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Junior Research Group “Climate-smart health systems”

The junior research group “Climate-smart health systems” is part of the research group “Climate Change, Nutrition and Health”.

Impacts of climate change pose a great threat to global health, while climate change mitigation offers great health opportunities . Therefore, health systems, defined as “all the activities whose primary purpose is to promote, restore or maintain health” need to be fit to integrate climate change adaptation and mitigation into all their core functions.  This junior research group is investigating new approaches for climate-smart health care with a particular focus on climate-sensitive health counseling, reducing greenhouse gas emissions in hospitals and climate change and health trainings for the health workforce.

Background

Climate change poses a great threat to human health, for instance by increasing extreme weather events, changing patterns of infectious diseases and allergies or adversely impacting mental health. Therefore, health systems, defined as “all the activities whose primary purpose is to promote, restore or maintain health” need to adapt to those challenges in their various functions. While climate change adaptation is necessary to manage the unavoidable, climate change mitigation is necessary to avoid the unmanageable. This is also true for health systems: The health care sector produces around 5% of global greenhouse gas emissions. Thus, it is necessary to decarbonize the health sector. On the other hand, individual lifestyles are responsible for both greenhouse gas emission and ill health, particularly with regard to food and mobility patterns. Therefore, promoting plant-based diets and active mobility (walking, biking) can both promote health and mitigate climate change (so called co-benefits). This research groups takes new approaches to address these aspects of climate change adaptation and mitigation in health systems.

Projects

Climate-sensitive health counseling.

Doctors have been identified as key players in steering a transformation towards more sustainable and carbon-neutral society. However, so far there is hardly any research about climate-sensitive health counselling in the clinical setting. Boland et al. have found that primary care physicians in the USA felt rather uneasy about addressing climate change in patient contacts, which they interpreted to be due to a lack of guidelines and specific trainings in this area. Kotcher et al. found in a recent international survey among physicians that 69% wish for training to communicate effectively about climate change and health. Yet, major research gaps exist in how to conduct CHC, and particularly in testing the efficacy, let alone the effectiveness, of such counselling strategies in terms of health and climate change mitigation outcomes.

The Climate Sensitive Health Counseling (CSHC) Project empirically investigates the phenomenon of and potential for CSHC in a sequential mixed-methods design. Currently a scoping literature review and qualitative semi-structured interviews with physicians, who conduct CSHC, and with patients, who took part in CSHC are conducted. This ongoing research generates hypothesis about the aims, the themes and the techniques of CSHC. These findings will be corroborated in a quantitative survey based on the HeReCa-Panel, a large online-based panel with participants from all over Germany, led by the University Hospital Halle. The survey will quantify which themes and communication methods are most promising to meet the interests and needs of the general population. The results will be triangulated with the qualitative findings and the scoping review in order to construct an evidence-based concept of CSHC.

 

ClimMedEd: Climate Change in Medical Education

To integrate knowledge and skills for climate change mitigation and adaptation into the education of the health workforce is an obvious building block for climate-smart health systems. However, Omrani et al. showed that only 15% of the surveyed medical schools addressed the topic of climate change and health in their curricula. Although concepts on how to integrate climate change and broader environmental issues into medical education are just advancing, little research on how and what should be taught has been conducted so far. Thus, one arm of this project assesses current medical students knowledge, role perceptions and teaching preference of Heidelberg medical students.

The other arm evaluates an CME-certified online course on “Climate Change – What is new for patient care?” (CME= continued medical education, obligatory training scheme for practicing physicians). This 20-hour course is teaching climate change and health aspects to medical doctors in collaboration with “Ärztekammer Nordrhein” ans “Université de Paris”. The evaluation will investigate the possible change of intentions to implement climate-smart health care based on the Theory of planned Behaviour in a  pre/post test design.

 

The KliOL-Project (“Klimaschutz an Kliniken durch Optimierung von Lieferketten”)

About two thirds of greenhouse gas emission of the health sector stem from so-called Scope 3 emissions, emissions form the supply chain including pharmaceutical products,  medical products, disposal of all those and mobility to and from health care services to only name the most important sources . A multi-stage literature and internet search identified only 62 hospitals and two clinic companies for Germany that record and publish their greenhouse gas emissions, which corresponds to about 12% of all hospitals in Germany. None of the hospitals or clinic companies recorded Scope 3 emissions, and also internationally the evidnce is scarce. Futhermore, little is known about the way to reduce hospital emissions and what barriers and facilitators need to be considered on the way. Thus RQ 4 focuses on how health care facilities can reduce their carbon footprint particularly in Scope 3.

To do so the KliOL-Project calculates greenhouse gas emissions generated at Heidelberg University Hospital together with ifeu (Institut für Energie- und Umweltforschung). The project particularly focuses on Scope 3 emissions, which consider supply chains, such as pharmaceuticals, medical products, catering and also mobility of patients and employees. In addition, exemplary measures that reduce greenhouse gases and improve health will be implemented and evaluated.

Past projects

HOPE-Project

The HOPE project investigated the role of health-co benefits in individual decisions about climate-friendly lifestyles in Germany, France, Norway and Sweden. Quantitative results showed, that information on health co-benefits of climate change mitigation measures made participants more willing to implement mitigation measures in the food, but not in the mobility sector. Qualitative results suggested, that participants were lacking some of the information on health co-benefits of the food sector, such as the health co-benefits of a largely plant-based diet .