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Flashcards in Sustainability and Occupational Health Deck (30)
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1
Q

What is the definition of sustainability?

A

Able to continue over a period of time

2
Q

What are the 3 levels of sustainability that relate to healthcare?

A

Global sustainability

Sustainability of the NHS

Personal and career sustainability

3
Q

Give 6 reasons why global sustainability is important to healthcare

A

Material inequality

Population and consumption

Resource depletion

Climate change

Loss of biodiversity

Crisis in healthcare

4
Q

Why is material inequality important to healthcare?

A

World’s wealthy are getting richer while at least half the world’s population live on less than £1.30/day.

The UN estimated in 1998 that the Millennium Goal of basic education for all could be attained by additional global investment of £3.8 billion; in 1998 in USA £5 billion was spent on cosmetics, Europe spent £6.9 billion on ice cream

5
Q

Why is population and consumption important to healthcare?

A

The world population is growing. In 2011 it was 7 billion, it is estimated to reach 9 billion by 2040.

More people means the need for more space, energy, food and water.

This is made worse by the fact that people in the developing world aspire to what the developed has by way of material goods and food.

6
Q

Why is resource depletion important to healthcare?

A

By 2005 it was estimated we had consumed half of the earth’s extractable reserves of oil and gas and that they are likely to be completely depleted by the end of the 21st century.

Water also becoming more scarce.

We will be more dependant on alternative sources of energy in the future e.g. nuclear power, shale oil, fracking

7
Q

Why is climate change important to healthcare?

A

Evidence from climate science is now strongly indicative that the world is getting warmer and that it is largely being caused by humans.

We have increased carbon dioxide in the atmosphere by burning fossil fuels and deforestation, methane by increasing our agriculture from plants to animals and by so doing increased greenhouse gases ( carbon dioxide, methane, nitrous oxide , and ozone).

We need greenhouse gases to provide a protective earth ‘cloud’ ,preventing wide ranges in temperature and maintaining air temperature at around 150 but we have oroduced the greenhouse effect by a change in the gas concentrations.

This impacts on food production due to regional floods and droughts, changes the environment with regards incidence of infectious disease eg risk of malaria , deaths from heat waves and droughts and leads to changes in human migration from affected areas.

Climate change will affect all countries, but will have the greatest impact on those who have the least access to the world’s resources and who have contributed least to carbon emissions.

8
Q

Why is there a loss of biodiversity?

A

There is an increased rate of animal extinction due to depletion of areas of habitat

9
Q

Why is there a crisis in healthcare?

A

There is a crisis in chronic health problems with increasing ageing population, increase in chronic diseases such as diabetes and increase in obesity.

There is a crisis in the cost of healthcare in developed countries is ever spiralling eg USA spent 17.4% GDP on health compared with 9% in Europe (2010) and these figures are increasing, unfortunately there is no evidence that spending more on healthcare actually improves health.

There is a crisis in healthcare use of energy eg 3% of the carbon footprint ( measure of greenhouse gases emitted through burning fossil fuels, always converted into carbon equivalent ) in England is due to NHS related activity.

10
Q

Give some actions that can be taken to combat climate change

A

Increase use of renewable energy resources (that is any natural energy resource that can be replenished with the passage of time)

Modifying human behaviour, being more active.

Move back to more plant based diet

Educate on carbon literacy and numeracy

Promote patient resilience

Teach healthcare students that as well as human anatomical systems we are also part of a wider ecological system

11
Q

We strive for Low Carbon Clinical Care and NHS sustainability.

What things can be done as part of this?

A

Prioritise Environmental Health

Substitute harmful chemicals with safer alternatives. Reduce and safely dispose of waste

Use energy efficiently and switch to renewable energy. Reduce water consumption

Improve travel strategies

Purchase and serve sustainably grown food

Safely manage and dispose of pharmaceuticals

Adopt greener building design and construction. Purchase safer more sustainable products

12
Q

How much short term reduction in emissions is technically feasible in the NHS without compromising standards of care?

A

40%

13
Q

Explain the NHS carbon reduction strategy

A

Based on national targets set by the Climate Change Act 2008.

Commits the health service to more than 80% reduction in emissions over the next 30 years.

So the health sector will be forced to reduce its carbon emissions.

The greatest part of carbon emission from NHS England is from purchasing of goods and services, 22% is from purchase of pharmaceuticals.

Sustainability is not just about more efficient use of energy in buildings but also of equipment and consumables.

14
Q

What would low carbon clinical care look like?

A

Be better at preventing conditions

Give greater responsibility to patients in manageing their health

Be leaner in service design and delivery

Use the lowest carbon technologies

15
Q

How can we better prevent conditions?

A

On World Health Day 2008, the director of WHO, Margaret Chan, forecast an increase in deaths worldwide from malnutrition, diarrhoea and infectious disease attributable to climate change.

Specialities should aim to tackle underlying causes of disease ; the social, economic and environmental determinants of health.

Make effective contraception more widely and easily available worldwide to help reduce the financial, social and environmental effects of unwanted pregnancies. Increasing access to clean water, proper sanitation and education on hygiene techniques such as hand washing.

16
Q

What do we mean by giving greater responsibility to patients in managing their health?

A

Give greater responsibility to patients in managing their health. Many patients could be empowered to take on greater role in the management of their health and healthcare. For example the use of information prescriptions instead of medication prescription by an East London GP practice.

17
Q

How can the NHS be leaner in service design?

A

Be leaner in service design and delivery e.g. combine clinics for diabetes, cardiovascular and stroke, use ‘lean’ principles to eliminate duplication and poorly targeted investigations.

Reduce the number of steps in patient pathway of referral to treatment by channelling patients from the clinic direct to pre assessment, reducing their journey time.

Greater use of online records, email and telephone can reduce travel emissions by moving information in place of patients, staff and lab samples.

More effective prescribing remembering pharmaceuticals comprise a fifth of carbon emissions from NHS England.

Disposing of the unused drugs has a marked environmental impact considering some reported figures of almost 50% non compliance

18
Q

How can the NHS use the lowest carbon technologies?

A

Use the lowest carbon technologies.

Inclusion of sustainability measures in the evaluation of medical technologies will allow service planners, clinicians and patients to choose clinically effective treatments with the best environmental profile and will encourage further development eg green nephrology project provides a model of sustainability. It has looked at dialysis water recycling, heat exchangers, reduction in packaging and virtual clinics

19
Q

It has now been suggested that we should remodel the WHO definition of “what is health” proposed in 1946.

What is the WHO definition of health and what is the new suggested definition?

A

A complete state of physical, mental and social wellbeing and not merely the absence of disease

Resilience, adaptation and self management in the face of physical, social and emotional challenges

20
Q

What is the definition of resilience?

A

Quickly return to a previous good condition

21
Q

What are the positive factors to sustain a career in medicine?

A

Job Security

Financial Security

Stable Terms and Conditions

Respect for Professionalism and Knowledge.

Appreciation for being in the role of a doctor.

Working with a team over time.

Ability to develop knowledge and interests.

Ability to fit work around interests and lifestyle choices.

22
Q

What are the challenges to sustaining a career in medicine?

A

Considerable and rapid workload – for example 10 minute appointments

Time management.

Increasingly complex care over time.

Relentless arrival of mail and blood results, and having enough time to action them diligently.

Care versus cure - long term conditions

Perhaps running a business over time.

Need to ensure the team is harmonious and effective.

23
Q

What is an occupational history?

A

an occupational and environmental history is a chronological list of all the patient’s employment with the intention of determining whether work has caused ill health, excacerbated and existing health problem or has ill health had an impact on the patients capacity to work

24
Q

What is included in an occupational history?

A

A description of the present and previous jobs from leaving school.

Identifying any exposure to chemicals or other hazards (may need to see confirmation from labels)

Did the symptoms improve when not exposed (e.g. at weekends, holidays?)

Determine the duration and intensity of exposure (e.g. was it so noisy it was impossible to communicate)

Is personal protection used (e.g. what kind of mask?)

What maintenance is in place for the protection measures?

Do others suffer similar symptoms?

Are there known environmental hazards in use?

Any hobbies, pets, worked overseas, moonlighting?

25
Q

What is a Fit Note?

A

Replaced the “sick note” in April 2010

It’s purpose is to facilitate earlier discussion about returning to work and about rehabilitation.

It now includes items of consideration for employers when signing a patient’s return to work such as to include a phased return, adjusted hours, adaptations to the work place and/or amendments of duties.

It can only be completed by a Doctor, it is advice to patients as employees, is not binding on the employer and does not affect Statutory Sick Pay.

It is required if the patient has been off more than 7 consecutive days ( including non working days):

26
Q

What are occupational health specialists role in occupational illness?

A

Ideally and uniquely placed to support and help people stay in work and live full and healthy lives

They play a key role in ensuring the health and well being of the working population by preventing work related ill health and providing specialist rehabilitation advice

They provide independent, impartial advice to employers and employees on the effects of work on health and the effects of health on work

27
Q

What do occupational health services do?

A

Help prevent work-related ill health

Advise on fitness for work, workplace safety, the prevention of occupational injuries and disease

Recommend appropriate adjustments in the workplace to help people stay in work

Improve the attendance and performance of the workforce – for example by assisting in the management of sickness absence

Provide rehabilitation to help people return to work, and give advice on alternative suitable work for people with health problems

Promote health in the workplace and healthy lifestyles

Recommend and implement appropriate policies to maintain a safe and healthy workplace

Conduct research into work related health issues

Ensure compliance with health and safety regulations including minimising and eliminating workplace hazards

Advise on medical health and ill-health retirement

28
Q

What is the effect of work on health?

A

The generally accepted theoretical framework about work and well-being is based on extensive background evidence:

Employment is generally the most important means of obtaining adequate economic resources, which are essential for material well-being and full participation in today’s society;

Work meets important psychosocial needs in societies where employment is the norm;

Work is central to individual identity, social roles and social status;

Employment and socio-economic status are the main drivers of social gradients in physical and mental health and mortality;

Various physical and psychosocial aspects of work can also be hazards and pose a risk to health.

29
Q

What is the effect of unemployment on health?

A

Conversely, there is a strong association between worklessness and poor health.

This may be partly a health selection effect, but it is also to a large extent cause and effect.

There is strong evidence that unemployment is generally harmful to health, including:
higher mortality;
poorer general health, long-standing illness, limiting longstanding illness;
poorer mental health, psychological distress, minor psychological/psychiatric morbidity; higher medical consultation, medication consumption and hospital admission rates.

30
Q

What is the effect of re-employment on health?

A

There is strong evidence that re-employment leads to improved self-esteem, improved general and mental health, and reduced psychological distress and minor psychiatric morbidity.

The magnitude of this improvement is more or less comparable to the adverse effects of job loss.