Dissolving the silos between asset and outcomes in healthcare

Given the urgency of acting on emissions and the availability of means to do so, it is frustrating that in so many cases, effective sustainability strategy and implementation gets derailed by siloed thinking or stalled by a perceived gap between stakeholder groups. For example, the oft-cited ‘split incentive’ disconnect between asset developers/owners and occupants, or the chasm between Paris Accord targets and practices in the business world.

Silos have been counterproductive in our collective efforts to protect the wellbeing of humanity on this planet. However, there is a shift in the air, and the recent Australian Federal Government National Health and Climate Strategy appears to be an excellent example of finally connecting the dots. It lays out a roadmap that is both good for the health of the economy, and good for the economy of health.

Right up front, it explains the fundamental interconnectedness of everything, with a “Health in All Policies perspective, recognising that collaboration across different policy areas is crucial to the development of just and equitable responses to address the impact of climate change on health. Good climate policy is good public health policy. Emission reduction across all sectors is necessary to reduce the impact of climate change on our health and wellbeing.”

What this means in practice is climate change mitigation and adaptation is everybody’s business, but it is particularly crucial for the health sector and the sector’s many operators, asset owners and asset managers. From state government agencies through to private hospital portfolios, aged care operators and investment funds that sink capital into the sector, the message is clear – if we want the sector to fulfil its purpose of keeping people healthy and we also want the sector to remain financially and operationally viable as climate impacts on health continue to escalate, action is needed.

Transitioning to net zero healthcare

The strategy sets out very clear areas of focus – including transitioning all existing health sector property to energy-efficient, all-electric and net zero operations. This has multiple benefits including reducing cost risks due to gas pricing shifts; reducing overall operational costs through avoided energy spend; improving climate event resilience where energy efficiency measures address passive performance; and reducing the sector’s contribution to pollution and further escalation of climate change.

The strategy also includes a focus on decarbonising other aspects of health services provision including transport, the medical supply chain, catering and waste.

These are all things the Climate and Health Alliance (CAHA) have been advocating around for some time, and it is in part thanks to the hard work put in by organisations like CAHA that the strategy even exists.

The breakthrough in the strategy is it goes the next step beyond the individual facility or health service, to break down the silos through clarity of purpose around addressing the specific needs of the most vulnerable in the community, including low-income persons, aged persons, First Nations persons and people with disability. The effects of extreme heat and other climate events are more lethal for those with pre-existing health conditions or those with low incomes and restricted access to climate-safe accommodation.

A lot of the effort around sustainability in the built environment has in some ways focused on those with the most significant resources such as the premium commercial office sector and the commercial tenant workforce. But as the impacts become more apparent, it is places like the residential areas of Western Sydney, or regional centres located hundreds of kilometres away from cooling ocean breezes where the health toll is most acute.

Mapping the threat landscape

Another aspect of the strategy that we hope will percolate across to other sectors is the proposal that all health services should undertake climate risk analysis for their facilities and operations and adaptation planning that responds to those risks.

Again, this is a path less travelled for the majority of communities aside from two areas – bushfire risk and flooding/sea level rise. Other climate impacts such as heatwave risk, air pollution impacts, hail and local flash flooding remain largely unmapped in terms of public information.

Making homes safe places to be

But it is perhaps the final focus area that should have everyone on the property sector paying close attention. The role of housing in providing safe shelter is - on paper - obvious. But much of Australia’s current housing stock is not fit for purpose to protect occupants during a heatwave. As part of the strategy, the government will promote the benefits of climate-adapted housing and have input around this to the National Housing and Homelessness plan and the National Construction Code.

From our perspective, if this results in changes to the code and to industry practices that result in highly efficient dwellings that can operate at net zero and protect occupants during extreme heat events even if the power grid fails, that will be a win. It will be an even greater win if there is meaningful and effective action to uplift the performance of the ‘glorified tents’ so many renters are paying increasingly astronomical rents for.

Just as we expect investment funds to consider the wellbeing of occupants and be responsible about transitioning their buildings to net zero, we equally could expect the same of residential investment property owners.

All hands on deck

None of this will happen overnight, and indeed there is a significant need for capacity building in terms of the skilled workforce and the supply chain to deliver the outcomes the strategy aims to achieve. It is also positive to see a commitment to investing in research around climate and health as an enabler for implementing the strategy. This should begin to address some of the knowledge gaps or evidence gaps that can otherwise be used as excuses for inaction.

The role of science in laying the foundations for a sustainability business case has been seen in momentum around transitioning the energy grid to renewables, incorporating trees and green space in urban planning, and basic public health and wellbeing measures such as improving ventilation in workplaces and schools.

There is currently very little research-based evidence available on strategies for protecting the health and wellbeing of the community from extreme heat. For example, we lack accessible data on the impacts of heatwaves on specific health conditions such as diabetes, and there is little research-backed insight on the role of building performance in practical preventative health strategies to protect people with these kinds of chronic diseases. Having credible information will be an asset in further discussions around both uplifts to planning and construction codes and programs to support retrofits at scale across the health sector, education sector, residential, civic buildings and retail.

This is a very well-thought out and considered strategy, and it takes the all-important first step of putting the whole built environment sector on the same page. In many ways, it is a quantum leap because none of us can say ‘oh, that’s not my problem’ – instead we can all see that climate adaptation and mitigation is an opportunity for all of us to do better so that everyone can live healthy lives. For those interested in the healthcare sector, working in it or investing in it, the strategy is well worth reading – you can access all the key documents here.