Recruiting health professionals as sustainability advocates
Authors: Ben Hubbert, Mohamed Ahmed, John Kotcher, Edward Maibach, Mona Sarfaty
Journal: The Lancet Planetary Health (2020)

In 2015, all United Nations member states adopted the 2030 Agenda for Sustainable Development, which explicitly recognised that sustainability is inextricably tied to human health and wellbeing.1United NationsTransforming our world: the 2030 agenda for sustainable development. United Nations, 2015Google Scholar Indeed, a diverse body of research has shown that climate and sustainability solutions—such as transitioning to clean energy, promoting plant-based and locally-sourced diets, and reducing air and water pollution—enhance population health.2Willett W Rockström J Loken B et al.Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems.Lancet. 2019; 393: 447-492Summary Full Text Full Text PDF PubMed Scopus (2197) Google Scholar, 3Watts N Amann M Arnell N et al.The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate.Lancet. 2019; 394: 1836-1878Summary Full Text Full Text PDF PubMed Scopus (455) Google Scholar, 4Landrigan PJ Fuller R Acosta NJR et al.The Lancet Commission on pollution and health.Lancet. 2018; 391: 462-512Summary Full Text Full Text PDF PubMed Scopus (1492) Google Scholar Moreover, a growing body of evidence indicates that communicating the health implications of threats such as climate change and air pollution can help generate the public and political support that is necessary to accelerate the adoption of sustainability solutions.5Kotcher J Maibach E Montoro M Hassol SJ How americans respond to information about global warming's health impacts: evidence from a national survey experiment.GeoHealth. 2018; 2: 262-275Crossref Google Scholar, 6Kotcher J Maibach E Choi W-T Fossil fuels are harming our brains: identifying key messages about the health effects of air pollution from fossil fuels.BMC Public Health. 2019; 191079Crossref Scopus (27) Google Scholar As a result, health professionals have a tremendous opportunity to become trusted voices as advocates for sustainability solutions that improve public health. Health professionals have the potential to inspire sustainability efforts externally with the public and policy makers, as well as to improve sustainability within the health-care industry, which is responsible for a substantial fraction of the world's air pollution and greenhouse gas emissions.7Eckelman MJ Sherman J Environmental impacts of the U.S. health care system and effects on public health.PLoS One. 2016; 11e0157014Crossref PubMed Scopus (243) Google Scholar, 8Kaplan SB Forst L Linking environmental sustainability, health, and safety data in health care: a research roadmap.NEW Solut J Environ Occup Health Policy. 2017; 27: 189-209Crossref Scopus (4) Google Scholar Professionals who lead by example are more likely to motivate sustainability actions by others.9Attari SZ Krantz DH Weber EU Statements about climate researchers' carbon footprints affect their credibility and the impact of their advice.Clim Change. 2016; 138: 325-338Crossref Scopus (39) Google Scholar Here we describe a qualitative study intended to evaluate how hospital staff react to the proposition that sustainability solutions are also health solutions. Our motivation to do the study arose after hearing the director of sustainability at a large hospital system explain that one of his goals was to turn every employee into a sustainability champion. Because of the health benefits of sustainability solutions, we suggested that positioning sustainability solutions as heath solutions might be a viable means of cultivating health professionals as sustainability champions in their place of employment. We interviewed staff (n=16) at a network of hospitals and urgent care centres in northern Virginia, USA between December, 2019, and January, 2020. Participants occupied a wide range of positions, including clinical and non-clinical roles and some had no previous involvement in sustainability activities in their place of employment, whereas other had varying degrees of involvement. Participants were first asked questions to assess their perceptions about connections between health and sustainability, their experiences with sustainability efforts at their workplace, and perceived barriers that might prevent their hospital system from becoming more sustainable. Next, they read a one-page essay that described sustainability solutions as health solutions, including brief descriptions of six categories of solutions that could be implemented in their hospital system (energy, food, transportation, buildings, consumption, and actions that can be taken in surrounding cities and communities; appendix p 1). Participants were specifically asked to mark passages of the essay that they liked or found to be particularly helpful with a green highlighter and those they did not like or found unhelpful with a red highlighter. After reading the passages, participants were asked additional questions to assess their reactions to what they had read. Before reading the essay all participants defined sustainability as relating to the environment; they frequently mentioned actions to reduce the impact of human activity, especially waste, on the Earth. Most did not, however, spontaneously mention any connection to human health. When asked specifically if they saw a connection between sustainability and health, all participants answered yes. Ten participants emphasised pollution, climate change, and other climate impacts as threats to public health and six participants emphasised hospitals' production of waste, greenhouse gas, and other environmental impacts. When asked if they see environmental sustainability as part of their job, eight participants gave a definite positive answer, three gave a definite negative answer, and five said that they have a moral responsibility to be sustainable, but that responsibility is separate from their profession. Most participants identified barriers that impede progress toward sustainability by the hospital system and its employees. Nine participants interviewed mentioned one or more of the following barriers to sustainability: little knowledge about how to be more sustainable, a workplace culture that does not prioritise sustainability, and the intense time pressure that most hospital workers experience in their jobs. Some participants noted these barriers are interrelated, saying that time pressure makes it difficult to learn about sustainability and develop a more sustainable culture. Other reported barriers included perceived absence of support from hospital leadership (n=6), perceived financial costs (n=4), and a belief among hospital employees that sustainability does not directly affect patient outcomes (n=6) and is therefore not relevant to the hospital's mission (n=3). Most participants agreed with the core argument and proposed solutions outlined in the essay, although there were differences in what they saw as the main idea. Eight participants saw the essay as fundamentally about the relationship between sustainability and health—which was indeed the aim of the essay—whereas the other eight saw it as either a list of possible solutions to implement, or as a general statement in support of sustainability. The parts of the essay that were selected as helpful by the largest number of participants included the premise that the health impacts of air pollution and other environmental problems may not be obvious, but they can cause serious harm to our patients' health, and the topics of the six categories of healthy, sustainable solutions (eg, healthy, sustainable energy). Of the statements that elaborated on the six solution categories in the essay, descriptions of solutions for food, energy and cities and communities were highly favored (appendix p 1). The most common criticism of the essay was that the proposed sustainability solutions need to be more specific to the hospital setting and should provide a roadmap for how to begin implementing them immediately. Participants were less enthusiastic about solutions they believed were out of the hospital's control, such as sustainable transportation. Four participants, most of whom had clinical and research backgrounds, wanted the essay to contain references to information sources, including scholarly articles, about the health benefits of sustainability. After reading the essay, all but one participant said they saw how environmental sustainability can improve health. 12 participants were supportive of their health system distributing information about the health benefits of sustainability to hospital workers, visitors, and patients. When asked whether they could see themselves using the information in the essay to advocate for sustainability in the workplace, 13 participants said yes, although they envisioned varying levels of engagement. Three participants who were involved in educating colleagues about sustainability already discussed the connection between health and sustainability in their advocacy; two more thought that this kind of information would be helpful to their efforts. Although ours was a small study done in a single hospital system, our findings suggest that health professionals and other employees in health-care settings are receptive to information about the connection between sustainability and health, and are open to seeing themselves as sustainability advocates in their place of employment on the premise that sustainability solutions are also health solutions. This intriguing possibility warrants further study. If shown to be robust, it has the potential to become a widely applied strategy in health-care systems to accelerate progress toward sustainability in health care, and for health care to become a role model for sustainability efforts more generally in society. We declare no competing interests. Download .pdf (.14 MB) Help with pdf files Supplementary appendix