Budapest 5
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Transition to a sustainable health system, climate change and green procurement
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Budapest 5
- 1. Sustainable Health A Different Approach Presented by Ann Marie Crosse
- 2. Rethinking Health Systems Systems Approach Ecohealth Social and Environmental Justice Behavioural and Cultural Change
- 3. Sustainable Health A Different Approach Presented by Ann Marie Crosse
- 4. Sustainability and Health SYNERGY ! Social Environment Economic Sustainable Health A Different Approach Presented by Ann Marie Crosse
- 5. Sustainable Health A Different Approach Presented by Ann Marie Crosse
- 7. The State of our Health The BIG 6 Stroke Acute Coronary Syndrome Heart Failure COPD Asthma Diabetes
- 8. The State of our Environment The BIG 6 Waste Air Biodiversity Agriculture Forestry & Fisheries Natural Resources Water
- 9. “”Climate change is the biggest global threat of the 21st century The Lancet Sustainable Health A Different Approach Presented by Ann Marie Crosse
- 10. Population Health & Health Inequalities Resource Efficency Leadership & System Capacity Technology & Research Sustainable Health A Different Approach Presented by Ann Marie Crosse
- 11. Systems Approach Procurement Estates Catering DieticsNursing Patients Staff Public Catering Sustainable Health A Different Approach Presented by Ann Marie Crosse
- 12. Sustainable Health A Different Approach Presented by Ann Marie Crosse
- 13. Antenatal Early Years Pre School Healthy Schools Campus Community Gardens Hospitals Healthy Vending Calorie posting Low Salt GPP 5- 25% Sustainable Health A Different Approach Presented by Ann Marie Crosse
- 14. Our single most important challenge is…. to help establish a social order in which the freedom of the individual will truly mean the freedom of the individual. We must construct that people centred society of freedom in such a manner that it guarantees the liberties and the human rights of all our citizens Nelson Mandela “”
- 15. Engagement Listening & Understanding Themes Priorities Action Reflection Behavioural & Cultural Change Sustainable Health A Different Approach Presented by Ann Marie Crosse
- 16. Way Forward Sustainable Health A Different Approach Presented by Ann Marie Crosse
- 17. Sustainable Health A Different Approach Presented by Ann Marie Crosse
- 18. “Ar Scath a cheile a mhaireann na daoine” People live in each others shadows Thank you for your time and attention
Editor's Notes
- Good afternoon Thanks to Kornelia Delighted to be here , we are on the early part of our journey Transition to a sustainable health system is complex and requires effective collaboration between all areas within the health service at national. regional and local levels
- System thinking works to decode this complexity and supports the design and implementation of effective , cross sectoral and sustainable health systems . Eco health makes the inextricable connection between the health of the population and the ecosystem on which we directly and indirectly depend. Ethical principles need to underly a health sustainable framework , theories of justice and environmental ethics are closely connected. A paradigm shift is required to support and drive this process of change , levers alone will not bring sustained change.
- golden eagle, bog asphodel , nature as a source and resource for health
- Twin interests of public health and the environment- Interrelated and need to be addressed in a integrated manner Socially - NCCDs increasing , levels of violence, war over natural resources , poor use of social capital , health inequalities increasing, social dysfunction, Environment, MEA, - 15 out of 24 ecosystems in decline, 60 % of services we depend are under threat environmental economics and valuing the ecosystem Economic - levels of poverty increasing , between and within countries , increasing consumption Save money within the system , conserve limited resources Growing convergence of solutions- sustainable development or what could be called resilience - balanced decision making model Rio , rio plus 20 Recogniition of interdependence , sustainability boundaries ( Jacobs) Save money / conserve limited resources Comply with regulations and law, governance Reduce environmental impact on health improve health outcomes , reduce inequalities innovate and improve / assure quality support staff to align personal and professional behaviour , to build community assets , to leave a legacy align actions with ethics Manage reputation, take exemplary action key principlles protecting the vulnerable and benefiting the least advantaged respecting different capabilities avoiding harm intergenerational equity precautionary principle sustainability boundaries balanced objectives- SEE seeing the whole economy and the entire lifecycle building resilience
- Ireland - A very green country !! potential to be a green battery - energy and food, low pollution, however … Market driven economy ,contractural commissioning and free market principles recovering from the demise of the celtic tiger , did not lift many boats , export driven , import over 60% of fruit and veg. CAP reform favours meat subsidy and we are set to increase meat production with obvious increase in water use and methane production, Low Public sector morale Health Inequalities and Intergenerational justice -Inequalites increasing and widening . Distributive Justice and Democratic Legitimacy- new forms of street protest .. water as a catalyst Health system - Public, Private mix, maket driven, GMS and GP cards over 60% of pop HSE budget - 14 billion 106,000 employees 3000 properties , 50 acute hospitals - 5 groups ( 337 mn spend) 2,500 vehicles 200 mn energy , 23 mn waste , 8 mn water , Annual health care - 3.5 mn outpatient treatment, 1.3 mn day care , 1.1 mn A &E Clinical Choices vs Resource limitation Health Procurement 52% Goods and services 7 Billion, New Buildings 337 million
- Healthy Ireland - first government wide health policy , health in all documents Sd is a key principle of the HI framework and supports the themes of partnership, empowering people and communities and health reform- through actions on s such as food sustainability, active transport etc sd can help meet HI goals of improving health and reducing obesity. Future health - health reform Our sustainable future - govt plans for advancing Sd in ireland framework recognises that a healthy enviro is inextricably linked to the health of our population, prevention, partnership, community seen as key in achieving health. National Climate change adaptation framework states that health is a key climate sensitive sector in ireland early action is imperative to minimise threats to public health, adaptation solutions Ed for Sust recognises need for behavioural and cultural change Likewise……
- Medical model vs the social model Focus on the determinants of health and wellbeing Ageing - increasing demographics - over 85 year olds , one of the highest in EU can do little about this NCCDs big 6 clinical care programs , add sustainability along route , prevention to treatment to management . Physical activity 22% inactive , 25% low levels of activity obesity 33% overweight, 25 % obese, 2000 deaths a year from obesity- 17% diabetes , 21% CHD, 8-24% cancers present 1. 3 children under 5 overweight, numbers increasing cost of treating obesity alone 0.4 bn, depression increasing , Increasing consumption - prudent choices not always the healthier choice, leaves out natural environment
- The Big 6 Water- Water Framework Directive , euthrophication, antibiotics , MRSA, our water good Air - Air Quality Standards 2011 ( EU 396,000 premature deaths per year , decrease GHGs by 30% below 1990 levels by 2020, cobenefits will result in a dramatic improvement in health outcomes (Pms) Biodiversity- National Biodiversity Plan 2011-2016 Agriculture,Forestry and Fisheries Natural Resources CAP, Food Harvest 2020 Waste - Waste Directive 2011 , 51% food waste homes and health care Climate Change , Increasing consumption
- “ climate change is the biggest global threat of the 21st century” The Lancet 2% increase will result in negative impact in all regions climate friendly health service -
- Focus on 4 areas - within a national strategy , imlement strategies across the disciplines - waste and energy , vending to prevention and community development, 14001 Resource efficency HSE spend 14 billion Energy bill over 200n, Reduction of 10% = 20 min Water 8 mn Waste 23 mn, 15 mn domestic and 8 mn clinical Procurement 52% Better food management can lead to signicficant savings - Green health care programme EPA id 1.5 mn in food waste reductions in hospitals Employment in new energies and locally sourced food has the potential of the multiplier effect in local economies and on local communities. Exemplar programmes - 5 biomass 3 eco health buildings - mainly energy - mental health, rehab and ambulance service Centralised metering of 3000 sites Green health care in 22 hospitals - up to 40% food waste , savings of 1.5 ,mn eg EPA 3 hospitals 80,000 savings in water retrofit, food waste 15 - 27% of waste os food., clinical waste audit in LGH potential of 100,000 a year in savings , using wrong bags. Population health approach - reduce carbon & pollution and promote transport - link to resp disease, cancers , link to active exercise, reduced accidents etc ….. healthier work places Reduce HI by targeting early intervention ,using social model , focus on prevention in cd and using levelling up strategies across the social gradient. Leadership
- Systems thinking is an approach to viewing the whole by understanding how all the components of our health, social , environmental and community settings influence one another.Through this understanding , we can develop interventions that address problems within the context of our society and environment , not in isolation. Systems thinking ,Cause and effect , Sum of the parts , Tipping point Involve cross sectoral working , mapping and measuring, Id blockages , link to microenvironmental change and how to implement change through policy and planning. Example of food journey , also in other areas - energy , clinical pathways , population health…. Procurement - huge leverage, now only 5% G procurement difficulty for procurement officials, move to govt centralised procurement Jan 2016 opportunity to influence Estates - Recycling , transport - Centralised storage , Choices Catering - ordering , overcooking, portion sizes , Dietiicis - more control , US joint management catering and Nutrition Nursing - overordering , assistance , education, informed choices , seeing food as medicine , and part of recovery and prevention, timings Patients , education, recent survey unsatisfied Catering - Food waste practices that focus on waste reduction and good recycling systems GHC up to 51% food waste = The responses of many health systems have been generally considered inadequate and naive… a systems failure requires a systems solution - not a temporary remedy” (WHO , World health report 2008)
- Ecohealth- inextricable link between population health and the health of our ecosystems Ecosystems and the services they provide are the planets life support systems for humans and all forms of life Provisioning - Products obtained from ecosystem - Water , Food Regualting - Climate , Flood, Disease Supporting - services needed for others- nutrient recycling Cultural - aesthetic, recreation link to MDGs and upcoming UN SDs State of the environment and ecosystems are modified by patterns of demographic growth, development and consumption, increasing vulnerability , rural populations , sea board , floods
- Ecohealth approach Focus on where people live, work and play Focus on the lifecycle and the determinants of health and of health inequalities Early intervention and Prevention Different settings, healthy places , look at each area in relation to the link to the ecosystem and a balance between Social, Environemntal and economic in all aspets
- Ethical Principles Rights based Approach- basic material for a healthy life - food , access to services Maximal Public Benefit Equality of access, equality of participation and equality of outcome Maximising Sustainable benefits Distributive Justice Environmental Duty Future Generations Equality of access , equality of participation, equality of outcome uality of life Disributive Justice Protecting the vulnerable and benefiting the least advantaged Respecting different capabilities Avoiding Harm Procedural Justice- Fairness, access to information , participation in decision making Environmental Justice Responsibiility to Act Polluter pays Respecting environment for its own sake Intergenerational Equity Sustainability Precautionary principle Reversability and keeping options open Sustainable boundaries Balancing economic, environmental and social boundaries Whole Life cycle Building Resilience – individual and community
- Evidence - people want to change , support this change HSE Tony O Brien DG “ the development of a sustainable health system is the most important priority“ need this leadership 1st sustainable health system conference , followed by inspire hub Engagment - informed by community development and Alinsky Chicago school - Active participation in planning , implementing and reviewing , what it means to them , need to be be specific, awareness, entry points , framing , narrative Vision, strategy and ambition- Focus on the future and the change, multiple benefits have something positive to say , country and globally Scale and pace- keep change components as manageable as possible( bite sized), Need to encourage people to test things out, learn new skills and use new behaviours in daily work. Understand barriers to change , support cultural change, good leadership, encourage middle mgt to own the activity Appreciate Challenges of Change, Understand and identify barriers Support and Training ID Champions Media - Target messages- Make it easy and worthwhile to change! Fit with existing culture or change the culture to fit the strategyPilot Reflect Champions and teams visual displays - how we are doing , measurements,
- Framework for developing sustainable health system Leadership is key , find the champion Systems thinking - the whole is the sum of the parts , start one small change , it will have the butterfly effect. Ecohealth - the intelinkage and interdepence on ecosystems , join up with environmentalists and use env economics Equaltity and justice - value based change process, involve people in the bigger picture, what do they want for the children of today? Democracy - reclaim our voices , active participation above all integration
- Leave you with the Svalborg seed bank, took a group of young irish and norwegians on a climate change program , 3 of these seedbanks , deep in the permafrost , embodies the future set amongst the fought over arctic oil resources which could destabilise the permafrost - perhaps a symbol of what could become a sustainable balanced decision making model - the health sector needs to involve themselves in these issues , the health of the planet underlies the health of its people.