A small child, lets call her Alice, is having an asthma attack at home. Her mother gives her her inhaler but still she is struggling for breath. Her heart is pounding. Her chest is heaving up and down. She is wheezing. She looks scared. Her mother is scared too. She calls an ambulance. It arrives quickly. The paramedics, professional and calm, are able to improve things with their nebuliser and oxygen. They take her to the emergency department where she is treated further. Overnight on the paediatric ward she improves and eventually smiles at her mother again. By the next morning she is back to normal. Her life has been saved. Her mother and the doctors, nurses and paramedics who have treated her are rightly happy. A wonderful child lives on to experience life in the full.

But there is a forgotten side to this story. The ambulance which rushed to help her was a diesel vehicle. As it sped along the road its exhaust pumped out fine particles and other pollutants. It passed a little boy in a buggy perhaps increasing his chance of suffering from asthma and an elderly gentleman perhaps worsening his heart disease. Throughout the city pollutants left the back of the ambulance and entered people’s lungs. Fine particulate matter (called PM2.5) is known to contribute to heart and lung disease. Much of this comes from vehicles. PM 2.5 is estimated to have an impact equivalent to 28,000 deaths per year in the U.K. This is no small problem.

On the day of Alice’s asthma attack her father is out of town. On hearing his only child is in hospital he rushes to her. Arriving in the evening, tired and anxious, he hurries to the paediatric ward where to his relief he finds she is much better and will probably be able to go home in the morning. He sits holding her hand until she sleeps. Then he remembers he hasn’t eaten since lunch so goes off to find food. He goes down to the hospital concourse and gets food in the first place he finds. It is a big chain fast food restaurant. Without thinking he orders a burger and chips. He has been trying to resist this sort of food since he found out he had Type 2 diabetes. But today he can’t worry about that. Besides he can’t see anywhere healthier to eat. As he is finishing his burger he looks across to the table opposite and sees the nurse who was looking after his daughter on the ward. She has finished her shift. She looks tired as she too eats a burger and chips. As he gets up he smiles and thanks her for helping save his daughter. Both feel a bit better because of this small exchange. Alice’s father and her nurse have both ended the day tired but happy that Alice is on the mend. Yet both are a bit less healthy than if they had eaten a different dinner. Hospitals in the UK are often a shockingly unhealthy environment to eat in. When visitors and staff are tired and stressed they are more susceptible to ‘nudges’ from their surroundings. Too often these push them towards unhealthy eating. This is another way the health service contributes to the shortening of lives, particularly of its own staff.

There is a third much bigger but more diffuse harm which also demands attention. All the activity required to save Alice’s life has a high carbon footprint from the hospital building to the vehicles driven and the drugs and devices used. These all contribute to climate change and so contribute to deaths across the world, for example from extreme weather events or food and water shortages. Climate change is recognised as the greatest threat to global health of the 21st century and it threatens to undermine all the progress we are seeing in health across the world. The stark science of climate change means we need to get to net zero greenhouse gas emissions as soon as we can to avoid catastrophic impacts.

These three examples illustrate how even while saving lives the NHS is also shortening them. A sustainable health service is surely one which can save people’s lives without killing other people. So here are three changes which would help make the NHS sustainable:

1. Only using zero emission vehicles
2. Making all healthcare settings healthy food environments and remove entirely the least healthy retailers such as fast food chains
3. Shifting to 100% renewable energy

There are many more things which need to happen. But these examples based on the story of Alice and the Ambulance illustrate this principle, the principle of healthcare without harm. It is easy to imagine a different world where Alice is taken in an electric ambulance to a hospital powered by renewable energy where her father and nurse would have a healthy meal in a hospital restaurant, a world in which the passing little boy wouldn’t have suffered from asthma and the older gentleman suffered a bit less angina and lived a bit longer, a world in which the climate changed a bit less than it would have otherwise so we had fewer malnourished children, fewer people made homeless by extreme storms and flooding and fewer people dying in heat waves.

The NHS is a wonderful thing but it could be even better. Let’s make this happen. Within the next five years we could make all vehicles zero emission ones, all hospitals healthy places to eat, and change the whole system so it is powered by renewable energy. If we do this then perhaps when another little girl like Alice has an asthma attack in 2020 she will be able to have her life saved without shortening the lives of others. Who knows perhaps she won’t even have the asthma attack in the first place.

Additional Notes:
NHS Sustainability Day 2015 is the 26th March. It is the day when individuals and organisations across the National Health Service (NHS) in England take and celebrate actions aimed at making the NHS more sustainable. There are many organisations in the NHS already taking great actions, for example the Care without Carbon strategy at Sussex Community NHS Trust which commits the organisation to becoming a net zero carbon emission healthcare provider. More examples of action can be found at the Sustainable Development Unit and the Centre for Sustainable Healthcare. International examples can be found via Healthcare without Harm. For more information on estimates of local impacts of particulate air pollution see here.

The characters in this story are fictional and any resemblance to real people is coincidental. The idea for this blog came from a conversation I had with a sustainability professional in the NHS who shall remain anonymous but who has my thanks.