Carbon Dependence

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Carbon Dependence

• A healthcare challenge

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• The carbon addict health effects of a high
  carbon lifestyle
• Is the NHS addicted?
• Complications adverse effects of a high carbon
  health service
• Detox what can health professionals do about it?
• Health services for a low carbon future

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• The carbon addict health effects of a high
  carbon lifestyle on individuals

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Carbon Dependence

• Epidemiology
• Early case reports date back to the 19th century,
  with prevalence rising exponentially in the last
  50 years
• Now reached epidemic proportions in the UK
  affecting almost 100 of the population
• Fears of global pandemic
• Causes
• No genetic influences identified
• Environmental factors important e.g.
  out-of-town shopping

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Carbon DependenceSymptoms

• T-Shirt in winter
• Car journeys under 3 miles
• Vegetable intolerance / meat-bingeing
• New-variant Consumption (nvC)

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A carbon-dependent society?

• Whats wrong with that?

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Carbon DependenceEarly Complications

• Reduced exercise tolerance
• fossil fuel use is replacing physical activity in
  daily living? negative impacts on cardiovascular
  health
• Anxiety, stress
• physical activity has psycho-protective effects,
  so doing less of it has negative impacts on
  mental health
• dissatisfaction
• Respiratory symptoms
• asthma and allergies. Less air pollution and more
  time spentin natural environments could reduce
  the risk of these complications.

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Carbon DependenceLate Complications

• Obesity and diabetes due to high fat diet and
  inactivity
• Cardiovascular disease high salt and fat diet,
  and inactivity
• Colorectal cancer correlates with high meat
  intake
• Falls inactivity ? low muscle mass, falls due
  to SE of medication
• Fuel poverty using more fuel costs money
• Social isolation interaction via facebook? TV
  entertainment?

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Am J Prev Med 200427(2)
each hour in car per day ? risk obesity by 6
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Circulation July 6, 1999
Walking lt0.25 mile/day ? risk CHD x2
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Journal of the National Cancer Institute, Vol.
97, No. 12, June 15, 2005
Red/processed meat ? risk colorectal cancer
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Carbon DependenceLate Complications

• Obesity and diabetes due to high fat diet and
  inactivity
• Cardiovascular disease high salt and fat diet,
  and inactivity
• Colorectal cancer correlates with high meat
  intake
• Falls inactivity ? low muscle mass, falls due
  to SE of medication
• Fuel poverty using more fuel costs money
• Social isolation interaction via facebook? TV
  entertainment?

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Carbon DependenceClimate Toxicity
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2004 Hurricane Catarina the first South
Atlantic hurricane.
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Carbon DependenceClimate Toxicity

• Already responsible for many deaths worldwide
  malnutrition, malaria, diarrhoeal disease (WHO)
• Severity not related to intensity of same
  individuals carbon addiction

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CO2 concentrations
Sustainable Energy without the hot air 2008
David MacKay. www.withouthotair.com
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Climate projections
IPCC Fourth Assessment Report (2007)
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Whats happening now?
Synthesis Report Climate Change, Global Risks,
Challenges Decisions, Copenhagen 2009
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• Is the NHS addicted? Understanding the carbon
  footprint of NHS England.

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Carbon Footprint NHS England
18 million tonnes CO2 in 2004
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Carbon Footprint NHS England procurement
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• Complications adverse effects of a high carbon
  health service.

Is the NHS getting flabby?
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High Carbon Care

• Elective surgery cancelled after last-minute
  anaesthetic review
• Blood tests repeated because not on system
• Hospital-acquired infections
• Post-operative pain
• Drugs to treat side-effects of drugs

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High Carbon Care (2)

• Patients attending for appointments without
  knowing why they are there
• Drugs continued when no longer needed
• Related conditions managed on separate days by
  separate teams
• Hi-tech interventions preferred, even where
  alternatives exist 

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High Carbon Care

• Activity ? outcome

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Risk-benefit can a move to single use
instruments cause harm?

• Health risks?
• lower quality surgical instruments gt bleeding
• chemical exposure?
• Environmental impacts?
• energy and carbon for manufacture
• transport
• pollution from waste disposal
• Waste of NHS resources? 

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Risk-benefit can referral to a specialist cause
harm?

• Health risks?
• infection, side effects, complications of
  invasive tests
• Psychosocial factors?
• perception of condition, stress
• time off work
• Environmental impacts?
• energy, transport - carbon emissions
• production of material resources needles, forms,
  gloves
• pollution from waste disposal
• Waste of NHS resources? 

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Climate ToxicityHospitals in heatwaves (press
stories)

• Nurses and administrative staff walked out in
  protest at high temperatures in brand-new PFI
  hospital "We can't work in this- we're suffering
  from heat exhaustion and everything
• Angry relatives claimed hospital could not
  provide for its most vulnerable patients. People
  on strict nil by mouth diet were left to lie in
  pools of their own sweat without ice and proper
  air conditioning as their limbs swelled in the
  heat
• Hospital facing demands for an enquiry into how
  vital equipment was allowed to break down during
  recent heat-wave, forcing the cancellation of
  scores of operations

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Climate ToxicityHospitals in heatwaves (press
stories 2)

• Public Health (Pathology) Laboratory stopped work
  - machines failed in heat.
• Nurses on cardiac ward were in tears at their
  inability to keep patients as cool as they should
  have been
• Drugs may be vulnerable to extreme temperatures
  in summer

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• Andy Williamson, Chair GSTT Kidney Patients
  Association
• As a kidney patient, Im acutely aware of my
  own vulnerability to climate events, and my
  dependence on drugs and dialysis equipment which
  rely on cheap oil for their availability.

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Discussion point

• Detox what can health professionals do about
  carbon addiction?

In your patients?
What are the barriers..?
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Medical Intervention

• Medical interventions are carbon intensive risk
  of increasing carbon dependence
• How can health professionals reduce medical
  interventions by PREVENTING ill-health?

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Active Travel

• Cycling burns about 300 calories per hour (5
  calories per minute)
• Regular cyclists enjoy a fitness level equal to
  that of a person ten years younger and a life
  expectancy 2 years above the average
• Cycling regularly to work is the most effective
  thing an individual can do to improve health and
  increase longevity.
• If one third of all short car journeys were made
  by bike, national heart disease rates would fall
  by between 5 and 10 percent  
• Only 28 of women in England and Scotland and 24
  in Wales meet the governments guidelines for
  physical activity levels.
• During rush hour a bicycle is about twice as fast
  as a car.

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Housing energy

• Housing improvement programmes benefit almost
  all carbon addicts, but particularly the elderly,
  living alone, those with cardiovascular or
  respiratory disease
• Referral systems from health services to fuel
  poverty schemes
• Educating patients on specific health benefits
  of housing improvements

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J Epidemiol Community Health 200862793797
BP 142/85 ? 123/73
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Discussion point

• Detox what can health professionals do about
  carbon addiction?

In the NHS?
What are the barriers..?
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• Health services for a low carbon future
  designing clinical care which is preventative,
  develops self-reliance, uses lean pathways and
  low carbon technologies.

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www.sdu.nhs.uk
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sustainable estates facilities sustainablecli
nical practice
sustainable healthcare

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Principles of Sustainable Clinical Practice

• (The Campaign for Greener Healthcare)
• Prevention
• Patient partnership
• Lean systems
• Low carbon treatment choices

www.greenerhealthcare.org/clinical-transformation
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Carbon DependencePrognosis

• Recent advances have transformed outcome in what
  was previously a universally disabling disease.
• With help of multidisciplinary team, addicts may
  even achieve full recovery.

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• Carbon Addict is an opensource project of The
  Climate Connection and
• The Campaign for Greener Healthcare.
• The illustrations are by www.worldofinferiors.co.u
  k and are licensed under a Creative Commons
  License.
• www.CarbonAddict.org