) intersect and are upheld. 


Importance of environmental sustainability

Climate change is the greatest threat to public health in the 21st century, but provision of healthcare itself impacts on our environment. For example, the NHS generates around 22 million tonnes of carbon dioxide equivalents (CO2e) each year in England, and 5.4% of net UK greenhouse gas emissions. The US healthcare industry generates over 1.7 million tonnes of plastic waste per year, and this is likely to rise given our increasing reliance on single-use plastics. The NHS is a major contributor to air pollution, responsible for 3.5% of all road travel in England.


Importance of social sustainability

Provision of healthcare also impacts on the lives of patients, their families, allied healthcare professionals, and those within the healthcare supply chain. The majority of the products we use within healthcare are manufactured overseas, and there are reports of widespread violations of labour rights in the manufacture of medical gloves, face masks, surgical instruments, and medical textiles.


Importance of financial sustainability

Healthcare spending has increased in line with an ageing population and medical advances. For health systems to remain financially viable requires efficient use of our resources and improved systems for delivery of care as well as an increased focus on disease prevention.

Venn diagram to show the three parts of sustainability healthcare system

Image of single use plastic medical equipment

Research

Research projects

We pursue a number of research interests in the sustainability of health systems. For instance, we use hybrid carbon footprinting methods to identify carbon hotspots within the operating theatre, life cycle assessments of the environmental impact of reusable versus single-use surgical items, and quantify the carbon footprint of healthcare waste and decontamination processes, to identify environmentally preferable options. We have also led action-research projects aimed at addressing precarious working conditions and modern slavery in the production of healthcare goods, have evaluated risk of labour rights abuse in healthcare supply chains and led national and international policy debates on this topic. 


Research repository                          

  • Rizan C, Brophy T, Lillywhite R, Reed M, Bhutta MF. Life cycle assessment and life cycle cost of repairing surgical scissors. International Journal of Life Cycle Assessment. Published online ahead of print (available at https://rdcu.be/cORRr) doi.org/10.1007/s11367-022-02064-7
  • Rizan C, Lillywhite R, Reed M, Bhutta MF. Minimising carbon footprint and financial costs of steam sterilisation and packaging reusable surgical instruments. British Journal of Surgery. 2021. Published online ahead of print (available at: https://academic.oup.com/bjs/advance-article/doi/10.1093/bjs/znab406/6445122) PMID: 34849606
  • Monsell A, Krzanowski J, Cuthbert S, Page LA, Harvey G. What mental health professionals and organisations should do to address climate change. British Journal of Psychiatry Bulletin. 2021 45:215-221, doi:10.1192/bjb.2021.17 (Open Access). Read it here >
  • Cuthbert  S, Kellas A, Page LA. Green Care in Psychiatry. British Journal of Psychiatry. 2021 Feb;218(2):73-74 doi: 10.1192/bjp. 2020.166 (Open Access). Read it here >
  • Harris H, Bhutta MF, Rizan C. A survey of UK and Irish surgeons’ attitudes, behaviours and barriers to change for environmental sustainability. Annals of the Royal College of Surgeons of England. 2021;103:725-729. PMID: 34719956
  • Rizan C, Bhutta MF. Environmental impact and life cycle financial cost of hybrid (reusable/ single-use) instruments versus single-use equivalents in laparoscopic cholecystectomy. Surgical Endoscopy. Published online ahead of print (available at: https://rdcu.be/cyAMF) PMID: 34559257  
  • Bhutta MF, Trueba M et al. Forced Labour in the Malaysian Medical Gloves Supply Chain before and during the COVID-19 Pandemic: Evidence, Scale and Solutions. July 2021. Read it here >
  • Rizan C, Bhutta MF. A strategy for net zero carbon surgery. British Journal of Surgery *Available online ahead of print. Doi: 10.1093/bjs/znab130. Read it here >
  • Rizan C, Reed M, Bhutta MF. Environmental impact of Personal Protective Equipment supplied to health and social care services in England in the first six months of the COVID-19 pandemic. Journal of the Royal Society of Medicine. 2021;114(5):250-263. PMID: 33726611. doi.org/10.1177/01410768211001583. Read it here >
  • Rizan C, Bhutta MF, Reed M, Lillywhite R. The carbon footprint of waste streams in a UK hospital. Journal of Cleaner Production. 2021;286:125446. Doi:10.1016/j.jclepro.2020.125446. doi.org/10.1016/j.jclepro.2020.125446. Read it here >
  • Trueba ML, Bhutta MF, Shahvisi A Instruments of health and harm: how the procurement of healthcare goods contributes to global health inequality Journal of Medical Ethics  Published Online First: 24 August 2020. doi: 10.1136/medethics-2020-10628 
  • Starup-Hansen J, Dunne H, Sadler J, Jones A, Okorie M. Climate change in healthcare: Exploring the potential role of inhaler prescribing. Pharmacol Res Perspect. 2020 Dec;8(6): e 00675
  • Rizan C, Steinbach I, Nicholson R, Lillywhite R, Reed M, Bhutta MF. The carbon footprint of operating theatres: a systematic review. Annals of Surgery. 2020; 272(6):986-995. Read it here >
  • Rizan C, Reed M, Mortimer F, Jones A, Stancliffe R, Bhutta MF. Using surgical sustainability principles to improve planetary health and optimise surgical services following COVID-19. 2020; The Bulletin. 102 (5). 177-181. Read it here >
  • Rizan C, Mortimer F, Stancliffe R, Bhutta MF. Plastics in healthcare: time for a re-evaluation. Journal of the Royal Society of Medicine. 2020; 113(2):49-53. Read it here >
  • Rizan C, Das P, Low R, Harden S, Flaherty B, Welland T, Bhutta MF. A streamlined pathway for patients with unilateral tinnitus: our experience of 22 patients. Clinical Otolaryngology. 2018; 44(2): 191-196. Read it here >
  • Thompson R, R Hornigold, L Page, T Waite. Associations between high ambient temperatures and heat waves with mental health outcomes: a systematic review. Public Health. 2018; 161: 171-191
  • Kim Y, C Ng, Y Chung, H Kim, Y Honda, Y Guo, Y-H Lim, B-Y Chen, L Page, M Hashizume. Air pollution and suicide in 10 cities in Northeast Asia : A time-stratified case crossover analysis. Environmental Health Perspectives 2018 126(3) Article number 037002 (Open Access). Read it here >
  • Bhutta MF. Time for a global response to labour rights violations in the manufacture of health-care goods. Bull World Health Organ. 2017 May 1;95(5):314-314A. Read it here >
  • Boyson C, S Taylor, L Page. The National Heatwave Plan – a brief evaluation of issues for frontline staff. PloS Currents 2014 Jan 13; 6 ecurrents.dis.aa63b5ff4cdaf47f1dc6bf44921afe93.
  • Page LA, Hajat S, Kovats RS, Howard LM. Temperature-related deaths in people with severe mental illness. British Journal of Psychiatry 2012 200:485-90. 
  • Page LA & Howard L. The impact of climate change on mental health (but will mental health be discussed at Copenhagen?) Psychological Medicine 2010; 40:177-180 
  • Paranjothy S, Gallacher J, Amlôt R, Rubin GJ, Page L, Baxter T, Wight J, Kirrage D, McNaught R, Palmer SR. Psychosocial impact of the summer 2007 Floods in England. BMC Public Health 2011 Mar 3;11:145 
  • Bhutta MF. Fair and ethical trade in health procurement Lancet. 2008 Dec 6;372(9654):1935-7. doi: 10.1016/S0140-6736(08)61826-7. 
  • Page LA, S Hajat, RS Kovats. The Relationship between Daily Suicide Counts and Temperature in England & Wales. British Journal of Psychiatry  2007; 191: 106-112
  • Bhutta MF. Fair trade for surgical instruments. BMJ. 2006 Aug 5;333(7562):297-9. doi: 10.1136/bmj.38901.619074.55. PMID: 16877453.

‘Planetary Health Edition of the Royal College of Surgeons of England Bulletin (July 2020), guest edited by Chantelle Rizan and Professor Bhutta, exploring sustainability in surgery. Read it here > 

students study during lecture

Education

Teaching and learning on sustainable healthcare

The key learning outcomes for sustainable healthcare

  1. Describe how the environment and human health interact at different levels
  2. Demonstrate the knowledge and skills needed to improve the environmental sustainability of health systems
  3. Discuss how the duty of a doctor to protect and promote health is shaped by the dependence of human health on the local and global environment 

Education on sustainable health and healthcare can therefore be framed as understanding how the environment impacts on health (eg air pollution as a risk factor for respiratory disease), the impact of healthcare on the environment (eg the carbon footprint of prescribing), ways to reduce the environmental impact of healthcare (eg lower carbon inhalers) and health promotion strategies (eg physical activity to improve mental health). 

The General Medical Council Outcomes for Graduates state that: “Newly qualified doctors must be able to apply the principles, methods and knowledge of population health and the improvement of health and sustainable healthcare to medical practice”.

 

Undergraduate curriculum at BSMS

Teaching on sustainable health and healthcare in the undergraduate curriculum includes: 

  • Year 1: ‘Environment and Health’ session looks at the interactions between the environment and health using air pollution as an example.  
  • Year 2: ‘Sustainable Healthcare’ which examines the impact of healthcare on the environment and ways in which healthcare can be made more sustainable 
  • Year 3: ‘Sustainable prescribing’ identifies the significant contribution made by prescribing to the NHS carbon footprint and identifies ways to reduce this including medicines optimisation and changing inhalers.  
  • Year 4: The ‘Climate change and Health’ session in the Global health day looks at the global health threat posed by climate change. The half day session on ‘Sustainable healthcare’ examines in more detail the ways that healthcare impacts on the environment and uses case studies from the NHS to demonstrate how sustainable healthcare practice and Quality Improvement (QI) can reduce these impacts and improve patients experience. Within their placements in ENT / neuro and ophthalmology in module 402, students are required to identify examples of waste (either physical or wasted clinical activity) and facilitated discussions examine how Sus-QI can be used to reduce this waste and lead to more sustainable clinical practice.  

 

Educational Events

The SHARE conference, organised jointly between University of Brighton School of Health Sciences and BSMS, is an annual conference which aims to share good practice between healthcare professionals, students and service users on topics related to sustainability and health and healthcare practice. Read more about the conference via the link below.

Read more about the conference here >


Green Medicine Society

The BSMS Green Medicine Society is a student-run organisation that raises awareness of the impact that climate change has on health and also the impact that healthcare has on climate change and the wider environment, as well as looking at ways to make healthcare more sustainable. They run talks, seminars, workshops and extracurricular events to promote medical student engagement in planetary health. If you would like to join or get involved, please contact the society at bsmsgreenmedicine@gmail.com or follow them on social media.

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SHARE conference 2022

After a hugely successful conference in 2021, SHARE is back for 2022. This conference will offer keynote talks, oral presentations and posters about putting the theory of sustainability principles into action in healthcare practice. The theme this year is Sustainable healthcare: theory to practice.

Find out more about the conference, register your place for free or submit an abstract below.

visit the conference webpage here > 

Image of the seven sisters cliff in Sussex

Useful links and resources

Useful links

Centre for Sustainable Healthcare
www.sustainablehealthcare.org.uk

Greener NHS
www.england.nhs.uk/greenernhs

BMA website
www.bma.org.uk/what-we-do/working-internationally/our-international-work/fair-medical-trade

Royal College of Surgeons of England webinar in which Chantelle Rizan and Professor Bhutta discuss the evidence surrounding environmental and financial cost of reusable versus single-use medical equipment, and barriers and opportunities to moving towards a circular economy.

 

Royal College of Surgeons of England webinar in which Prof Bhutta and Chantelle Rizan discuss ways of improving environmental and social sustainability of surgery in the below webinar video.


Chantelle Rizan discusses the interplay between healthcare and the environment, and her research in the field. Listen to the podcast here >

Prof Mahmood Bhutta discusses modern slavery, PPE and the NHS. Listen to the podcast here >

Royal College of Psychiatrists Position Statement 2021 'Our planet's climate and ecological emergency'. Read it here >

The impact of climate change on mental health and emotional wellbeing: current evidence and implications for policy and practice. Grantham Institute Briefing Paper No 36. May 2021. E Lawrance, R Thompson, G Fontana, N Jennings. Read it here >

The 2021 Royal Society of Medicine Climate change series: Resources on health and climate change | The Royal Society of Medicine. View it here >

Contact us

Email Dr Anna Jones at a.jones@bsms.ac.uk.