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Greening up: Environmental sustainability in general practice

The waste hierarchy

It’s also useful to consider the waste hierarchy when creating an environmentally sustainable practice. The waste hierarchy is a set of priorities for the efficient use of resources and waste management used in Australian policymaking. These include (in order of preference):

  • avoidance, including action to reduce the amount of waste generated by households, industry and all levels of government
  • resource recovery, including re‑using, recycling, reprocessing and energy recovery consistent with the most efficient use of the recovered resources
  • disposal, including management of all disposal options in the most environmentally responsible manner. (13)
  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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