RESEARCH GROUP “CLIMATE-SMART HEALTH SYSTEMS”

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.

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.

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.

Climate change is one of the greatest challenges of the 21^st century and poses various threats to human health through increased flooding and prolonged heat waves and pollen seasons.  Adapting to these changes provides a challenge for the health sector. The care of and adaptation to climate-related health risks, especially amongst vulnerable population groups such as the elderly or people with pre-existing diseases has hardly been an area of focus in GP and specialist medical practice.

Therefore, the AdaptNet project aims to develop and implement a program to adapt specialist and GP practices in the Nuremberg region to climate change. To this end, the project aims to (1) study the health effects of climate change in the urban Nuremberg region and (2) develop a ‘climate toolbox’. This is expected to consist of a basic course on climate change and health for health professionals, a pre-summer medicine check-up as preparation for heat waves, emergency plans for GPs and medical specialists for extreme weather events, and information handouts for patients. The ‘climate toolbox’ will be developed based on results from part (1) and a survey among GPs and medical specialists and their patients in the Nuremberg region. Once developed, the ‘climate toolbox’ will be implemented in practices, refined, and its acceptance and usability evaluated. GPs, specialists, and their patients will be closely involved in the entire process. The aim is to develop a guide to transfer this ‘climate toolbox’ to GP and specialist practices in other parts of Germany and to contribute to the adaptation to and care of climate-sensitive health risks.

The project is funded by the “Innovationsausschuss” of the “Gemeinsamer Bundesausschuss (G-BA)” for three years with about 1.2 million euros. Consortium partners are the University Augsburg, the University Hospital Erlangen, the ‘Gesundheitsnetz Qualität und Effizienz eG’, AOK Bayern, and Heidelberg University Hospitals.

For more information: https://innovationsfonds.g-ba.de/projekte/versorgungsforschung/adaptnet-adaptation-und-vernetzung-der-haus-und-fachaerztlichen-versorgung-im-hinblick-auf-die-gesundheitlichen-auswirkungen-des-klimawandels.55

Although highly relevant, climate change-induced risks to health and well-being is still significantly underrepresented within the medical education. This pilot project aims to elaborate and implement a curriculum for planetary health for future physicians in order to educate them in the interactions of climate change and (public) health. Therefore, cross linked to the clinical modules, suitable topics of climate change and health will be incorporated in existing, compulsory lectures and POL- seminars. Through PlaN-Med, medical student should be sensitized not only for reinforcing climate change-induced risks to health and well-being, but also understand their responsibility and important position as an future health advocate with then competence in appropriate mitigation and adaptation strategies to climate change.

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 .