IHPME trainees target health care pollution and engage in national dialogue on environmental sustainability—one person at a time

By Alisa Kim

We can’t just continue living as if there was no tomorrow, because there is a tomorrow.

— Greta Thunberg

It’s an uncomfortable reality that, barring major collective action to reduce greenhouse gas emissions, the world’s temperature is on track to have increased by 1.5 degrees since the Industrial Revolution. Scientists warn that this rise in temperature will expose about 350 million more people to drought, and bring 120 million people into extreme poverty.

The health care sector, which espouses to “do no harm,” is a major contributor to climate change. If it were a country, the health sector would be the fifth largest emitter of greenhouse gases, note Victoria Haldane, Anna Cooper Reed and Danielle Toccalino, who, along with Dr. Colin Sue-Chue-Lam, lead a grassroots organization called Emerging Leaders in Environmental Sustainability in Healthcare (ELESH).

All are PhD students at the Institute for Health Policy, Management and Evaluation (IHPME) at the University of Toronto. The mission of ELESH is to foster interdisciplinary learning and action across the various disciplines and professions that deliver care.

“A lot of the work we do is advocacy-related,” says Cooper Reed, who notes that among other students enrolled in health care programs, trainees in health services and policy research are not taught that health care is a major polluter. In Canada, for example, the health sector accounts for 4.6% of the country’s total greenhouse gas emissions, resulting in a staggering 23,000 years of life lost each year from disability or early death—that according to 2019 paper in CMAJ. “This can be a newer area for many faculty and trainees—the nexus of climate change and health and health care. We want to build community and a movement and get students interested in this topic,” she says.

ELESH, which is supported by the Centre for Sustainable Health Systems (founded by IHPME professor Fiona Miller), has developed a framework for thinking about how to transform health systems so that they are more equitable, resilient and sustainable.

In October 2020, the group brought together 10 students from across Canada to form the Health Services and Policy Research Trainee Committee on Environmental Sustainability. The committee discusses how environmental sustainability can be brought to bear upon how research is carried out, what research is done, and what students are taught.

The committee held a virtual town hall on Nov. 6, 2020 that was attended by representatives from the CIHR Institute of Health Services and Policy Research to discuss their recommendations, which have the ultimate aim of protecting people and the planet better.

“It laid out a framework and road map for what we as trainees are committed to doing to help embed [environmental sustainability] into our own practice and curricula, and outlining opportunities for CIHR to help facilitate this,” says Toccalino, who notes there will be another town hall with delegates from CIHR in the spring of 2021 to follow up on the ideas discussed.

The goal is to establish environmental sustainability as a way of looking at health services. “The status quo is clearly harmful, and we have to push towards better systems in whatever ways we can,” says Haldane. “Where there isn’t education, you try and build processes to get that awareness so that it becomes as common as applying a sex and gender lens to your research. We think about the impact of our research in terms of environmental sustainability. We’ve already shown it can be done with other lenses we apply to our work, so why not this lens?”

The group is also coming off a successful virtual case challenge that drew participation from interdisciplinary teams nationally. The event, held jointly with trainees from Choosing Wisely Canada, had teams pitch their solutions for single-use products in the Canadian health system, a major source of hospital waste with lasting impact on the environment.

The winning team was a trio of McGill University medical students. They were awarded the first prize of $1,000 for their proposal for equitable distribution and use of menstrual hygiene products in Montreal.

As part of their advocacy work, ELESH is committed to building capacity in environmental sustainability by educating trainees from diverse programs and faculties. “As the health system is interdisciplinary, we must be, too, if we want to combat this problem,” says Cooper Reed. “I love learning from people from different disciplines like public health, medicine and nursing. It’s this collaborative effort that has been so central to ELESH.” The group holds book club meetings every other month to discuss climate and ecological issues more broadly, not just in relation to health care.

The group also represents trainees at the Sustainable Health Systems Community of Practice, a collaboration between hospitals in the Toronto Academic Health Sciences Network and U of T’s Council of Health Sciences.

When asked whether they are daunted by the enormity of climate change, Cooper Reed, Haldane, Sue-Chue-Lam and Toccalino are unanimous in their resolve to address the issue. “I think IHPME training us to be health systems leaders asks us to step into big shoes and transform complicated, and in many ways, deeply flawed, institutions and systems,” says Haldane. “If, as emerging leaders, we want to think ahead to the health systems we will inherit, this is going to be one of the issues. It’s interconnected with equity, racism—with all of these public health crises that are already happening. We’re just trying to do our due diligence to be best equipped to deal with that.”

Sue-Chue-Lam, who is a general surgery resident, says he is optimistic because he sees opportunities for change. “We are not without agency and health care has a parcel of emissions and ecological impacts that is under our institutional control. Every tonne of carbon matters, so while I may have cynicism about the scale and pace of transformation of other systems that are outside of my control, I’m hopeful about our ability to transform health care and hopefully, by mobilizing people within health care, that’s a mechanism for social transformation that pushes for bigger changes.”

To learn more about environmental sustainability in health care or get involved with ELESH, head to https://elesh.sa.utoronto.ca/