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As the world grapples with the negative health effects posed by climate change, Fiona Miller says the health-care sector must not only treat the resulting medical conditions — but take steps to ensure it's not contributing to them.

“In Canada and in most other countries, the health-care sector accounts for about five per cent of greenhouse gas emissions,” says Miller, professor of health policy at the Institute of Health Policy, Management and Evaluation (IHPME) in the Dalla Lana School of Public Health at the University of Toronto. 

“Globally, if health care were a nation, it would be the fifth largest emitter.”

Miller is director of IHPME’s Centre for Sustainable Health Systems and chair in Health Management Strategies.

When she speaks of health care and its impact on environmental degradation, Miller is referring to everything involved in caring for the health of society. That includes massive hospitals that require heating and cooling – and may be generating power from coal – to the overuse of single-use medical items such as hypodermic needles and syringes, as well as the packaging that becomes garbage. It includes individuals driving to see a doctor for an in-person physical that may not be medically necessary – and the use of certain kinds of inhalers and anesthetic gases that are not environmentally-friendly. 

“The health-care sector is buying an enormous quantity of products,” Miller says. “They own lots of capital and infrastructure. They are very much part of urban environments. And with everything that goes with that, they have negative environmental impacts.”

The paradox, she says, is the health-care sector is inadvertently helping to create new health problems – linked to pollution and climate change – in its effort to treat others.

“We often don’t recognize that these very significant social institutions are part and parcel of climate change.”

But Miller, who recently received a Connaught Global Challenge Award for her work, notes that there are signs the sector is changing its ways. 

“Organizations around the world are waking up to their responsibility to manage sustainability,” she says. “Health care is no different in terms of needing to get its house in order and mitigate the environmental harms it is responsible for. In fact, there is a greater obligation in health care because its mission is health.”

Miller points to the precedent-setting work of the National Health Service in England, which has committed to a net-zero health system for the full scope of its direct and indirect emissions by 2045.  She also notes (which sprung from a U.S. initiative that launched in 2012) that is encouraging health professionals and patients to take a hard look at identifying unnecessary medical tests, treatments and procedures. 

And the push for sustainable health care got a big boost earlier this year when Environment and Climate Change Canada awarded $6 million to launch CASCADES (Creating a Sustainable Canadian Health System in a Climate Crisis). 

The project is being led by Miller, who is partnering with Sean Christie and Gillian Ritcey of Dalhousie University, Andrea MacNeill of the University of British Columbia, and Linda Varangu of the Canadian Coalition for Green Health Care. 

The mandate of CASCADES, says Miller, is to “build and leverage capacity on the front lines, among management and leadership levels, through continuing professional development, knowledge mobilization and networking, supporting the testing, spreading and scaling of innovations in sustainable care, using improvement methods.” 

She adds that CASCADES will focus on encouraging health systems in Canada to work in a co-ordinated way to achieving net-zero emissions.  While there have been “pockets of extraordinary excellence and effort,” it has often been too piecemeal, she says.   

Andrea MacNeill believes CASCADES is the right initiative to manage these limitations. 

“We possess sustainability and health-care expertise, with deep connections with both sectors,” she says.  “We understand how to engage diverse members of the health-care community on their own terms and pursue national co-ordination while respecting local priorities, provincial and territorial jurisdiction and differences across professions, practices and context.”

And Miller is pleased to report that there is “actually tremendous energy in the health-care sector around this. I think the appetite is really there. The timing of launching CASCADES is very good, given the urgency. People want to know how to bring this into their professional lives and how to be on the right side of history on this issue.”

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