prof john agar renal services, university hospital geelong...

ProfJohnAgarRenalServices,UniversityHospitalGeelong

BarwonHealth,Geelong,AustraliaADC–SeaAle:February28th2016

Green‘serious’+Green‘funky’

Atalkin2parts:

First:AjourneythroughClimateChangeandit’spotenOalimplicaOons

–  Atagloballevel–  Atahealthcarelevel–  Atadialysisdeliverylevel

Later:Aglimpseofsome’funstuff’wehavebeendoingataservicelevel–totryto‘makeadifference’

Green‘serious’+Green‘funky’

Atalkin2parts:

First:AjourneythroughClimateChangeandit’spotenOalimplicaOons

–  Atagloballevel–  Atahealthcarelevel–  Atadialysisdeliverylevel

Later:Aglimpseofsome“funstuff’wehavebeendoingataservicelevel–totrytomakeadifference

“Houston:wehaveaproblem…”

•  TheUnitedNaOons(U.N.)IntergovernmentalPanelonClimateChange(IPCC)recentlyreleasedits5threportonthecurrentstateofscienOficknowledgerelevanttoclimatechange

–  Theworkofover1000scienOsts

–  The‘mostcomprehensiveassessmentofclimatechangeever’

•  Its’conclusionswerefrightening

1.  theworldis“unequivocally”warming

2.  humanacOvityis“extremelylikely”tobethedominantcause

•  Moreconcerning,itstatedwith“highconfidence”that:

–  conOnuedunchecked,warmingwouldleadto“severe,pervasiveandirreversibleglobalimpactsforpeopleandecosystems”.

hAp://www.ipcc.ch/report/ar5/wg1/

“Houston:wehaveaproblem…”

•  TheUnitedNaOons(U.N.)IntergovernmentalPanelonClimateChange(IPCC)recentlyreleasedits5threportonthecurrentstateofscienOficknowledgerelevanttoclimatechange

–  Theworkofover1000scienOsts

–  The‘mostcomprehensiveassessmentofclimatechangeever’

•  Its’conclusionswereabitscary

1.  theworldis“unequivocally”warming

2.  humanacOvityis“extremelylikely”tobethedominantcause

•  Moreconcerning,itstatedwith“highconfidence”that:

–  conOnuedunchecked,warmingwouldleadto“severe,pervasiveandirreversibleglobalimpactsforpeopleandecosystems”.


IPCCpredicEonmodels

•  Fourdifferentmodelsweresuggested,eachbasedondifferent21stcenturypathwaysforgreenhousegasandairpollutantemissionsandland-use.

–  ‘best-case’scenarioinvolvingdrasOcreducOonsingreenhousegasemissions,starOngnow

a2°Cglobalrise

Throughto…

–  ‘businessasusual’scenariowithgreenhousegasemissionsconOnuingattheircurrenthighrate

A>4°Cglobalrise


Consequencesofa>4°Cglobaltemperaturerise

•  TheIPCCwarns,withhightoveryhighconfidence,of:

–  increasedheatstress–  morefrequent&severedroughts–  risingsealevels–  coastalandinlandflooding–  stormsurge–  landslides–  oceanacidificaOon–  reducOoninmarinebiodiversity–  exOncOonofa‘largefracOon”ofplantandanimalspecies.




–  increasedheatstress–  morefrequent&severedroughts–  risingsealevels–  coastalandinlandflooding–  stormsurges–  landslides–  oceanacidificaOon–  reducOoninmarinebiodiversity–  exOncOonofa‘largefracOon”ofplantandanimalspecies.




–  increasedheatstress–  morefrequent&severedroughts–  risingsealevels–  coastalandinlandflooding–  stormsurges–  oceanacidificaOon–  reducOoninmarinebiodiversity–  mudslidesandlandslips–  exOncOonofa‘largefracOon”ofplantandanimalspecies.




–  increasedheatstress–  morefrequent&severedroughts–  risingsealevels–  coastalandinlandflooding–  stormsurge–  oceanacidificaOon–  reducOoninmarinebiodiversity–  mudslidesandlandslips–  exOncOonofa‘largefracOon”ofplantandanimalspecies.


Currentglobalwaterstress

Currentglobalheatstress

EarthKicksOff2016WiththeMostAbnormallyWarmMonthEverMeasured

NASA_January_2016_global_temperature.png.CROP.promovar-mediumlarge.png

Australia-heatstress…2013-2014

Further…

– FuturewaterscarcityandreducedagriculturalandfisheryproducOvityareexpected,withmajorimpactsonglobalfoodsecurity

– Onestudyhassuggesteda40%reducOoningloballabourcapacityinsummermonthsduetoheat(1)

– Anotherhaspredicteddisplacementofupto1billionpeople(1in7ontheplanet)-mainlyduetowatershortagesandcoastalandriverineflooding(2)

(1)  DunneJPetal.NatureClimateChange.2013;3:563–6.(2)  hAp://www.chrisOanaid.org.uk/images/human-Ode.pdf.

OpEonsdoremain…

•  TheIPCCtellsusthat:

–  OpOonstotransiOontoalow-carboneconomysEllexist

– MulOplemiOgaOonpathwaysareavailabletolimitwarmingto2°C

–  “Allweneedisthewilltochange..mo3vatedbyknowledgeandunderstandingofthescienceofclimatechange”

RajendraPachauri-ChairoftheIPCC


OpEonsdoremain…

•  TheIPCCtellsusthat:

–  OpOonstotransiOontoalow-carboneconomysOllexist

– MulOplemiOgaOonpathwaysareavailabletolimitwarmingto2°C

–  “Allweneedisthewilltochange..mo8vatedbyknowledgeandunderstandingofthescienceofclimatechange”

RajendraPachauri-ChairoftheIPCC


Healthimpacts

•  WHOesOmates~250,000extradeaths/yrby2030fromchangesto:–  ambienttemperatures–  cleanair–  safedrinkingwater–  sufficientfood–  secureshelter

•  Directhealthcarecostsofthiswillbe~US$4billion/yrby2030

•  Impactsareexpectedtobemostseverefor:–  thedevelopingworld–  theyoung–  theelderly–  thosewithpre-exisOngmedicalcondiOons(i.e.dialysispaOents)

ZarocostasJ.BMJ.2014.349:g5403.

Healthcaresystemsarehugecontributors

•  HealthcaresystemsemitanenormousCO2burden

–  TheUKNHScreates25%ofallpublicsectoremissions(1)

–  8%ofallUSCO2emissionsarisefromhealthcare(1)

•  And…withinhealthcare...

– DialysisprogramscontributedisproporEonately

(1)WHOFactsheet266.hAp://www.who.int/mediacentre/factsheets/fs266/en/

withthisinmind

Twostudies(oneintheUK,oneinAustralia)

havedocumentedtherecurrentpercapitadialysisenvironmentalfootprint

…Oneofthesehasbeenourownstudy

Thecarbonfootprintofhaemodialysis

TheAustralianstudyexaminedtherelaOvecontribuOontothetotalCO2footprintofsuburbansatelliteHDunit…including:

•  procurementofpharmaceuOcals/consumables

•  medicalequipment

•  energyuOlizaOon

•  travelandtransport

•  waterusageandwaste

•  Theannualper-paOentHD-generatedcarbonfootprintwas10.2tonnesCO2-equivalents

•  ThisismorethanhalftheAustralianmeanannualpercapitaCO2emissionesOmateof18.8tonnesCO2-equivalents

LimAE,PerkinsA,andAgarJWM.AustralianHealthReview,2013,37,369–374

Thecarbonfootprintofhaemodialysis

•  AnAustralianstudyhasexaminedtherelaOvecontribuOontothetotalCO2footprintofsuburbansatelliteHDunit…including:

•  procurementofpharmaceuOcals/consumables

•  medicalequipment

•  energyuOlizaOon

•  travelandtransport

•  waterusageandwaste

•  Theannualper-paOentHD-generatedcarbonfootprintwas10.2tonnesCO2-equivalents

•  ThisismorethanhalftheAustralianmeanannualpercapitaCO2emissionesOmateof18.8tonnesCO2-equivalents


CarbonFootprintData(Suburbansatelliteunit–Geelong2012)


Factorseasiesttomodify

andtoreduceoverallcarbon

impact

Asa%oftotaltonnesCO2-equivalents

PubliclyAvailable

SpecificaOon(PAS2050)



SomeHDmachinesmayleavealightercarbonfootprint

Ref:Connoretal:QJM2010.103(12):965-975



Mainlyconsumableswiththemainmodifiable

impactbeingwastedisposal

So…

whatistheenvironmental‘price’ofdialysis

Summary–Australiandata

Water

WaterconsumpOonfora“standard”4hourHDsessionisapproximately500L/Rx

ComparethistotheaverageAustraliandailypercapitadomesEcuseof160L

BarracloughKA,HoltSG,AgarJWM.Nephrology:ClimateChangeandUs(InPress)


Power

Theweeklypowerdrawfor1convenOonal3x4HDRxplustheper-capitaweeklypowerdraw

forROwatertreatmentforthosesessions

Equatesto50%oftheweeklypowerdrawofanaverageAustralian4personhome



Waste

The2.5kgofdialysisconsumablewaste/treatmentyieldsacumulaOve~400kg/person/year

ComparethiswiththemunicipalwastegeneraEonof660kg/Australian/year


So…isitalltoohard?or

ArethereproacEve,miEgaEngsteps?

Inhealthcare,weareverygung-hoatthefrontendofcare

Buttakelihleinterestinthebackendofcare

TheUKGreenNephrologyNetwork

Onecountryisshowingustheway

AsystemaEc,naEon-wideapproach

•  TheUKGreenNephrologyNetworkcomprisesclinicians,renaltechnicians,industrypartnersandpaOents

•  SinceformaOonin2009,thisgrouphastransformedthesustainabilityofUKkidneycare

•  TheyhavedevelopedsystemaOchighqualityresearch

•  TheyhavedevelopedasetofnaOonal“greenguidelines”thathaveledawtudeandpracOcechange

•  Thisincludes:

•  widespreadROwaterrecycling

•  retro-fiwngofheatexchangersintodialysissystems

•  plasOccaprecycling

•  telemedicinetoreducetravel-relatedemissions

AsystemaEc,naEon-wideapproach

•  TheUKGreenNephrologyNetworkcomprisesclinicians,renaltechnicians,industrypartnersandpaOents

•  SinceformaOonin2009,thisgrouphastransformedthesustainabilityofUKkidneycare

•  TheyhavedevelopedsystemaOchighqualitynaOonaleco-research

•  TheyhavedevelopedasetofnaOonal“greenguidelines”thathaveledawtudeandpracOcechange

•  Theseinclude:

•  widespreadandsystemaOcROwaterrecycling

•  retro-fiwngofheatexchangersintoalldialysissystems

•  plasOccapandotherplasOcproductrecycling

•  WidespreaduseofO/Ptelemedicinetoreducetravel-relatedemissions

CourtesyFrancesMorOmer:NHSGreenNephrologyprogram

UKunits‘signedon’toGreenprograms2009-2011

And,since2011

alltheremainingblackdotshavegonegreen

Weshouldalllearnfromthem

hhp://sustainablehealthcare.org.uk/green-nephrology

TheSustainablePhysician..ClinicalMedicine.2010.10(2):110–11

IfyoutakenothingelsefromthistalkpleasereadFrancesMorEmer’sEditorialin:

Weshouldalllearnfromthem

hhp://sustainablehealthcare.org.uk/green-nephrology

TheSustainablePhysician..ClinicalMedicine.2010.10(2):110–11

IfyoutakenothingelsefromthistalkpleasereadFrancesMorEmer’sbriefeditorialin:

InAustralia

•  VisitthefreewebsitebuiltbyourGeelongRenalService

www.greendialysis.org

– Oursiteoffersa‘greenguide’foralldialysisservices

–  Itdetailsarangeof‘howtodo’and‘howtosetup’greeneropOonscovering…

– WaterconservaEonpracEces

–  AlternaEveenergyopEons

– Wasterecyclingprograms

AgarJWM:hAp://www.greendialysis.org

InAustralia

•  VisitthefreewebsitebuiltbyourGeelongRenalService

www.greendialysis.org

– Oursiteoffersa‘greenguide’foralldialysisservices

–  Itprovidesarangeof‘howtodo’and‘howtosetup’greenopEonsthatcover…

– WaterconservaEonpracEces

–  AlternaEveenergyopEons

– Wasterecyclingprograms

AgarJWM:hAp://www.greendialysis.org

InEurope

TheEDTNAEnvironmentalGuidelinesforDialysis

•  ThecombinedEuropeandialysisnurse,technician,andindustryassociaOons(theEDTNA:ERA)haveproduced:

–  Acomprehensivehandbookfor‘goinggreenindialysis’

–  ItcontainscurrentandhighqualityguidelinesandpracOcalhintstoreducetheenvironmentalburdenofdialysis

KastlandPancirova.EnvironmentalGuidelinesforDialysisAvailableat:hAp://www.edtnaerca.org/

ItsEmetogetsmart

Wedon’tneedashoephone

ItsEmetogetsmart

Wedon’tneedashoephone Weneedto…

It’sacaseof…

So

Letushaveashortbreak

beforeItalkabout

*AgarJWM.SeminarsinDialysis.2015.28(2).186-192

prof john agar renal services, university hospital geelong...

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