Health and Climate Change: common challenges, common solutions?
Highlights & Insights
from The Council of Europe Development Bank's high-level event on 'Health and Climate Change: common challenges, common solutions?'
6 May, in collaboration with Decide – Health Decision Hub
How can we break the vicious circle of environmental degradation and declining state of health?
What strategies and investments do we need for healthier and more sustainable European societies post-pandemic?
To address these, the Council of Europe Development Bank brought together a high-level panel of speakers in an open webinar on May 6, moderated by CEB Communications Officer, Jelica Vesic:
Council of Europe Development Bank Director of Technical Assessment and Monitoring, Monica Scatasta
EuroHealthNet Director, Caroline Costongs
European Association of Service providers for Persons with Disabilities (EASPD) Policy Manager, Thomas Bignal
European Network Architecture for Health (ENAH) Managing Director, Stefanie Matthys
European Hospital and Healthcare Federation (HOPE) Chief Executive, Pascal Garel
Council of Europe Development Bank Technical Advisor for Health and Social Care, Thomas Kergall
This webinar was the first in a series of CEB events on the theme of an inclusive, sustainable and resilient recovery from the pandemic.
Council of Europe Development Bank
Council of Europe Development Bank
Director of Technical Assessment and Monitoring
Ms Scatasta introduced the challenges posed to the healthcare sector by climate change and the pandemic, stating the need for European healthcare systems to adapt to these new challenges in alignment with the Paris Agreement. She stated that "the ongoing crisis has clearly indicated that resilient and inclusive health systems are a pillar of our societies as well as our economies". Ms Scatasta underscored that "understanding the nexus between the resilience and inclusiveness of health systems and the challenges posed by climate change and environmental degradation is clearly an important element in this reflection".
Noting that environmental degradation and climate change have a direct impact on our ability to achieve global health goals, Ms Scatasta explained that the CEB has already begun to address the increasing incidence of non-communicable diseases and other important health impacts of environmental degradation over recent decades, alongside investments in health-related infrastructure and social care. Ms Scatasta underlined the importance of better understanding the connection between human health and climate change in order to prepare health systems and design better solutions.
Ms Scatasta emphasised the crucial correlation between human health and well-being and environmental health, citing a number of striking statistics:
"a quarter of global disease burdens and more than a third of the burden with regards to children's and treating children's health was attributable to modifiable environmental factors from air pollution, particularly as regards fine particulate matters to contaminated waters and other aspects", according to a 2006 WHO estimation
"one in every eight deaths in Europe can be linked to air water or noise pollution, as well as extreme weather events that are related to climate change"
"the percentage of deaths linked to environmental causes stands at almost 30% in Bosnia Herzegovina and well over 20% in Albania"
As Ms Scatasta stated, "we are approaching the limit in an increasing number of our planetary boundaries. We need to have healthcare systems that are ready and able to face these challenges". She went on to say that "primary healthcare in particular are key actors in delivering health responses to climate change. There are a number of responses, both in terms of climate change mitigation - in the way we build, in the way we provide our services - and in terms of the climate change adaptation of healthcare systems to make them more resilient". Ms Scatasta underlined that it is necessary to consider "how we can better mainstream both climate-related environmental considerations in our healthcare systems as well as how we conceive and operate them".
Ms Scatasta noted that the CEB is in fact currently finalising a report on how they, as international financiers, can contribute to the resilience of Europe's healthcare systems in a way that is socially inclusive, territorially sensitive, and environmentally sustainable, with diverse focus areas - from primary healthcare and long-term care to smarter and greener hospitals.
Ms Costongs agreed that banks in general have a greater responsibility to take care in what areas they invest in, as they have the possibility of playing a very significant role in achieving the necessary changes. Ms Costongs emphasised the importance of health promotion and disease prevention as a way to pre-empt and reduce pressure on health systems, noting that these measures can also have positive effects on the environment and social sector.
While the choices of individuals are key to this, particularly in the areas of diet and mobility, Ms Costongs emphasised the role and responsibility of institutions in enhancing and giving momentum to sustainable lifestyle and environmental change. Ms Constongs explained that institutions are in a uniquely empowered position to promote a healthier society, by taking concrete actions to shift social norms towards more virtuous lifestyles.
"We are not living sustainably. We are not living within the limits of our planet. If everyone in the world lived a European lifestyle, we would need the natural resources of two planet Earths, and if everyone lived an American lifestyle, it would require the resources of four planet Earths. So we do need to make different choices in our lives."
Ms Costongs emphasised the positive environmental and biodiversity impacts of adopting a plant-based diet, while acknowledging that there is here also a challenge in changing people's attitudes towards this notion, and their willingness to alter their customary choices. Ms Costongs highlighted that this may become easier with recent progress in and growing demand for delicious, convincing, environmentally- and health-friendly 'laboratory meat' and 'substitute meat' options.
With regard to mobility choices, Ms Costongs emphasised the twin benefits that more active or group transport options can have for individual as well as collective health and the environment. Initiatives promoting such lifestyle choices can also have a positive and energising effect on the local community, businesses and cityscapes, driving demand for transformation and adapted services, Ms Costongs explained, citing a case study on the promotion of cycling in Prague.
Ms Costongs also raised the counterpoint that not all lifestyle characteristics are within the individual's ability to choose. Economic inequality can, for example, be a barrier to accessing healthy and affordable food, or living in a less polluted area, or in better-insulated housing. To many, these are luxuries, not viable options. Added to this are the risks of certain people being more vulnerable to certain unintended consequences of climate change adaptation measures, such as loss of employment.
Ms Costongs underlined that with any health and climate initiatives or investments, three behavioural science factors need to be considered:
- People's habits and motivation
- People's available opportunities
- People's capabilities and resources
Ms Costongs noted past successes of legislative measures such as the smoking ban, raising the need for similar measures to limit the marketing of ultra-processed foods towards children, for instance, and to improve front-of-package labelling on the health and sustainability of products. She also commented that a great deal can be done through taxation, and providing subsidies for fruit and vegetables, "which is particularly important if we want to reach the whole social gradient" as well as "providing really nutritious and healthy foods in schools, in canteens and so on".
Another approach to promoting awareness as well as access to healthy nutrition and green spaces, particularly in inner-city areas and more deprived communities, is the creation of 'pocket parks', miniature forests, and 'food gardens', linked to schools, for instance. Ms Costongs gave the example of such a project in Rotterdam, where a harbour wasteland was transformed into a food garden and volunteers and unemployed people were invited to train in tending to it. The project was connected with a restaurant, where they could get further training, and also to a children's school, so the children could also learn about it.
Ms Costongs noted that this was a particularly good case as it brings social, health, wellbeing and climate together, as well as education. Given this, Ms Costongs stated that "it is these kinds of community projects and grassroots initiatives that we need to support. We need to give them some seed money. We need to take away barriers that may exist - legal barriers and political barriers - and try to really get that mobilisation from the ground. Because if we want to see change, I think it first comes from people, then from the investors and businesses, and maybe only later from governments".
Considering the climate crisis, however, there is a need to build the necessary momentum and accelerate change. Supporting climate change adaptation is important, but driving climate change mitigation is also critical. Ms Costongs therefore welcomed the potential of the upcoming measures that will follow from the 'healthier and greener' investment emphases of the Green Deal and Member States' Recovery and Resilience Plans. She noted that "legislators and investors have the most important tools at hand to make the urgent change that is required in order to move away from the 'business as usual' of the past", and stressed in conclusion that "the Council of Europe Development Bank, and all banks, in fact, have the responsibility as well as the power to invest in sustainable, healthy and social projects, and perhaps also to disinvest in those projects or products that are not so sustainable".
European Association of Service Providers for Persons with Disabilities (EASPD)
Bringing the perspective of the social care sector, Mr Bignal explained the importance of personal agency, stating that actions taken by organisations must not remove the choice of the individual. He also underlined the importance of the WHO's definition of the concept of health as "physical, mental, and social well-being", and posed the question of whether existing social care structures do in fact promote health, if understood in this more complete way. The social well-being aspect is traditionally under-considered, he stated.
With the example of the high number of pandemic deaths in care facilities, Mr Bignal pointed out that the vulnerability of those living in such situations is also caused by the settings themselves, rather than being a purely personal vulnerability, independent of circumstance. He explained that "in these types of settings and institutions, the structures themselves - which promoted the spread of the infections - also tend to isolate people. They don't really provide people with independence, with choice and control over their lives. […] There is no choice and control, and therefore no health".
With this in mind, Mr Bignal underlined the need to "focus more on the social environment around an individual, on helping them to live independently and on responding to the individual needs that people have". The approach for the future should be "to invest less in large institutional settings and more in in helping people to stay at home and live in their communities. Projects which support individual needs, quality of life, social participation, and which help people have choice and control over their lives, have a much better impact on the health of people, than other types of services". For this, however, greater investment is needed, as well as public initiatives.
Mr Bignal also underlined that people with support needs – such as older people, people with disabilities, children and homeless people – are more affected by climate change than the general population. In the face of pollution, floods and fires, such people are less able to leave.
Compounding this is the effect of climate change on public budgets. Mr Bignal pointed to a growing "climate expenditure versus social expenditure dilemma", commenting, "if you look at the new European recovery plans, where are the priorities? Green, digital… Where is social?". He stated that, while difficult and complex, this 'climate versus social expenditure dichotomy' must be resolved; we cannot do one without the other.
Mr Bignal concluded by stating that "whatever the measures that are taken to mitigate climate change – whether in hospitals, by society as a whole or by social service providers - we really need to co-create the solutions together with the individuals who may be suffering from it most".
European Network Architecture for Health (ENAH)
Ms Matthys prefaced her presentation by confirming, in connection with Mr Bignal's points, that "investment in healthcare infrastructure is very much focused on economic success, and these social aspects often come at the end of the discussion".
She went on to say that the impacts of climate change, such as rising temperatures, extreme weather events and the rising sea level, pose direct risks for healthcare infrastructure. Disruption of supply chains and energy systems will also cause disruption to health services. Heatwaves will perhaps have the most immediate impact, particularly on those with cardiovascular or respiratory diseases, as well as elderly people, newborns and children. Many of these more vulnerable people will be living in hospitals or care homes, so making these more resilient will protect these at-risk groups.
Ms Matthys noted that another challenge is the buildings themselves, and the building sector in general, which are also contributors to climate change. Ms Matthys cited that 40% of energy consumption and 36% of CO2 emissions are from buildings alone, in the EU. She emphasised that the problem is principally a combination of older buildings, 75% of which are not energy efficient, and the fact that only approximately 1% are renovated for energy efficiency.
Building with both resilience and energy efficiency in mind are therefore key for the future. For this, Ms Matthys noted, there are many aspects and solutions to consider, such as the use of insulating or shading facades, cross ventilation, or greenery for both shade and insulation. "We should also look at the surroundings of infrastructure because it's very, very important to have green and unsealed surroundings to enable reduction of temperature and evaporation", she explained. With regard to using greenery, another consideration is the plants' resilience to climate change and temperature rise. Roofs should also be actively used by "transforming them into green spaces and also by using them for solar panels and photovoltaic panels in order to change the energy consumption of the buildings and switch over to renewable energy".
A very significant contributor in healthcare infrastructure is the building technology, Ms Matthys noted, stating that "we have to use heat recovery systems and a diametric exhaust air cooling systems to have a better efficiency", as well as "using thermal activation of the building structure". Within buildings, simple solutions such as choosing light colours can provide reflection and reduce indoor temperatures. Ms Matthys underlined that such systems can be adapted to existing structures.
In terms of how hospital environments could be adapted to dealing more effectively with future pandemics, Ms Matthys proposed that hospital infrastructure could be made more flexible as well as incorporating more space. Using modular architecture and flexible structures, rooms set up for normal care could be quickly adapted for intensive care, for example.
Ms Matthys also brought attention to the wider urban habitat. Urban planning is also a very important factor in empowering people and creating healthy lifestyles, Ms Matthys noted, pointing to long-standing studies by the WHO on the impact of urban settings on health. Given the degree of research and awareness of this, Ms Matthys put forward that "all urban developments should be subject to health impact assessments"; "health could be the guiding principle of urban planning in the future".
Ms Matthys grounded this, commenting that "maybe the main barrier to why these healthy city ideas or urban planning ideas are not yet implemented is because we haven't discussed the business case of the Healthy City". She questioned who benefits from healthy urban planning and who has an interest to invest, concluding that it is not the private sector. As such, some incentives may be required, Ms Matthys concluded.
European Hospital and Healthcare Federation (HOPE)
Mr Garel explained that there are a range of mindsets and priorities in healthcare systems and hospitals across the EU, from national down to regional level within States. He commented that the effect of the Recovery and Resilience Plans may affect these for the better, bringing into focus the overarching smart and green priorities, but the proposed solutions that are coming forward differ between States, and may not necessarily be coordinated.
As an example of a practice in need of solutions, Mr Garel highlighted how hospitals' focus on patient and professional safety resulted in the development and extensive use of single-use materials, such as surgical masks. Waste management and recovery is an area which healthcare systems are bringing their attention to now, as a result of growing environmental and resource consciousness.
Mr Garel highlighted that, following the financial crisis, there was pressure on those using public money, which resulted in cost-cutting, often in areas where the impact would not be immediately visible, such as environmental investments in green buildings. Many hospitals and regions are now not in a position to build new eco-friendly facilities, and this is an area where support will certainly be needed from institutions such as the CEB.
Mr Garel highlighted, however, that good practices and solutions are being exchanged between healthcare systems and hospitals, bringing to light important that more hospitals could implement, such as producing their own energy, using electric ambulances, reducing food waste and pharmaceutical water contamination, reprocessing single-use materials. Mr Garel concluded, stating that "there are plenty of initiatives that are coming from the bottom that will be taken individually by hospitals, but what will be significant is that at the top, in particular for climate, the energy is greener, and also that investment is made at national and regional level from those who have the money to help us to be more vigilant in this issue".
Council of Europe Development Bank
Technical Advisor for Health and Social Care
Mr Kergall brought the event to a close with a stark reminder that "if unchecked, climate change may cause 250,000 deaths per year, between 2030 and 2050, by the combined effect of loss of biodiversity, poor nutrition, water sources becoming inaccessible, and soil degradation", as many reports concur. Mr Kergall underscored that "the potential impact of climate change and environment degradation on the health and other related systems in our societies" is greatly compounded by "the convergence of progressive societal ageing, innovating and expensive treatments for lifelong chronic conditions, which are creating indeed, further disparities in our inequal societies, dementia and mental health degradation, requiring long term social care and palliative medical treatments". Given this, Mr Kergall stated that investing in climate mitigation projects is on top of the CEB's agenda, along with investing in more energy-efficient and resilient buildings. Mr Kergall concluded with the hope that the "pandemic lessons will not be forgotten and that the resilience plans that are being put in place will address the key changes we need to include in our agenda for the future".
Schuman Associates was delighted to work with the Council of Europe Development Bank in the organisation of this event.
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