Climate and Health

The changes in the health debate can be viewed as steps towards recognizing health as collectiveglobal and economic challenge and takes place alsoon economic forums agenda where role of climate change was underlined several times.The nation’s most at risk for climate-triggered health crises are primarily in Asia/pacific and are already affected by the highest rates of disease burden globally although vectors spreads to European countries. This is now observed in France in several departments (with risk of dengue, malaria, chikungunya.)


Climate and health
As I write, the whole country is in the grip of an unprecedented heatwave.The temperature outside is more than 40°C.Meanwhile, I am sitting at my desk doing something I learnt to do many years ago when I was managing a very busy operating theatre suiterostering!However, this time I am not rostering fabulous nurses to staff busy operating rooms working 24 hours a day.No, this time I am putting together teams of trained volunteer firefighters, members of my local community.Within a 150 km radius there are two major fires burning, with the closest fire front just 10 km from my rural home.The fires have been burning for more than three weeks now and we have been sending out teams of firefighters in our three brigade fire trucks for both day and night shifts on many of those days.With the next predicted substantial rain not forecast until April it seems that these fires are unlikely to be fully extinguished for several months.We have little water in our dams to fight local fires and we have all been brushing up on our 'dry firefighting' skills.The world has observed a 1°C temperature rise above preindustrial levels… a rise as high as 3°C in north western Canada.Eight of the ten hottest years on record have occurred in the past decade.Such rapid change is primarily driven by the combustion of fossil fuels… the health care sector is responsible for about 4•6 per cent of global emissions, a value which is steadily rising across most major economies. 1at are our responsibilities as health professional leaders in mitigating the greatest risks facing the health system and the community today?While being responsible for a relatively high proportion of emissions, the health professions also have a professional responsibility to take action to respond to the health threats that climate change is generating.According to the 2018 report of The Lancet 'Countdown on health and climate change: Shaping the health of nations for centuries to come': Given that climate change is the biggest global health threat of the 21 st century, responding to this threat, and ensuring this response delivers the health benefits available, is the responsibility of the health profession; indeed, such a transformation will not be possible without it. 2, here we are at this juncture in history, possessing both the reality of causation and the professional responsibility to get involved.This we can do, at a broad policy, political, strategic and national level, and by taking direct and local action in perioperative health services and our own 'backyard'.
The Climate and Health Alliance (CAHA) is a coalition of health care stakeholders who work together to promote action to ensure that the threat to human health from climate change and ecological degradation is addressed through prompt policy action.The membership of CAHA includes organisations and individuals from across the health sector, with organisations representing health care professionals from medicine, nursing, public health, social work and psychology as well as health care service providers, research and academic institutions, and health consumers.CAHA's members recognise that health care stakeholders have a particular responsibility to the community in advocating for public policy that will promote and protect human health.CAHA aims to contribute to the development and implementation of evidence-based public policy to reduce greenhouse gas emissions and protect the health of the community 3 .

Local action
By acting locally we can make a very big difference to mitigating the impact of rising global emissions.
Think about what you might be able to do within your own zone of influence.Already there is an international movement that is active in Australia that can assist us in these endeavours -the Global Green and Healthy Hospitals 4 (GGHH) network.The GGHH network is an initiative of CAHA's international partner, Health Care Without Harm, with CAHA coordinating the GGHH network in Australia and New Zealand.The GGHH network is a vibrant international community of health services, hospitals, health systems and other health organisations dedicated to reducing their ecological footprint and promoting public and environmental health.The GGHH network connects and supports people leading the environmental agenda in health care institutions so they can share best practices and find solutions to common challenges 4 .
GGHH has an agenda with 10 goals outlined in Figure 1 below.Rather than feeling overwhelmed by attempting to tackle all of the goals locally, GGHH urges health professionals working in health services to identify one or two of the above goals where it is possible to make a difference within their own service and individual units.Some areas worth consideration may be: • reducing, re-using, recycling, treating and safely disposing of health care waste, the significant waste stream that perioperative health services generate with the high usage of disposable equipment, clothing and drapes • substituting harmful chemicals with safer alternatives.For example, anaesthetic gases (including the hydrofluorocarbons sevoflurane and desflurane; the chlorofluorocarbon, isoflurane; and nitrous oxide) are expelled into the atmosphere where they contribute to anthropogenic climate change.
The use of the most damaging agent, desflurane, is rapidly increasing 5 .
• energy efficiency measures, which may be as simple as turning lights and equipment off when they're not in use.
Many of you will already be turning your minds to these and acting on them individually or collectively, and if you haven't connected with GGHH, as yet, I invite you to do so.

National and global action
We all have a choice.We can create transformational action that will safeguard the living conditions for future generations.Or we can continue with our business as usual and fail.That is up to you and me.

Swedish climate activist, Greta Thunberg
As the remarkable youth advocate Greta Thunberg states, it is not just about local action.As citizens of our planet and health professionals we have a greater responsibility and challenge.We need to accept these responsibilities and challenges if we are going to slow or stop the increasing environmental escalation and dramatic health impacts  • propose (and design the solution) • build the movement

Conclusion
As perioperative nurses, we can contribute a greal deal to the global, national and local efforts that each go some way to reducing the health impacts of climate change.We can contribute in our roles as citizens, as employees of the health sector and as health professionals.Each of us can be party to making a difference.
Ethically and professionally we cannot use the defence we are hearing from some of our senior politicians that 'our efforts won't make a difference'.
I am making a difference as a member of my rural fire brigade and as an active member of the Climate and Health Alliance.The capabilities I attained as a perioperative nurse have equipped me well!I urge you to decide what you are able to contribute, and to take action. Bibliography

Figure 1 :
Figure 1: Global Green and Healthy Hospitals goals