There is one major issue being overlooked in the discussion on health reform - it is the interaction between health care and the environment. Should the Prime Minister Kevin Rudd choose to address it, he could be kicking two important pre-election goals at once - health and climate.
The issues driving demand for health reform are many and varied. There are legitimate concerns regarding the sustainability of quality health care in Australia - decades of cost and blame shifting between governments, ballooning costs due (in part) to unfettered profiteering by technology and pharmaceutical companies. Coupled with a failure to invest in population health and primary health care to prevent illness this has led to increases in chronic (and preventable) illnesses, a disgruntled workforce, issues with the quality and safety of health care, and inequitable access across socioeconomic divides.
Much of this is now under discussion among government and health care stakeholders following Rudd's recent announcements regarding reform of hospital financing, plus some assertions regarding improvement to primary health care and prevention, and most recently, offers of additional funding and streamlining of responsibilities for aged care. All these reforms are badly needed, but as yet, none of this will be enough to address to the fundamental issues associated with (and arising from) lack of integration between services, divided responsibilities between governments, and a failure to fund services according to health-care need (as opposed to demand).
You might think that dealing with these issues was quite enough for our governments - and it is certainly true that health is complex both politically and in the development of acceptable public policy (made even more so with conflicting views and motivations of key stakeholders).
However, ensuring the sustainability of health-care financing requires consideration of even broader issues, like the environment. For example, the potential implications of the increasing effects on human health from climate change and the impact of any establishment of a price on carbon on health-care budgets. The health effects of climate change include an increasing incidence of infectious diseases associated with rising global temperature (due to increases in parasites and decline in water quality), as well as heat stress and injuries and mortalities from more frequent and extreme weather events (bushfires, floods etc). Witness for example the surge in notifications for dengue fever (which can have severe and potentially fatal consequences) in north Queensland last year with more than 900 reported cases in Cairns in 2008-09 (compared to, for example, 49 cases in 2000). And no one could be unaware of the huge environmental and psychological consequences arising from the 2009 bushfires in Victoria that also claimed 173 lives and caused a massive surge in demand for emergency services and personnel as people affected by both heat and fire sought assistance.
These are some of the current impacts with a 0.8 degree rise in global average temperature. Our population size will mean we do not experience the massive losses seen when severe heatwaves in Europe in 2003 caused tens of thousands of deaths, but given that with global average temperature predicted to increase by up to 7 degrees by the end of this century (under a business as usual scenario), we can expect a dramatic increase in mortality associated with unmitigated climate change.
The effects on the health sector from these increased health risks will mean greater demand on health-care services, and therefore increased costs. Given the inevitability of a price on carbon, whether it is through an emissions trading scheme or a carbon tax, it is vital to consider the implications of this cost on health-care budgets and therefore its effect on service provision. Hospitals in particular are big users of energy, so increased energy costs will have important implications for this sector. If there are no plans (and there do not seem to be) to include increased energy costs associated with climate change mitigation in the health sector in budget forecasts, does this mean we will face cuts to services or a reduction in quality to make up the shortfall?
There is one easy way to free up some funds that could counter increased demand and costs, and that is through energy efficiency. As the McKinsey cost curve study showed, and the recent ClimateWorks Australia report confirmed, many energy-efficiency measures are cost-positive, that is, they save money. So improving the environmental performance of our hospital and health-care infrastructure (through moderating energy demand and lighting, heating and ventilation efficiencies) could actually save money, and cut emissions at the same time. Reducing the environmental impact of the health sector in other ways is vitally important too - reduction of waste is a particularly key issue, as hospitals and healthcare providers are profligate users of resources and producers of waste. Much of it is toxic, and its careful disposal an important consideration. But many health professionals would agree that, despite the constraints of infection control, there is much that could and should be done to reduce the production of waste from the sector. Other measures to audit (with the airs of reducing) water use are important too. It is time the healthcare sector took seriously its own missive to "do no harm". There is too much harm being done to the environment in the delivery of health care and it must be addressed. So some obligations around environmental performance responsibility in exchange for healthcare dollars might be a way to deliver both health and some modest environmental reforms. At the very least it would send a signal that the Rudd Government understands the complexity of climate policy, and that no single policy will be enough. But introducing a carbon price and creating sectoral obligations that are linked to financing would be a healthy place to start.
There are signs that the health sectors in other countries are beginning to act - Britain's largest NHS Trust has committed to cutting emissions by 10 per cent this year - yes, that's in one year. So far, our Federal Parliament has been unable to get it to commit to even a 5 per cent cut by 2020. Addressing climate change means every sector will have to develop emission reductions strategies, and health care is no different. It's time the sector accepted responsibility for its environmental impact and for the Government to act to ensure health reform brings about better health outcomes. And there may even be political gains - greening health care offers the opportunity for the Government to address both the mess that is the health-care system and demonstrate some sorely needed environmental credentials.
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