Australian Rheumatology Association urges ‘ambitious action’ on climate change

Days ago, Furnace Creek in California’s Death Valley saw its hottest July 16 on record when officials there reported a high temperature of 128 degrees Fahrenheit — among the highest temperatures recorded on Earth in the past 90 years.

Meanwhile, record-breaking heatwaves have gripped much of the southern United States, torrential downpours have triggered fatal floods in the Northeast, and wildfires in Canada have blanketed the Midwest and Northeast with smoke for the second time in less than a month.

Elsewhere in the world, the town of Sanbao, in northwest China, announced a national record of 126F on July 16, while a combination of wildfires and back-to-back heatwaves have pummeled residents across Europe. Officials in Italy and France have issued heat-related warnings as temperatures soar as high as 118F.

All of these material impacts of climate change have potential repercussions for health — including potential associations and triggers for autoimmune and rheumatic diseases.

The Australian Rheumatology Association in June released a position statement on climate change, becoming one of the first professional rheumatology organizations to directly address the topic in such a way.

The statement serves as a call to action for all rheumatologists seeking ways to minimize the environmental impacts of their daily practice, and contains bullet points for rheumatologists to consider as they work to make their practices more sustainable. In addition, it offers larger perspectives on climate change in medicine overall.

The group recommends “rational use” of resources, such as diagnostic tests, pharmaceuticals and imaging procedures. For example, imaging procedures like X-ray and ultrasound leave less of a carbon footprint than MRI and CT, and should be used only when clinically appropriate, according to the ARA.

Patients, meanwhile, should be encouraged to use telehealth when possible to minimize their own carbon footprint. Rheumatologists additionally should advocate that their patients eat healthy foods and exercise not only for general health, but to minimize the use of medical resources.

Thinking more broadly, the ARA also encourages rheumatologists to voice opinions about packaging and plastic use for medical devices and delivery services.

Healio sat down with Tracey Rudd, BPharm, general manager of the Australian Rheumatology Association, to discuss some of the finer points of the document, specific ways rheumatologists can reduce the carbon footprint in their daily work lives, and suggestions for patients who also wish to “reduce, recycle and reuse.”

Healio: In the paper, you described the concept of “low value care.” Please discuss what this is and how reducing it can have a positive impact on climate change.

Rudd: Low value care is care that provides little or no benefit, may cause patient harm, or yields marginal benefits at a disproportionately high cost. Examples of low value care in rheumatology include unnecessary tests, procedures, and imaging. The ARA top five recommendations on low value practices can be found at the Australian Rheumatology Association website (evolve.edu.au).

Pathology testing and diagnostic imaging together contribute 9% of health care’s carbon footprint, according to a paper published by McAllister and colleagues in Lancet Rheumatology. If we can reduce the use of pathology testing and diagnostic imaging that is considered low value care, this will reduce the overall carbon footprint and have a positive impact on climate change.

Healio: Apart from turning off imaging machines when not in use, what other practical, office-based measures can rheumatologists use to reduce their carbon footprint?

Rudd: The ARA Board recently agreed to support and endorse the Australian Medical Association and Doctors for the Environment’s GreenCollege Guidelines. These guidelines provide practical and affordable ideas to make climate friendly organizational improvements. For example, some office-based measures that could be implemented by rheumatologists could include exploring rooftop solar options for buildings, turning off all appliances/computers at the end of the day, using computers with energy saving settings and using recycled products, such as paper and toner cartridges, as much as possible.

Avoiding unnecessary printing and maximizing the recycling of waste are also ways to be environmentally friendly. There are so many small ways that rheumatologists can make a difference and these guidelines are a great starting point.

Healio: COVID-19 lockdowns brought telehealth into the mainstream of rheumatology care. Apart from minimizing travel for patients, how else can telehealth minimize environmental impact of rheumatology practice?

Rudd: Telehealth brings about advantages that extend beyond reducing patient travel — it also plays a pivotal role in minimizing the travel of the entire rheumatology health care team. Travel, with its heavy reliance on fossil fuels, is a notable contributor to carbon emissions across various sectors. By reducing travel, telehealth not only helps mitigate carbon emissions but also facilitates waste reduction.

In the case of patients traveling to see a rheumatologist in person, additional activities such as purchasing food, beverages and accommodation often contribute to their carbon footprint. Similarly, when rheumatologists and multidisciplinary teams travel to provide care in regional, rural and remote areas, these activities also result in carbon emissions. By embracing telehealth, health care professionals can actively contribute to environmental sustainability by minimizing travel-related carbon emissions and the associated ecological impact.

Healio: Are there concerns that using renewable energy in rheumatology clinics could negatively impact patient outcomes?

Rudd: Using renewable energy in rheumatology clinics would not generally be expected to have negative impacts on patient outcomes. However, it is important to consider potential concerns and address them appropriately. Consideration would have to be given to reliability and power backup and equipment compatibility with renewable energy sources. The cost of renewable energy infrastructure may be prohibitive for some practices.

Healio: Even if most physicians agree that the packaging of medications and medical instruments creates too much waste, how can they really convince a distributor or manufacturer to ‘reduce, recycle and reuse?’ What concrete steps can they take?

Rudd: To promote environmentally friendly practices within the health care industry, it would be advantageous for distributors and manufacturers to provide carbon footprint estimates for their products. When faced with two equally effective medication options for a patient, rheumatologists could then make informed decisions based on the medication with the lowest carbon footprint. Such a practice would incentivize distributors and manufacturers to prioritize climate-friendly approaches in the production and distribution of their products.

Healio: What kind of response do you expect from the Australian government as you try to implement these initiatives?

Rudd: The Australian government is committed to taking ambitious action on climate change. I believe that they will be supportive of any initiatives that ARA and our members implement which will help to reduce our carbon footprint.

Healio: What else can rheumatology patients be doing to reduce their carbon footprint beyond eating healthy and using telehealth?

Rudd: In addition to adopting a healthy diet and utilizing telehealth when appropriate, patients can actively reduce their carbon footprint by opting for “active” transportation methods, such as walking or cycling, when feasible for their appointments. Moreover, patients should educate themselves on the concept of low value care, enabling them to comprehend the reasons behind their rheumatologist’s recommendations against unnecessary blood tests or scans.

The GreenCollege Guidelines, although originally aimed at medical colleges, offer practical and affordable ideas that all individuals can implement in their daily lives to effectively reduce their carbon footprint.

Reference:
McAllister S, et al. Lancet Rheumatol. 2023;doi: 10.1016/j.lanwpc.2022.100459.