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How green is your practice?

Climate change will place a severe strain on public health - there will be more cases of skin cancer, cataracts and food poisoning, as well as major emergencies and heat-related deaths. So what can we as individuals do to make our working lives a bit "greener"?

Victoria Johnson
PhD MSc BSc(Hons) DIC
Lead Researcher
nef (new economics foundation)
Climate Change and Energy Programme

Wendy Johnson
MSc BSc(Hons) RN DipN(Lond) NPDiP PGCIE
Advanced Nurse Practitioner
Senior Lecturer

In 2007, the Director-General of the World Health Organization, Margaret Chan, identified climate change as the defining issue for public health in the 21st century.(1) As health professionals, we must respond. And, if we do it right, rising to the challenge could lead to healthier, happier, lower-carbon lives for all.
Health professionals will have to deal with the health impacts of climate change, and promote strategies to reduce vulnerability; but perhaps the greatest challenge lies in playing a part in halting the process of climate change. Without this, the NHS will find responding to the impacts of climate change an uphill struggle that becomes exponentially steeper. Quite literally, dealing with the symptoms while the disease rages on and takes hold. But there is hope. Precedents like the success of antismoking campaigns, and the simple reality of the sheer number of patient contact hours in the NHS - over one million every 36 hours - means that the health service is uniquely placed to encourage the huge lifestyle and behaviour changes needed if we are to respond effectively to the challenges of a warming world.(2) And, as one of the largest public sector services in the world, it is also uniquely placed to put its own house in order.
Nurses are on the frontline of public health, and in an ideal position to raise awareness of the health risks of a changing climate, but also of the many benefits of taking action now to prevent runaway climate change.
Climate change is here to stay. We've put so much of the stuff that causes it (mainly the greenhouse gas carbon dioxide) into the environment, that whatever we do now, the climate will continue to change for at least the next 50 years. And, new and cautious calculations by nef's (the new economics foundation) climate change and energy programme suggest that we may have as little as 100 months starting from August 2008 to stabilise concentrations of greenhouse gases in the atmosphere, before the risk of uncontrollable global warming occurring increases significantly.(3)
Earlier this year, the Department of Health and Health Protection Agency updated its report on the health impacts of climate change.(4) It outlined a diverse array of the health impacts of a changing climate - from increased accidents and trauma as a result of flooding to an increase in diarrhoeal disease (see Table 1). Climate change doesn't just mean warmer weather, it also means more variable weather, from heat waves to heavy downpours - so-called "extreme" weather events are expected to become more frequent and more extreme.


In the UK, heat-related deaths could increase by around 2,800 cases per year. Conversely, milder winters could lead to a fall in cold-related winter deaths of up to 20,000. Cases of food poisoning are likely to increase significantly, by perhaps 10,000 cases per year.(5) Unrelated to climate change, the effects of general air pollutants on health (eg, respiratory illness) could decline if current trends continue, but under global warming the damaging effect of surface ozone during the summer is likely to increase. The chemical reactions producing ozone from air pollution are temperature dependent. The impact of such ozone increases could be a 15-53% rise in deaths and hospital admissions from respiratory diseases related to air pollution each year.(6) Milder, more humid winters will also lead to more mould growth in housing - already a major cause of respiratory allergies. Cases of skin cancer are likely to increase by perhaps 5,000 cases per year and cataracts by 2,000 cases per year in the UK by 2050 according to current projections.(5)
As well as causing injuries and infectious diseases, serious flooding can result in increased anxiety and depression linked to physical and economic insecurity, especially in the elderly. People whose homes were flooded in Lewes, East Sussex in 2000 experienced a fourfold increase in psychological distress compared with those whose homes were not affected.(7) Stress of this nature is associated with an increased risk of hypertension, heart disease and diabetes.(8)
And, to make things worse, chronic illness caused by our increasingly sedentary lifestyles means that people will become less resilient to the health impacts of climate change - in itself, a major public health problem.
But, it is all too easy to get caught up in the drama of the headlines and the magnitude of the task in hand and switch off, because it all seems beyond our control. But what if, rather than being overwhelmed by negative messages of climate disasters, and interpreting the changes needed as restrictive, we reimagined responding to climate change as an opportunity to promote healthier and happier lives? If done well, responding to climate change also has obvious long-term health benefits. Encouraging people to drive less, walk and cycle more would reduce emissions, but also has clear benefits for health and wellbeing, which in turn increases resilience to the impacts of climate change - it's a win-win-win situation.

What can you do?
But first, to put our own house in order. The NHS itself, in its sheer scale and high levels of energy use, makes a highly significant contribution to the UK's carbon emissions, contributing one million tonnes annually. For example, 5% of all road transport emissions and one in every 100 tonnes of domestic waste are produced from NHS-related activities. It is one of the world's most resource-hungry public services. But, its sheer size also gives huge potential to promote positive change. The icing on the cake is that positive actions to reduce emissions will ultimately lower costs for the already resource-stretched NHS - in the short and long term. As nurses, you can lead the way by encouraging change in your patients, practices and your NHS.
As a start, we've put together a list of practical things you can do in your place of work - whether it's a small surgery or a huge hospital.

  • To begin at the beginning, cut out this article, put it in your staff area, and encourage colleagues to take action.
  • Use less energy. Ten percent of greenhouse gas emissions related to the energy use in buildings could be reduced simply by conserving energy.
  • Promote green travel. Five percent of all the UK's greenhouse gas emissions from road transport are due to NHS-related journeys. This includes journeys made by staff, patients and visitors.
  • Reduce, reuse and recycle. One in every 100 tonnes of domestic waste generated in the UK comes from the NHS - with a vast majority going to landfill.

Finally, here are 10 key questions for you and your colleagues to put the NHS response to climate change on track - ranging from evidence of leadership to the way in which goods and services are procured:

  1. Leadership - have you discussed the climate change agenda at work?
  2. Strategy - does your organisation have a climate change strategy and action plan?
  3. Targets - is your organisation meeting mandatory targets for reduction in energy consumption and increasing the energy efficiency of buildings?
  4. Partnership - is your organisation working collaboratively on tackling climate change with patients?
  5. Energy - how much money did your organisation spend on energy last year, and was any of this "green" electricity, ie, from renewable energy sources?
  6. Procurement - how many of the goods and services your organisation purchases are sourced locally? Do you buy recycled?
  7. Transport - do you have a green travel plan?
  8. Waste - do you have a waste plan?
  9. Water - do you have a plan to reduce water consumption?
  10. Staff - do your colleagues know what to do? For example, do they know when their computer is completely turned off? Do they know how to reduce the temperature of the building if it gets too warm?

If we get it right, the NHS could provide a remarkably convincing platform for the kind of individual and collective changes we need to make. We could respond to the century's greatest public health challenge in a way that equips us to deal with the health impacts of the changes to the climate that we already know are on their way, reduces our impact on the climate and promotes healthier, happier lower-carbon lives for all. If we get it right, public services really could save the planet.



  1. WHO. Climate change and health: preparing for unprecedented challenges. The 2007 David E Barmes Global Health Lecture. 2007 Available from:
  2. Johnson V, Simms A. Taking the temperature: towards an NHS response to global warming. London: NHS Confederation; 2007.
  3. Johnson V, Simms A. 100 months: technical note. London: nef; 2008. Available from:
  4. Department of Health and Health Protection Agency. Health effects of climate change in the UK 2008: an update of the Department of Health report 2001/2002. London: DH and HPA; 2008. Available from: andstatistics/publications/publicationspolicyandguidance/DH_080702
  5. Health Protection Agency. Health effects of climate change in the UK: an update of the Department of Health Report 2001/2002. London: HPA; 2007.
  6. Bell M, Goldberg R, Hogrefe C, et al. Climate change, ambient ozone and health in 50 US cities. Climate Change 2007;82:61-76.
  7. Reacher M, McKenzie K, Lane C, Nichols T, Kedge I, Iverson A, et al. Health impacts of flooding in Lewes: a comparison of reported gastrointestinal and other illness and mental health in flooded and non-flooded households. Communicable Dis Public Health 2004;7:56-63.
  8. Weisler R, Barbee J, Townsend M. Mental health and recovery in the gulf coast after hurricanes Katrina and Rita. JAMA 2006;296:585-8.