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Publication date (Electronic): 7 March 2024
Journal: Canadian Journal of Kidney Health and Disease
Publisher: SAGE Publications
Keywords: planetary health, sustainable health care, sustainable nephrology, green nephrology, nursing, nephrology nurse
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The increasing frequency of extreme climate events underscores the need for urgent action on climate change. The health care system contributes 4.6% of greenhouse gas emissions (GHGs) in Canada; thus, it is a major contributor to the country’s carbon footprint. Kidney care in particular can involve high amounts of waste (eg, plastic and consumable waste associated with dialysis, transportation, emissions, energy, and water consumption). Therefore, sustainability initiatives within the health care system, and especially in the context of kidney care, have great potential to make a positive impact on planetary health. Here, we outline ways in which nephrology nurses can expand our duty of care to the environment and incorporate sustainability into our work. A small advisory group of nephrology nurses in partnership with the Canadian Association of Nurses for the Environment (CANE) assessed ways that sustainable practices can be incorporated into nephrology nursing. Drawing on the Planetary Health Care model used by the Canadian Society of Nephrology: Sustainable Nephrology Action Planning (SNAP) committee, we assessed how the model could be adapted in the context of kidney care using 3 main actionable themes in their work: reducing the demand for health services, matching the supply of health services with demand, and reducing emissions from the supply of health services. We also reviewed and selected real-world examples of initiatives pursued by colleagues. Through this established framework, we provide recommendations and case examples for nephrology nurses to expand our duty of care to the environment. We describe nursing-led strategies used in Canada to improve environmental sustainability in kidney programs and consider their applicability to other renal programs. In 1 case example, we show how a simple nurse-led initiative at a single dialysis clinic can lower plastic waste and associated costs by $2042.59 per year. More broadly, we provide recommendations and actions for nephrology nurses to improve environmental sustainability in kidney care. Contexte: L’augmentation de la fréquence des phénomènes climatiques extrêmes met en lumière la nécessité de prendre des mesures urgentes pour lutter contre les changements climatiques. Le système de santé est responsable de 4,6 % des émissions de gaz à effet de serre (GES) au Canada et contribue grandement à l’empreinte carbone du pays. Les soins rénaux en particulier peuvent générer de grandes quantités de gaspillage (p. ex., déchets plastiques et consommables associés à la dialyse, transport, émissions, énergie et consommation d’eau). Par conséquent, les initiatives de durabilité dans le système de santé, et en particulier dans le contexte des soins rénaux, pourraient avoir une incidence positive sur la santé de la planète. Dans cet article, nous décrivons comment le personnel infirmier en néphrologie pourrait élargir son devoir de soins à la protection de l’environnement par l’intégration des pratiques durables dans son travail. Sources de l’information: Un petit groupe consultatif constitué d’infirmières et infirmiers en néphrologie, en partenariat avec l’Association canadienne des infirmières et infirmiers pour l’environnement (ACIIE) et le Sustainable Nursing Action Planning (SNAP) Committee, s’est réuni pour évaluer comment les pratiques durables pourraient être intégrées aux soins infirmiers en néphrologie. Nous avons utilisé un modèle de soins favorisant la santé de la planète et décrit de manière itérative les façons dont celui-ci pourrait être adapté au contexte des soins rénaux. Nous avons également examiné quelques exemples concrets d’initiatives prises par des collègues. Principales observations: Nous décrivons comment le personnel infirmier en néphrologie pourrait appliquer un modèle de soins favorisant la santé de la planète dans le cadre de son travail. Ce concept est présenté sous trois principaux thèmes exploitables: réduire la demande pour des services de santé, adapter l’offre de services de santé à la demande et réduire les émissions liées à l’offre de services de santé. Dans ce cadre, nous formulons des recommandations au personnel infirmier en néphrologie et nous lui présentons des exemples de cas pour élargir son devoir de soins à la protection de l’environnement. Nous présentons des stratégies utilisées au Canada, et menées en soins infirmiers, pour améliorer la durabilité environnementale des programmes rénaux. Nous examinons également leur applicabilité à d’autres programmes rénaux. Dans un des exemples de cas, nous montrons comment une simple initiative dirigée par une infirmière, au sein d’une seule clinique de dialyse, a permis de réduire la quantité de déchets plastiques et les coûts connexes de 2 042,59 $ par année. De manière plus générale, nous formulons des recommandations et proposons des actions qui pourraient être posées par le personnel infirmier en néphrologie pour améliorer la durabilité des soins rénaux. Abstract
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Life cycle environmental emissions and health damages from the Canadian healthcare system: An economic-environmental-epidemiological analysis
Matthew Eckelman, Jodi D Sherman, Andrea MacNeill (2018)
Background Human health is dependent upon environmental health. Air pollution is a leading cause of morbidity and mortality globally, and climate change has been identified as the single greatest public health threat of the 21st century. As a large, resource-intensive sector of the Canadian economy, healthcare itself contributes to pollutant emissions, both directly from facility and vehicle emissions and indirectly through the purchase of emissions-intensive goods and services. Together these are termed life cycle emissions. Here, we estimate the extent of healthcare-associated life cycle emissions as well as the public health damages they cause. Methods and findings We use a linked economic-environmental-epidemiological modeling framework to quantify pollutant emissions and their implications for public health, based on Canadian national healthcare expenditures over the period 2009–2015. Expenditures gathered by the Canadian Institute for Health Information (CIHI) are matched to sectors in a national environmentally extended input-output (EEIO) model to estimate emissions of greenhouse gases (GHGs) and >300 other pollutants. Damages to human health are then calculated using the IMPACT2002+ life cycle impact assessment model, considering uncertainty in the damage factors used. On a life cycle basis, Canada’s healthcare system was responsible for 33 million tonnes of carbon dioxide equivalents (CO2e), or 4.6% of the national total, as well as >200,000 tonnes of other pollutants. We link these emissions to a median estimate of 23,000 disability-adjusted life years (DALYs) lost annually from direct exposures to hazardous pollutants and from environmental changes caused by pollution, with an uncertainty range of 4,500–610,000 DALYs lost annually. A limitation of this national-level study is the use of aggregated data and multiple modeling steps to link healthcare expenditures to emissions to health damages. While informative on a national level, the applicability of these findings to guide decision-making at individual institutions is limited. Uncertainties related to national economic and environmental accounts, model representativeness, and classification of healthcare expenditures are discussed. Conclusions Our results for GHG emissions corroborate similar estimates for the United Kingdom, Australia, and the United States, with emissions from hospitals and pharmaceuticals being the most significant expenditure categories. Non-GHG emissions are responsible for the majority of health damages, predominantly related to particulate matter (PM). This work can guide efforts by Canadian healthcare professionals toward more sustainable practices.
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Does telemedicine reduce the carbon footprint of healthcare? A systematic review
Amy Purohit, James Smith, Arthur Hibble (2021)
In the rapidly progressing field of telemedicine, there is a multitude of evidence assessing the effectiveness and financial costs of telemedicine projects; however, there is very little assessing the environmental impact despite the increasing threat of the climate emergency. This report provides a systematic review of the evidence on the carbon footprint of telemedicine. The identified papers unanimously report that telemedicine does reduce the carbon footprint of healthcare, primarily by reduction in transport-associated emissions. The carbon footprint savings range between 0.70–372 kg CO 2 e per consultation. However, these values are highly context specific. The carbon emissions produced from the use of the telemedicine systems themselves were found to be very low in comparison to emissions saved from travel reductions. This could have wide implications in reducing the carbon footprint of healthcare services globally. In order for telemedicine services to be successfully implemented, further research is necessary to determine context-specific considerations and potential rebound effects.
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Planetary health care: a framework for sustainable health systems
Andrea MacNeill, Forbes McGain, Jodi D Sherman (2021)
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Author and article information
Journal
Journal ID (nlm-ta): Can J Kidney Health Dis
Journal ID (iso-abbrev): Can J Kidney Health Dis
Journal ID (publisher-id): CJK
Journal ID (hwp): spcjk
Title: Canadian Journal of Kidney Health and Disease
Publisher: SAGE Publications (Sage CA: Los Angeles, CA )
ISSN (Electronic): 2054-3581
Publication date (Electronic): 7 March 2024
Publication date Collection: 2024
Volume: 11
Electronic Location Identifier: 20543581241234730
Affiliations
Author notes
[*]Sarah Thomas, BC Renal, British Columbia Provincial Health Services Authority, 260-1770 W, 7th, Ave., Vancouver, BC V6J 4Y6, Canada. Email: sarah.thomas1@ 123456bcrenal.ca
Author information
Sarah Thomas https://orcid.org/0009-0001-3526-8539
Article
Publisher ID: 10.1177_20543581241234730
DOI: 10.1177/20543581241234730
PMC ID: 10921849
PubMed ID: 38463382
SO-VID: 1ecd3fea-b702-4c74-8865-1b32eb131e15
Copyright © © The Author(s) 2024
License:
This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).
History
Date received : 23 May 2023
Date accepted : 15 January 2024
Categories
Subject: Sustainable Nephrology – Introduction, Perspectives, and Pathways to Low Carbon Quality Kidney Care
Subject: Program Report
Custom metadata
cover-date January-December 2024
typesetter ts1
Keywords: planetary health,sustainable health care,sustainable nephrology,green nephrology,nursing,nephrology nurse
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Keywords: planetary health, sustainable health care, sustainable nephrology, green nephrology, nursing, nephrology nurse
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