• Energy Research

Environmental, economic and social impacts influence the sustainability pathway of all health care systems. Transformation of health sector is a necessary process to emphasize sustainability. Health care systems should realign themselves and work on sustainability and better adaptation to the changing environment. The mission of the health sector is protecting human health, but unfortunately, it has also a major contribution to the climate change process. Health care sector’s climate footprint is equivalent to 4.4% of global net emissions, equivalent to the annual greenhouse gas emissions from more than 500 coal-fired power plants. Health care’s climate footprint sources are numerous. During the process of health care delivering, health care systems also produce emissions of greenhouse gases, both directly and indirectly. Reduction of these emissions should be implemented at national or regional levels. According to the data available, emissions emanating directly from health care facilities and vehicles owned by health care systems make about 17%, indirect emissions from purchased energy sources such as electricity, steam, cooling, and heating comprise another 12%, and 71% represent the majority of emissions, primarily derived from the health care supply chain through the production, transport, and disposal of goods and services, such as pharmaceuticals and other chemicals, food and agricultural products, medical devices, hospital equipment, and instruments (HCWH&Arup 2019). The health care sector should take accountability for its climate footprint and react to the rising climate change emergency not only by treating patients, but also by fundamentally reducing its own emissions through taking informed decisions. Health care climate action is aligned with the ambition of the Paris Agreement to achieve net zero emissions by 2050 or even earlier. Heath care sector must undertake this effort by using Sustainable Development Goals and Green Deal as major arguments. Climate change is a serious challenge for health sector. Climate impacts increase burden of different disease, morbidity and mortality on one side, but also press the health service provision and increase emission and footprint, on the other side. Decarbonization strategies in the health care sector should take into account that people in low income countries are living without sufficient health care. Future research has to investigate the connection between the health carbon footprint, health care performance and health outcome (Pichler 2019). What is needed hereof is better understanding of the permeation a health care and climate change, analysis of health care emissions in future, investigation of the supply chain of health sector and its climate impact, health and economic costs, as well as the benefits analysis of transition to climate-smart healthcare. All of the above require further research. Since Green Deal aims at an inclusive transition to help improve people’s well-being and secure a healthy planet for generations to come, it is also important to improve Health care organizations. Transformation should follow the roadmap towards SDGs, EU Green Deal, and other useful agreements in mitigating the climate change and better adaptation of the health systems to new circumstances. Health managers should use SDGs and Green Deal as “players” to better organize and lead health systems to sustainability.

We are the witnesses of huge changes and health sector disorder due to COVID-19 pandemic crisis. Such real-life scenarios only showed us how fragile the health workforce is and how much action we need to undertake for any adaptation to future climate changes and related disruptions. For two years, the whole health workforce was in an emergency state. Burnouts, mental and physical pressure are everyday sights among health care workers and we only foresee the top of the iceberg. It is clear that we need preparedness for the crisis happening now and those to come. Building stronger health preparedness and climate-smart healthcare is essential. Preparedness for a chronic long term climate crisis we are already facing the consequences that need to come as a synergistic response to the COVID-19 and climate crises. Health community supported global leaders at COP26 with a “Healthy climate prescription” and underlined, above all, the importance of strengthening health system capacity and resilience, leadership/governance and health workforce in climate change and health issues. COP26 was an opportunity to highlight the unique role of all health professionals and evaluate health system contributions to climate change, focusing on hospital carbon footprints, emissions reduction and insisting on consideration of both adaptation and mitigation strategies. It produced recommendations with the aim of improving the evidence-based policiesto protect health from climate change. WHO produced in 2020 guidance for climate resilient and environmentally sustainable healthcare facilities. This document aims to guide professionals working in healthcare settings to understand and effectively prepare for the additional health risks posed by climate change; monitor, anticipate, manage and adapt to the health risks associated with climate change. It is a guide for healthcare facility officials: to work with health-determining sectors (water and sanitation, energy, transportation, food, urban planning, environment), to prepare for additional health risks posed by climate change through a resilience approach, and to promote-environmentally sustainable practices in providing these services. It provides tools to assist healthcare facility officials assess their resilience to climate change threats, and their environmental sustainability based upon the appropriate use of resources (water, energy, sustainable procurement), and release of hazards, to the surrounding environment. It is a roadmap for climate resilient and environmentally sustainable healthcare facilities, it promotes actions to ensure that healthcare facilities are constantly and increasingly strengthened and continue to be efficient and responsive to improve health and contribute to reducing inequities and vulnerability within their communities. All these interventions require knowledge, skills and significant changes in the process of educating the health workforce for the future. Evaluation and advocating for increased climate change education for health professionals is essential. Intensifying changes in the process of educating the health workforce is a condition in shaping sustainable systems for achieving the goals for Climate-smart Health Care.

Background: Approximately 3 billion people, worldwide, rely primarily on biomass for cooking. This study aimed to investigate the association between respiratory symptoms among women in charge of household cooking and the type of fuel used for cooking. Methods: A community-based cross-sectional survey was conducted. A total of 1705 women that were randomly selected, completed the survey. We also performed a bivariate and a multivariate analysis to verify the possible associations between respiratory symptoms in women in charge of household cooking and the type of cooking fuel used. Results: Dry cough, breathing difficulties, and throat irritation frequencies were statistically high in biomass fuel users when compared to liquefied petroleum gas (LPG) users. It was also the case for some chronic respiratory symptoms, such as sputum production, shortness of breath, wheezing, wheezing with dyspnea, wheezing without a cold, waking up with shortness of breath, waking up with coughing attacks, and waking up with breathing difficulty. After adjustment for the respondents’ and households’ characteristics; dry cough, breathing difficulties, sneezing, nose tingling, throat irritation, chronic sputum production, wheezing, wheezing with dyspnea, wheezing without a cold, waking up with shortness of breath, waking up with coughing attacks, and waking up with breathing difficulty were symptoms that remained associated to biomass fuel compared to LPG. Women who used charcoal reported the highest proportion of all the chronic respiratory symptoms compared to the firewood users. However, this difference was not statistically significant except for the wheezing, waking up with coughing attacks, and waking up with breath difficulty, after adjustment. Conclusion: Exposure to biomass smoke is responsible for respiratory health problems in women. Charcoal, which is often considered as a clean fuel compared to other biomass fuels and often recommended as an alternative to firewood, also presents health risks, including increased respiratory morbidity in women. Effective and efficient energy policies are needed to accelerate the transition to clean and sustainable energies.

Climate change malady had united decision-makers, politicians and most diverse countries in their pursuit in preserving health and solving climate change process. Climate Summit in Paris COP21 in 2015. was not only an important but truly historical moment, where we saw that most decision makers, even they are not health professionals, directly or indirectly argued that climate change is practically and ethically essential to caring about public health. According the evidence based data, climate change malady, resulting with rise in morbidity and mortality from different diseases. Beside morbidity and mortality climate change produce rise of absenteeism and health costs, also. In our mission to preserve health, as health professionals, we have to persist in raising our voice for healthy energy combating climate change. Health Professionals, among other professionals, have a unique role in action for healthy energy. Healthcare sector for its achievements and goals (to help individual and population becoming healthier, to manage different diseases...) but through its requirements and needs (a lot of medical and managerial knowledge and skills, equipment, consumables...) have become a major economy factor. More than that, healthcare sector requires a lot of energy for power generation, heating, lighting, electrical equipment, transport, supplies, ventilation, air conditioning and all other professional activities, which is combination knowledge, skills and energy needs. It was roughly estimated that EU hospitals responsible for 5% of the carbon dioxide emissions annually. The health professionals and health sector as whole have a considerable carbon footprint. All countries in EU and wider should focus more attention in areas such as energy efficient buildings, renewable heating, cooling and transport in healthcare. Healthcare sectors should be persistent and united in their efforts to find win-win models which includes patient care and sustainable and healthy energy choices at the national and local levels. Climate change is resulting in changing human resources needs in health sector, more equipment and consumables, better preparedness, smart organization and work on resiliency of health sector in future. But health professionals should give also an example within the sector by their own endeavor and behaviour that reduction of GHG footprint is possible. One of the most important steps in that process is rethinking our priorities and needs at individual and professional level. Patient safety and care must stay the main goal, but also including advocacy for environmental health, ecologically sustainable healthcare, and high standards in energy efficiency. "Reinventing" healthcare because of climate change malady is a big challenge and process. It needs help from other professions but we have to persist in our efforts to include topic on healthy energy into education of all health professionals in order to change our attitude in professional life and quality standards of health organizations.

The Climate Pact was launched in December 2020, with hope that the upcoming vaccine would help us overcome the COVID-19 pandemic “storm”. Even though humans are in the canter of the Covid pandemic storm, it is still important not to forget the climate change challenge, as it is a highly active “factory”. Unfortunately, there is no vaccine for the climate change process and biodiversity crises. The Climate Pact is an opportunity to create a European-wide movement that supports, encourages and acknowledges individual climate achievements. According to SDG 13 (climate action), Climate Pact encourages actions such as: green areas, green transport, green buildings and green skills. Also, it is important to expand sustainable consumption and production, the quality of soil, healthy food and sustainable diets, oceans, and rural and coastal areas. Therefore, Climate Pact is a driver for Sustainable Development Goals, and it is based on the ideas and contributions of all interested individuals and various organisations. Climate Pact Ambassadors are representatives of civil society and citizens with the strength for action (despite the Covid 19 pandemic “storm”) and collaboration among themselves as well as with researchers, academic citizens and policy makers to beat climate change and give contribution to SDG 13.

In the course of the COVID-19 pandemic, it has become clear that primary healthcare systems play a critical role in clinical care, such as patient screening, triage, physical and psychological support and also in promoting good community advice and awareness in coordination with secondary healthcare and preventive care. Because of the role of social and environmental factors in COVID-19 transmission and burden of disease, it is essential to ensure that there is adequate coordination of population-based health services and public health interventions. The COVID-19 pandemic has shown the primary and community healthcare (P&CHC) system’s weaknesses worldwide. In many instances, P&CHC played only a minor role, the emphasis being on hospital and intensive care beds. This was compounded by political failures, in supporting local community resilience. Placing community building, social cohesion and resilience at the forefront of dealing with the COVID-19 crisis can help align solutions that provide a vision of ‘planetary health’. This can be achieved by involving local well-being and participation in the face of any pervasive health and environmental crisis, including other epidemics and large-scale ecological crises. This paper proposes that P&CHC should take on two critical roles: first, to support local problem-solving efforts and to serve as a partner in innovative approaches to safeguarding community well-being; and second, to understand the local environment and health risks in the context of the global health perspective. We see this as an opportunity of immediate value and broad consequence beyond the control of the COVID-19 pandemic.

Climate change requires swift action aimed at adaptation and mitigation. Health sector is witnessing increased healthcare needs due to climate change and emerging diseases. Globally, the health sector is emitting 5% of total greenhouse gases (GHG) . It is necessary, thus, to make a strategic decision for the decarbonisation process of this sector. To become an environmentally-friendly and sustainable healthcare system requires a broad and fundamental transformation. The COVID-19 pandemic crisis has been a significant disruption to all health systems but confirms the need to transform them into zero pollution systems. The objective of the EU Green Deal and European Climate Pact is to encourage actions aimed at climate neutrality. The role of the European Climate Pact Ambassador is, among other things, to motivate and contribute to the understanding of the need for actions aimed at mitigation and adaptation to climate change. Encouraging the health sector for climate-friendly actions designed to reduce GHG is of great importance, as well as all strategic decisions in that direction. Health sector should focus on: energy efficiency of their buildings, different work processes, low-carbon transport vehicles, but also initiatives for the green environment. Medical waste management, including recycling of single-use personal protective equipment and other waste, is a big challenge during the COVID-19 pandemic with a possibility for large achievements in reducing pollution and saving on embedded carbon in disposable matters. Healthcare sector contribution to air pollution, land and water pollution also needs to be considered. Digital health innovations should be considered as a potential in providing health care which is reducing GHG emissions. It is also important to underline that the health-care sector has a significant role in improving intakes of healthy, sustainable food and teaching in healthy dietary choices. European Academies' Science Advisory Council (EASAC) and Federation of European Academies of Medicine (FEAM) produced an important document for healthcare professionals regarding the decarbonisation of the Health Sector. In this Commentary it is underlined that policy-makers and health sector managers should work together in developing climate change mitigation and adaptation actions. Necessary action could be strengthened by Climate Pact Ambassadors aiming to ensure that the health sector itself achieves ambitious decarbonisation targets and systems change in the health-care sector which requiresthat healthcare organisations at all levels adopt sustainability organisational culture. Beside the primary task of the healthcare sector – healing patients and improving their health, healthcare professionals should be aware of their responsibility in potential externalities due to GHG emissions, (as a population health consequence). Health sector should emphasise also the importance of decarbonisation in the education process, through the formal education, as well as lifelong learning