Pandemic was just a trailer of the scale and the magnitude of disaster that climate crisis can bring.
Shweta Narayan, Health Care Without Harm
In conversation with Shweta Narayan from Health Care Without Harm, we discuss health systems’ environmental footprint and what can be done to prevent and mitigate the next crisis to come.
Health Care Without Harm works to transform health care worldwide so that it reduces its environmental footprint, becomes a community anchor for sustainability, and a leader in the global movement for environmental health and justice.
How does Health Care Without Harm work towards transforming healthcare systems worldwide to reduce their environmental footprint and become community anchors for sustainability?
Shweta Narayan: There’s a lot to unpack in this question. To reflect on the mission of Healthcare Without Harm – we are an international nonprofit and we primarily work with the health sector and we believe in the oath of First Do No Harm. Believing in that, we find that the health sector itself, through its operation, has a serious environmental and climate footprint. And a sector that is engaged in healing people cannot be harming them. So to carry on the mission of health care, the health systems themselves cannot be a reason for illnesses and diseases in the communities that they serve. Almost 27 years ago we began working with health systems in cleaning up their environmental and climate footprint. We started with mercury that was used in the hospital equipment. Mercury is toxic, it causes death if there’s exposure. So working with the hospitals and health systems and making a case for phasing out mercury, phasing out incinerators in the U.S., the medical waste incinerator or waste management, chemical management, planning buildings, and systems that are complementing the environmental and planetary health. In a gist, this is what the mission, the vision of Healthcare Without Harm is.
We also need to understand the huge economic power of the health sector – it constitutes 10% of the global economy. And if the health sector leverages its power in the right direction of sustainability, its processes in harmony with the environment, then systems move. The health sector does not just have a role in improving its footprint, but it can influence other sectors. And that’s a very important thing to understand. When it comes to environmental and climate justice we must understand that the health sector is at the peak of this climate trauma that we are experiencing. Of course, it is at the forefront of taking care of people who are hurt by extreme weather events or air pollution and respiratory distress. However, the health sector itself contributes significantly to the climate crisis. Their climate footprint is 5% or more. And its greenhouse gas emissions are increasing. The predictions are if the health sector continues business as usual, their footprint is going to triple by 2050. To put the numbers in perspective, 5% of global greenhouse gas emissions make the health sector the fifth largest emitter. If the health sector was a country, it would be the fifth largest emitting country of greenhouse gasses when it comes to adding to the climate crisis. It is absolutely important to work within the sector to make its practices aligned with the environmental and planetary boundaries and to make it a sector that is truly on the mission of healing people.
Hearing those numbers is definitely shocking. We want to make sure that we do all we can for our patients and it turns out that the health sector is heavily contributing to climate crisis and its consequences. So as a global climate and health campaigner, can you share with us some examples of successful collaborations between your organization and the healthcare sector?
Shweta: I’ll take two examples. One within the sector itself and influencing the ways the sector has moved and one relating to a wider leadership. So these numbers are indeed shocking. In 2019, when we did this estimate in collaboration with an organization called Arup, we were also quite shocked. We had anticipated it, but it was still shocking. In 2021 we went ahead, did an analysis, and produced a road map of what would health sector climate action look like and what those pathways through which the health sector itself can become a climate leader. We identified seven very important interventions. So powering the health sector with a hundred percent renewable, clean, healthy energy; sustainable procurement of pharmaceuticals by this I mean low carbon pharmaceuticals and vaccines; sustainable production of food that is procured by the health sector; zero carbon buildings; zero carbon transportation; and overall health systems efficiency, which includes telemedicine and better-networked health services. Now, if we implement those seven interventions now, by 2050, we can reduce 44 gigatons of carbon. And, again, putting those numbers in perspective, 44 gigatons of carbon was the entire world’s economy’s carbon emissions for 2017. So In terms of scale, this is the kind of impact the health sector can have.
By 2050, the health sector can reduce 44 gigatons of carbon. It’s like the entire world’s economy’s carbon emissions for 2017.
Now, what happens with this data and this knowledge in terms of partnerships? We have health facilities, systems, and institutions in different parts of the world already incorporating these transformative pathways to climate action in their programs. We have our flagship program called Global Green and Healthy Hospitals. It’s present in about 81 countries and represents about 74, 000 hospitals and health systems around the world. Every one of these institutions is incorporating climate action, sustainable practices, and environmentally friendly ways of functioning as part of the UNFCCC’s climate champions race to zero program. In the last three years about 14, 000 hospitals and health facilities from 21 countries have joined the Race to Zero program, pledging net zero by 2050. And that’s a significant momentum in the health facility.
Let’s also reflect on what data and information can do in terms of weaving that global policy collaboration. We have the roadmap, we have the race to zero commitments. And then in 2021, at COP26, Health Care Without Harm was part of the COP26 health program in collaboration with the World Health Organization and the UK government. This collaborative program is now called ATACH – Alliance for Transformative Action on Climate and Health. Now we have 67 countries, and national governments that signed up as ATTACH and have committed to low carbon and climate resilient health care. And that’s a huge commitment from the sector. Especially in the journey where at one point nobody thought that health care could even make this kind of damaging impact on climate change. Realizing the problem and realizing that governments need to take action. And national governments are committing to it, G7 countries are committing to it, and G20 countries are in the process of committing to it. For me, this is an example of a successful collaboration. You have data, you have evidence, and you’ve been able to influence policymakers at a global, local, and regional scale to recognize that this is a problem and to commit to action.
As I said before, if you don’t recognize the problem, you will never find the right solution. This is the first and most difficult step of accepting that yes, indeed, there is a problem we need to tackle.
Now, an example from within the health community. With the climate crisis itself, accelerating at a pace that nobody had imagined and at a scale that exceeded our predictions, we are now seeing the health community coming to the forefront and leading a lot of climate action. And not in just changing the ways of working of the health sector itself, because that’s still the 5% only, but also using health leadership to influence policy-making and guide communities. So health professionals are sort of lending solidarity to communities who are on the frontline of climate disasters or air pollution, providing testimonies to courts, or in countries like Australia advocating for better climate policies and influencing the election.
From the scale of providing evidence, testimonies, and data to mobilizing support across communities, to influence policymaking in the countries. Health professionals are leading those roles and that’s for me an example of success.
It is very inspiring to hear how collecting data and getting evidence answer the question of what is wrong and what can be done next. How this step can influence everyone, on every level. Let’s go back in time now, to 2020, COVID-19. Of course, the COVID-19 pandemic revealed multiple disparities and inequalities. How it has impacted your work when it comes to working towards climate justice in health systems?
Shweta: In the most recent times, of course, COVID has been sort of a shock. I always feel it personally when I look back and I try to remember something in the past, this moment of the pandemic has been a blur. I think it’s also how we process trauma and that we try to forget about it. But it was also a moment of a stark realization of everything that is wrong with the way our policymakers, the way our practices harm the planet. It also showed how deeply connected human and planetary health are.
From the health systems perspective, I think a lot of countries realized that our health systems are not prepared for multiple stressors. So when the pandemic hit, and I can especially speak from India example, regular services in hospitals were suspended. So for example pregnant people, people who needed dialysis, or people who had mental health issues, had no way to access medicines or care. It was chaotic because the whole system was focused on dealing with the pandemic. So other diseases were not addressed.
What COVID pandemic also reiterates how important the health voices were. And how quickly governments and people adhere to the advisories of health professionals, be it a mask or be it precautionary travel, or basic measures to keep themselves safe. It reiterated the credible, trusted voices. of health professionals and what influence they had in keeping society safe.
In a lot of places, COVID-19 also brought forward a lot of existing inequities. Everything is interrelated and we saw a sneak peak of what Disasters at this scale can do to people how it can hurt communities and how inaction can hurt communities. The pandemic was just a trailer of the scale and the magnitude of disaster that climate crisis can bring. The pandemic response was a trailer of what’s wrong with our systems in times of crisis and how to deal with a crisis. So for us, it’s a lesson. The way the pandemic manifested is a lesson and a warning of how worse the climate crisis can be. And there are lessons learned from the pandemic, on how to do things right, and how not to do them.
I think for us this is a big learning in terms of keeping to the planetary boundaries, making sure that the environment and health, which are so deeply interrelated, are balanced, and making sure that within the health response, no one is left behind. And of course to make sure the health sector is prepared to deal with these kinds of crises.
The Pandemic also showcased that digital health technologies and telemedicine played a significant role during the pandemic response. So how does your organization also utilize and view the integration of those technologies into health systems to overall improve the healthcare?
Shweta: If you remember, I reflected on the seven pathways. And overall health system efficiency is one of them. Bringing in efficient ways of care, including digital and telemedicine is not only effective during the pandemic. It’s sustainable. It’s also low carbon. And it also increases health systems’ efficiency and resilience. Innovative and successful solutions that have been successful in ensuring that nobody’s left behind are also effective solutions such as climate actions. So if somebody is working on digital health and telemedicine, they are already contributing to climate action. What I’m trying to say is that all of these solutions, all of these lessons from the recent examples and crises are lessons to be learned and integrated as climate action measures. If you’re able to use digital medicine and telemedicine for minor care, you’re also reducing the transportation burden to the hospital. So the transportation emissions are taken care of, right? That’s the connection.
And that’s what is required in terms of better efficiency, better utilization of services, and innovative services when we are looking at the climate crisis.
It’s really important to realize that everything is interconnected, whatever happened during the pandemic, we can learn from it for another crisis and so on. It is important to have this perspective because we can achieve much more if we consider a lot of different backgrounds and lessons learned. So to build on that but also getting medical students into the perspective. We play a vital role in shaping healthcare in the future. So how can we engage meaningfully to help in driving your organization’s mission, and vision, and to to further connect both healthcare systems and climate justice?
Shweta: Yes, you’re right. Medical students have a very critical role and very important role as the leaders of the present, not even the future. One would expect the medical students also to break certain barriers and, and to move ahead with just and sustainable action. Realizing how critical the role of young health professionals and students is very important. And we are in a moment in history where we know that we don’t have much time when the time for the window for action is closing really fast. So it’s no longer going to be enough to just work on sustainability within health care. With everything that’s happening around us and everything that we see online and in the news, it just feels like we need to act. In every possible direction and every urgent manner possible.
So health professionals have a role to ensure that their systems are sustainable and not harming people and not harming the climate, yes. But at the same time, they also have a role to lead some of the conversation. Push policies outside the health sector. They should not limit their role within the health sector, but they should be the leaders that societies need and that policymakers need to listen to in framing just and equitable policies and climate action. They have to work within the sector and make sure that the sector becomes sustainable and climate-just. At the same time, they have to work with communities, with policymakers, with anybody and everybody who can listen to them in influencing policies at a larger scale.
And I think that’s a lot, and that’s overwhelming. But people hold a lot of trust in the health community. This can be the moment to leverage to get that lot happen.
Collaborate, educate, and talk to anybody willing to listen and act. Organize and speak up. Now.
What advice you would give to someone who just wants to start integrating environmental health and justice into medical education, into research, into exchanges that happen between student organizations, and also in IFMSA?
Shweta: Collaborate, educate, talk to anybody willing to listen and act. I would say organize. And realize the power that young people have. And I think that to a very good extent, young people are using that power. So continue to collaborate, and continue to develop evidence. But it’s not enough to just develop evidence. Share it. Give it to people who would use it if you are not able to use it. But let that data, let that evidence, let that any indication of action speak and speak louder. I’m not trying to overwhelm anybody here, but the task is mammoth and only collectively we’ll be able to deal with it.
Whether we will be able to resolve it or not, we need to at least put up a fight, we need to be together. And young people, young health professionals are at that moment where they should collaborate with a diverse group of people, with environmental justice groups, with frontline communities, and with policymakers to understand what actions are being taken, and what implications are there. Organize and speak up. Now.
Thank you for this powerful call to collaborative action. Do you have anything else to share with the medical students’ community?
Shweta: I have just one more thing to add. I also see this climate crisis as an opportunity. It sounds kind of weird to say, but it is an opportunity to fix some of the problems that we have been either causing or being part of. And it is an opportunity for the health systems and health sector to reimagine health and transform the sector. Focus on prevention, rather than just on a curative part. Invest in people, invest in health workers, invest in communities. Invest in local solutions, and sustainable solutions, and build that resilience.
Because I frankly think that health systems are not just places where you go and cure yourself. These are places where you heal yourself. And to play that role of healer, you have to anchor communities. And that has to happen along with people and along with communities. So this is an opportunity to rethink the way we’ve been operating, reimagine the way we can operate, and ensure that no one is left behind.
Shweta Naranyan in conversation with Olga Wdowiczak
Photos by Mohammad Elyann from IFMSA-Jo
Shweta Narayan is an India-based environmental health researcher and has over two decades of campaigning and advocacy experience in environmental justice issues in India. Her work focuses on providing legal, media and scientific research support to the residents of pollution affected communities and workers exposed to toxic chemicals. Since 2014, she has been coordinating the Healthy Energy Initiative (HEI) program in India. As part of the program, she has worked with several sub-national governments and health professionals in developing climate and environmental health policies. She is a trained Social Worker with specialisation in Criminology and Correctional Administration from Tata Institute of Social Sciences, India.
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