So, what makes healthcare sustainable? Economically sustainable healthcare might involve something as simple as eating an apple a day to keep the doctor away (or other similar metaphors for healthier lifestyles). Environmentally sustainable healthcare might include just having better quality green spaces and parks close to where people live to relax in, or safe cycling routes to schools to reduce childhood obesity levels. Socially sustainable healthcare might be just as easy as getting old and young people together to grow vegetables on an allotment or having surgeries and hospitals within walking distance of home and surrounded by birdsong and greenery rather than high-rise car parks. There are many more sophisticated combinations of how to make healthcare sustainable and better and cheaper with long-term preventative strategies worth billions of pounds every year. Much of the complexity of what we currently have might be due to the increasing urbanisation of the UK's demography, the unhealthy habits people have acquired through lack of good quality green infrastructure, car use, sedentary work and leisure and everyday eating of processed, sugary-starchy-fatty, quick-fix foods. There is also, on the health systems side, the concentration of specialist services, dilution of neighbourhood scale provision, declining numbers of (worn-out) local GPs and the mind-boggling numbers of healthcare staff just getting to and from work everyday. The NHS is Europe's biggest employer with c 1.7 million staff. They burn a shed load of fuel just getting to a place to help people 'get better' even if the system they are part of is not getting better. The philosophical basis of the UK's NHS is a caring thoughtfulness of sheer but simple brilliance. However, it exists within such a massive number of unhealthy social, environmental and economic variables that keeping the philosophy pure and effective grows ever more difficult to sustain. Something needs to change before the equation of 'apple x 1/365 = 0 Rx' becomes an anachronism.
This month, the first of a new decade, and part of my New Year 2020 resolutions, I have been been offered the opportunity to contribute to this challenge by being invited to become a Trustee of an Oxford-based charity the Centre for Sustainable Healthcare (CSH). I'm looking forwards to getting engaged with the practicalities; CSH describes its overall mission as:
Since 2008 the Centre has been exploring methodologies and metrics that can help to transform models of care. We work with key partners to engage healthcare professionals, patients and the wider community in understanding the connections between health and environment, and to reduce healthcare’s resource footprint.
Our range of programmes seeks to inspire healthcare professionals to develop sustainable models of care. We provide tools and resources to empower and enable individuals and groups to make their own changes and we work with them to transform practice. Recognising that the natural community of practice in healthcare is most often the specialty, the Centre has developed its, much acclaimed, clinical sustainable specialties programme.
We also run the NHS Forest which carries out practical work on the empirical links between health and the environment. The NHS Forest works with healthcare professionals and organisations to make their green spaces available to local communities, patients and staff.
As one of the least forested countries in Europe, the UK, and England in particular, needs to see the re-establishment of accessible, nature-rich woodland (through natural regeneration particularly) close to where most people live, surrounding cities and towns (and large villages) as one of the most desirable forms of creating sustainable health for the longterm benefit of tens of millions of people. The NHS Forest project is a flagship but it needs to have a larger fleet.
A new report, an audit of 140 recent housing development designs, by CPRE and UCL's Bartlett School of Architecture (released today 21 January 2020) has shown that most are 'overwhelmingly mediocre or poor' and 1 in 5 were so poor that they should have been refused planning permission. Design is critical to sustainable health outcomes because poorly designed communities - often in the poorest areas (as this report also highlights) build in stress such as road and neighbour noise or fail to provide the useful, calming, green infrastructure for cycling and walking whilst increasing noisy, polluting vehicle traffic provision. Britain already has enough 'crap towns' (as self-certificated by suffering residents) but it really doesn't need any more new ones: It wants, and should demand from the PTB, sustainably healthy towns and cities.
You can discover more about the people and work of CSH at www.sustainablehealthcare.org.uk