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Greening up: Environmental sustainability in general practice

Roles of the practice team

The role of GPs

As highly trusted professionals, GPs are well placed to effectively communicate the health risks of climate change to their patients, the public and policymakers. (14) Through leading by example and advocacy, general practice can promote healthy, sustainable living and reduce carbon emissions. (15) Advocacy is needed for adaptation (ie healthcare support for the physical and mental effects of climate change) and mitigation (ie through government policies to reduce emissions), promoting urgent action to mitigate climate change through individual, practice‑based, and social and population‑based initiatives. (15)
 

Key actions for GPs 
Level of influence Action
Individual
  • Use alternative transport.
  • Minimise air travel.
  • Reduce highly processed food consumption.
  • Reduce meat consumption.
  • Encourage use of smaller or electric vehicles; driven less often. (16)
  • Lead, support and participate in new or existing sustainability measures in your practice; ie becoming a ‘climate champion’, recycling waste correctly, using alternative/active transport, meat‑free Mondays.
  • Start a conversation with your practice team about its importance for you and your patients and sharing this resource with them.
Clinical
  • Identify patients who are particularly vulnerable to heat, ensuring they have a plan, take precautions and are monitored during heatwaves.
  • Ensure patients and the local community understand public health advice, such as disaster and weather warnings from health departments and emergency services.
  • Identify co‑benefits of action to reduce climate change in clinical consultations; eg encouraging alternative/active transport, promoting low‑energy diets (including less meat and processed food consumption when appropriate, depending on the patient) and promoting energy‑efficient homes.
  • Adopt the use of social prescribing to support patients with improved wellbeing and lifestyle changes, such as increased physical activity.
  • Consider the impact of prescribing and referring decisions – approximately two‑thirds of general practice’s carbon footprint comes from prescribing; eg metered‑dose inhalers account for a large part (10) – and reduce unnecessary prescribing also has co‑benefits for patients, such as by reducing problematic polypharmacy.
  • Use telehealth appropriately may support better patient outcomes through improved follow‑up and selfmanagement, as well as reducing carbon output from unnecessary patient travel.
Population
  • Keep abreast of the issues and raise awareness with other health professionals, patients and the wider community about climate change and its impact on individual and population health.
  • Support public health measures and institute systems to deal with the increase in climate‑induced diseases (such as malaria and Japanese encephalitis) when they arise.
  • Lead the response to the burden of non‑communicable diseases that are the main cause of morbidity and mortality in Australia today, such as mental illness, and that may be exacerbated by climate‑related disasters, extreme weather conditions etc.
  • Recognise that climate change exacerbates health inequities (eg through the unequal impacts of extreme weather events) and seek opportunities to promote health and social equality. (1)
  • Support community action; eg community gardens for local food production, public open space for outdoor recreation and physical activity, safe walking and cycle ways, high‑quality public transport systems, and the need for disaster management plans. (10)
  • Use your general practice expertise and professional position as a trusted community leader to advocate on behalf of patients for effective climate‑change policy and action (16); eg write/talk to politicians, counsellors and mayors, write to newspapers (op‑eds, letters to the editor) and other businesses.

We discuss other key organisational and non-clinical dimensions in more detail next, such as reducing energy usage
  1. Parise I. A brief review of global climate change and the public health consequences. Aust J Gen Pract 2018,47(7):451–56.
  2. AdaptNSW. Causes of climate change. Sydney South, NSW: New South Wales Government [date unknown] [Accessed 17 May 2022].
  3. Climate Council. Agriculture’s contribution to Australia’s greenhouse gas emissions. Sydney, NSW: Climate Council, 2021 australia‑agriculture‑climate‑change‑emissions‑methane [Accessed 17 May 2022].
  4. Intergovernmental Panel on Climate Change. Climate change 2021: The physical science basis – Summary for policymakers. Geneva: IPCC, 2021 downloads/report/IPCC_AR6_WGI_SPM_final.pdf [Accessed 17 May 2022].
  5. World Health Organization. Climate change overview. Geneva: WHO [date unknown] climate‑change#tab=tab_1 [Accessed 17 May 2022].
  6. World Health Organization. Climate change and health. Geneva: WHO, 2021 fact‑sheets/detail/climate‑change‑and‑health [Accessed 17 May 2022].
  7. The Royal Australian College of General Practitioners. Climate change and human health: Position statement. Melbourne, Vic: RACGP, 2019 media/documents/RACGP/Position%20statements/Climatechange‑and‑human‑health.pdf [Accessed 17 May 2022].
  8. National Health Service. Delivering a ‘net zero’ National Health Service. London: NHS, 2020. Available at www.england. delivering‑a‑net‑zero‑national‑health‑service.pdf [Accessed 17 May 2022].
  9. McAlister S, McGain F, Peterson M, et al. The carbon footprint of hospital diagnostic imaging in Australia. Lancet, 2022.24:100459.
  10. British Medical Association. Sustainable and environmentally friendly general practice: GPC England policy document. London: BMA, 2020 media/2570/bma‑sustainable‑and‑environmentally‑friendlygeneral‑practice‑report‑june‑2020.pdf [Accessed 17 May 2022].
  11. Pernigotti D, Stonham C, Panigone S, et al. Reducing carbon footprint of inhalers: Analysis of climate and clinical implications of different scenarios in five European countries. BMJ, 2021,8:e001071. doi:10.1136/ bmjresp‑2021‑00107. [Accessed 17 May 2022].
  12. Woodcock, A, et al. Effects of switching from a metered dose inhaler to a dry powder inhaler on climate emissions and asthma control: Post‑ hoc analysis. Thorax BMJ, 2022. doi:10.1136/ thoraxjnl‑2021‑218088. [Accessed 17 May 2022].
  13. New South Wales EPA. The waste hierarchy. Sydney, NSW: NSW EPA 2021 [Accessed 17 May 2022].
  14. E bi K, Tong S. Preventing and mitigating health risks of climate change. Environ. Res., 2019;174:9–13. doi:10.1016/j. envres.2019.04.012. [Accessed 17 May 2022].
  15. Royal College of General Practitioners. Sustainable development, climate change and green issues. London: RACGP, 2022 [Accessed 17 May 2022].
  16. Xie E, de Barros EF, Abelsohn A, et al. Challenges and opportunities in planetary health for primary care providers. Lancet Planet. Health, 2018;2(5):e185–e187. doi:10.1016/S25425196(18)30055‑X. [Accessed 17 May 2022].
  17. B ansal A, Blashki G. Six steps to both greener and better primary care. London: The BMJ Opinion, 2020 [Accessed 17 May 2022].
  18. Office of Environment and Heritage. I am your optimisation guide: Heating, ventilation and air conditioning systems. Sydney, NSW: New South Wales Government, 2015 business/150317HVACGuide.pdf [Accessed 17 May 2022].
  19. Sustainability Victoria. Reduce heating, ventilation and air conditioning (HVAC) costs in your business. Melbourne, Vic: Victorian Government, 2021. Available at www.sustainability. [Accessed 17 May 2022].
  20. The Royal New Zealand College of General Practitioners. Greening general practice: A toolkit for sustainable practice. Auckland: RNZCGP, 2016 [Accessed 17 May 2022].
  21. Sustainability Victoria. Avoid food waste at home. Melbourne, Vic: Victorian Government, 2022 avoid‑waste/food‑waste [Accessed 17 May 2022].
  22. Downes J, Borg K, Florin F. A type of ‘biodegradable’ plastic will soon be phased out in Australia – That’s a big win for the environment. Melbourne, Vic: The Conversation, 2021 [Accessed 17 May 2022].
  23. Greener Practice. Why Environmentally Sustainable Practice? UK: Greener Practice, [date unknown] [Accessed 17 May 2022].
  24. SEE Sustainability. Helping you get your practice to netzero. UK: SEE Sustainability, 2022. Available at https:// [Accessed 17 May 2022].
  25. Myhre G, Shindell D, Bréon FM, et al. Anthropogenic and natural radiative forcing. In: Stocker TF, et al, editors. Climate Change 2013: The Physical Science Basis. Contribution of Working Group I to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge: Cambridge University Press; 2013. [Accessed 17 May 2022].
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