Observatory on the Future of Healthcare
The Observatory on the Future of Healthcare (OFOH) is located at the Australian Institute of Health Innovation.
OFOH members
Leads
Professor Jeffrey Braithwaite |
Professor Yvonne Zurynski |
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For enquiries, contact Dr K-lynn Smith at klynn.smith@mq.edu.au
Introduction
Healthcare systems have a bi-directional problem with climate change. Healthcare contributes substantial emissions and is also on the front lines of caring from those affected by climate change.
Climate change negatively impacts human health through exposure to climate-related events, such as hurricanes, heatwaves, floods, and droughts, and through the creeping, ubiquitous intrusion of infectious and vector-borne diseases. It exacerbates chronic conditions, such as cardiovascular disease and respiratory illnesses and increases the incidence of climate-related disorders, such as heat stroke.
The damage extends beyond physical health causing anxiety, depression, and for many, existential dread. One in eight people across the world have some sort of mental ill-health, to which climate change is increasingly contributing.
This cacophony of problems exposes the bi-directional problem: every episode of healthcare produces greenhouse gas (GHG) emissions, which contributes to climate change and potentially damages human health, thereby increasing healthcare system usage. If healthcare were a country, it would be the fifth largest contributor of the global GHG burden, at ~4.4 % of all emissions.
This research program aims is to contribute to the development of a low-carbon, climate-resilient healthcare system—one that is affordable, cost-effective, and delivers improved health outcomes for all, while limiting its contribution to climate change.
OFOH produces best practice studies, systematic reviews and authoritative, evidence-based solutions to the many challenges.
Decarbonising healthcare systems: The way forward
Healthcare systems worldwide contribute approximately 4.4% of all greenhouse gas emissions.
Public and private hospitals, pharmaceuticals, and physicians and clinical services account for much of the emissions that healthcare systems directly have control over. Knowing the source of emissions is not enough; research is urgently needed into designing implementable interventions to decarbonise healthcare systems while maintaining the quality and safety of healthcare. These interventions must be evaluated to ensure health systems are meeting the goal of ‘net zero’ emissions.
Below are some of our research areas.
The 60:30:10 challenge: Reducing low-value care to lower healthcare’s carbon footprintIt has been estimated that 30% of all healthcare provides little to no benefit to the patient. This includes repeated pathology tests, unwarranted surgeries, overtreatment of conditions, and over prescribing of pharmaceuticals. This waste not only costs the system financially, but it also contributes substantially to the carbon footprint of healthcare systems. Our research focuses on ways to reduce unwarranted variation in care to improve the sustainability of healthcare systems.
Examples of publications: Braithwaite J, Glasziou P, Westbrook J. The three numbers you need to know about healthcare: the 60-30-10 challenge. BMC Medicine. 2020;18:102. https://doi.org/10.1186/s12916-020-01563-4 Buchbinder B, Harris I, O’Connor D. What is overtreatment and why is it a problem? In J. Braithwaite, Y. Zurynski, C.L. Smith (eds). The Routledge Handbook of Climate Change and Health System Sustainability. Routledge (pp 383-396); in press. Smith CL, Quain A, Page SW. Antimicrobial use and antimicrobial resistance in people and animals and its potential impacts on planetary health. In J. Braithwaite, Y. Zurynski, C.L. Smith (eds). The Routledge Handbook of Climate Change and Health System Sustainability. Routledge (pp 57-68); in press. |
How do we get the evidence for low-carbon healthcare systems into practice?It is not sufficient to identify high-emission areas in health systems. Real system change is urgently needed, and everyone has a role to play, including clinicians, health consumers, policy makers, health administrators, allied health professionals, and IT system designers. Our research seeks to work across health sectors to create sustainable change. Examples of publications: Braithwaite J, Pichumani A, Crowley P. Tackling climate change: the pivotal role of clinicians. BMJ.2023; 382:e076963. https://doi.org/10.1136/bmj-2023-076963 Smith CL, Zurynski Y, Braithwaite J. We can’t mitigate what we don’t monitor: using informatics to measure and improve healthcare systems’ climate impact and environmental footprint. Journal of the American Medical Informatics Association. 2022;29:2168-73. https://doi.org/10.1093/jamia/ocac113 |
Digital health: Measuring, monitoring, and mitigating using AI, Big Data, and informaticsThis research aims to respond to the health impact of climate change using digital technology. Managing data during health crises can be complex; digital health is a central solution to enable healthcare systems to respond efficiently. Examples of publications: Coiera E, Magrabi F. What did you do to avoid the climate disaster? A call to arms for health informatics. Journal of the American Medical Informatics Association. 2022;29:1997-9. https://doi.org/10.1093/jamia/ocac185 Rahimi-Ardabili H, Magrabi F, Coiera E. Digital health for climate change mitigation and response: a scoping review. Journal of the American Medical Informatics Association. 2022;29:2140-52. https://doi.org/10.1093/jamia/ocac134 Rahimi-Ardabili H, Magrabi F, Coiera E. Digital health solutions to climate change challenges. In J. Braithwaite, Y. Zurynski, C.L. Smith (eds). The Routledge Handbook of Climate Change and Health System Sustainability. Routledge (pp 233-246); in press |
Integrated healthcare systems: Improving outcomes for patients and the planetIntegrated care has the potential to enable people to be more in control of their health and wellbeing and to support self‑care solutions and preventative action that reduce the need to consume healthcare resources. Care integration—by delivering the right care, in the right place, at the right time, at the right cost—creates a better user experience and a more efficient journey through the care system. Examples of publications: Zurynski Y, Goodwin N, Wijekulasuriya S. It’s not what you do, it’s the way that you do it: Reducing the carbon footprint of healthcare through models of integrated care. In J. Braithwaite, Y. Zurynski, C.L. Smith (eds). The Routledge Handbook of Climate Change and Health System Sustainability. Routledge (pp 295-305); in press. Zurynski Y, Vedovi A, Smith C. Social prescribing: a rapid literature review to inform primary care policy in Australia. Consumers Health Forum of Australia; 2020 2020/02/10. |
Creating climate-resilient healthcare systems: What must we do?
Future proofing healthcare systems against climate change and pandemicsLearning healthcare systems (LHS) are health systems that are effective at learning, can use data well, and skilfully embed knowledge into daily clinical practice and decision making of both health providers and patients. The concept was first advanced by the US National Academies of Medicine (previously the Institute of Medicine) in 2007. While many health systems have begun their journey to becoming an LHS, there is still much to do. And there is little time. Climate change and new infectious diseases, such as COVID-19, are placing increasing strain on already stretched health systems. This research seeks to answer the pressing questions: How can healthcare organisations be strategically enabled to become next-generation Learning Health Systems (LHS2.0)? Examples of publications: Braithwaite J, Dammery G, Spanos S, Smith CL, Ellis LA, Churruca K, Fisher G, Zurynski Y. Learning Health Systems 2.0: Future-proofing healthcare against pandemics and Climate Change. A White Paper. Macquarie University. Braithwaite J, Ellis LA, Fisher G, Smith CL, Zurynski Y. Is the Learning Health System 2.0 (LHS 2.0) a solution to healthcare’s climate challenges? In J. Braithwaite, Y. Zurynski, C.L. Smith (eds). The Routledge Handbook of Climate Change and Health System Sustainability. Routledge (pp. 260-270); in press. Braithwaite J, Tran Y, Ellis LA, Westbrook J. The 40 health systems, COVID-19 (40HS, C-19) study. International Journal for Quality in Health Care. 2020;33:1-7. https://doi.org/10.1093/intqhc/mzaa113 Braithwaite J, Zurynski Y, Smith CL, editors. The Routledge Handbook of Climate Change and Health System Sustainability. Routledge. 2024;in press. Clay-Williams R, Rapport F, Braithwaite J. The Australian health system response to COVID-19 from a resilient health care perspective: what have we learned? Public Health Research & Practice 2020;30:1-6. Coiera E, Braithwaite J. Turbulence health systems: engineering a rapidly adaptive health system for times of crisis. BMJ Health & Care Informatics. 2021; 28:e100363. https://doi.org/10.1136/bmjhci-2021-100363 Dammery G, Ellis LA, Churruca K, Mahadeva J, Lopez D, Carrigan A, Halim N, Willcock S, Braithwaite J. The journey to a learning health system in primary care: a qualitative case study utilising an embedded research approach. BMC Primary Care. 2023;24 Pomare C, Mahmoud Z, Vedovi A, Ellis LA, Knaggs G, Smith CL, Zurynski Y, Braithwaite J. Learning health systems: a review of key topic areas and bibliometric trends. Learning Health Systems. 2022:e10265. Smaggus A, Long JC, Ellis LA, Clay-Williams R, Braithwaite J. Government actions and their relation to resilience in healthcare during the COVID-19 pandemic in New South Wales, Australia and Ontario, Canada. International Journal of Health Policy and Management. 2021. Smith CL, Dammery D. Learning healthcare systems: How to improve health system sustainability in the era of climate change. In J. Braithwaite, Y. Zurynski, C.L. Smith (eds). The Routledge Handbook of Climate Change and Health System Sustainability. Routledge (pp. 247-259); in press. Smith CL, Fisher G, Dharmayani PNA, Wijekulasuriya S, Ellis LA, Spanos S, Dammery G, Zurynski Y, Braithwaite J. Progress with the Learning Health System 2.0: a rapid review of Learning Health Systems’ responses to pandemics and climate change. BMC Medicine. 2024;in press. Zurynski Y, Smith C, Vedovi A, Ellis LA, Gul H, Braithwaite J. Diversity of scale and context of implemented learning healthcare systems: a narrative literature review Cochrane Database of Systematic Reviews. 2020;9:1. Zurynski Y, Smith C, Vedovi A, Ellis LA, Gul H, Braithwaite J. The role of health consumers in learning health systems: scoping the literature Cochrane Database of Systematic Reviews. 2020;9:1. Zurynski Y, Smith C, Vedovi A, Ellis LA, Knaggs G, Meulenbroeks I, Warwick M, Gul H, Pomare C, Braithwaite J. Mapping the learning health system: a scoping review of current evidence. A white paper. Partnership Centre for Health System Sustainability; 2020 2020/11/10. |
Creating a future-ready health workforceA skilled and capable workforce with capacity to mount rapid response is essential to ensure ongoing health system performance as we enter the era of “global boiling” and climate related events such as heatwaves, floods, and hurricanes become more frequent. The impacts of climate change, however, are compounded by an already stretched health workforce. The WHO estimates a shortfall of at least 15 million healthcare workers by 2030 and the Lancet Global Health recently raised alarm over the emigration of health workers from countries with some of the lowest health-care workforce densities. What needs to be done to prepare and protect the health workforce of the future? Publication: Zurynski Y, Fisher G, Wijekulasuriya S, Leask E, Dharmayani PNA, Ellis LA, Smith CL, Braithwaite J. Bolstering health systems to cope with the impacts of climate change events: a review of the evidence on workforce planning, upskilling, and capacity building. International Journal of Health Planning and Management. 2024; 1-25. https://doi.org/10.1002/hpm.3769 |
Mobilising implementation science to tackle the impacts of pandemics and climate changeImplementation science is study of methods and strategies that facilitate the uptake of evidence-based practice and research into clinical practice and policy decision-making. The goal is to close the gap between the generation of knowledge and its application. This is particularly important given the urgency of change needed by health systems to prepare for current and future pandemics and the increasing frequency of climate-related events. Examples of publications: Braithwaite J, Ludlow K, Churruca K, James W, Herkes J, McPherson E, Ellis Louise A, Long Janet C. Systems transformation: learning from change in 60 countries. Journal of Health Organization and Management. 2020;34:237-53 Churruca K, Ludlow K, Taylor N, Long JC, Best S, Braithwaite J. The time has come: embedded implementation research for health care improvement. Journal of Evaluation in Clinical Practice. 2019;25:373-80. Rapport F, Clay-Williams R, Braithwaite J, editors. Implementation Science: The Key Concepts. 1st ed. London: Routledge; 2022. |
Mental health in the era of climate change and pandemicsThe world is changing fast; so fast that many people are increasingly feeling that it is out of control. Our research shows that anxiety and depression are at record levels. COVID-19 has had a massive effect on populations throughout the World. Other pandemics seem much more likely in the near future. What must health systems do to manage these increasing demands? Examples of publications: Ellis LA, Dammery G, Wells L, Ansell J, Smith CL, Tran Y, Braithwaite J, Zurynski Y. Psychological distress and digital health service use during COVID-19: A national Australian cross-sectional survey. Frontiers in Psychiatry. 2022; 13. doi: 10.3389/fpsyt.2022.1028384 Leask E, Ellis LA, Dammery D, Braithwaite J. Mental health in a time of crisis: The detrimental effects of climate change. In J. Braithwaite, Y. Zurynski, C.L. Smith (eds). The Routledge Handbook of Climate Change and Health System Sustainability. Routledge (pp. 44-56); in press. Zurynski Y. The importance of local context and governance structures for the implementation of mental health integrated care programs for suicide prevention. International Journal of Integrated Care. 2021. Zurynski Y, Ellis LA, Tong HL, Laranjo L, Clay-Williams R, Testa L, Meulenbroeks I, Turton C, Sara G. Implementation of electronic medical records in mental health settings: scoping review. JMIR Mental Health. 2021;8. Zurynski Y, Herkes-Deane J, Holt J, McPherson E, Lamprell G, Dammery G, Meulenbroeks I, Halim N, Braithwaite J. (2022). How can the healthcare system deliver sustainable performance? A scoping review. BMJ Open. 2022;12(5), e05920 |
Selected publication highlights
Braithwaite J, Zurynski Y, Smith CL, editors. The Routledge Handbook of Climate Change and Health System Sustainability. Routledge. 2024; in press.
Smith CL, Zurynski Y, Braithwaite J. We can’t mitigate what we don’t monitor: using informatics to measure and improve healthcare systems’ climate impact and environmental footprint. Journal of the American Medical Informatics Association. 2022;29:2168-73. https://doi.org/10.1093/jamia/ocac113
Rahimi-Ardabili H, Magrabi F, Coiera E. Digital health for climate change mitigation and response: a scoping review. Journal of the American Medical Informatics Association. 2022;29:2140-52. https://doi.org/10.1093/jamia/ocac134
Coiera E, Magrabi F. What did you do to avoid the climate disaster? A call to arms for health informatics. Journal of the American Medical Informatics Association. 2022;29:1997-9. https://doi.org/10.1093/jamia/ocac185
Zurynski Y, Fisher G, Wijekulasuriya S, Leask E, Dharmayani PNA, Ellis LA, Smith CL, Braithwaite J. Bolstering health systems to cope with the impacts of climate change events: a review of the evidence on workforce planning, upskilling, and capacity building. International Journal of Health Planning and Management. 2024; 1-25. https://doi.org/10.1002/hpm.3769
Smith CL, Fisher G, Dharmayani PNA, Wijekulasuriya S, Ellis LA, Spanos S, Dammery G, Zurynski Y, Braithwaite J. Progress with the Learning Health System 2.0: a rapid review of Learning Health Systems’ responses to pandemics and climate change. BMC Medicine. 2024;in press.
Braithwaite J, Dammery G, Spanos S, Smith CL, Ellis LA, Churruca K, Fisher G, Zurynski Y. Learning Health Systems 2.0: Future-proofing healthcare against pandemics and Climate Change. A White Paper. Macquarie University. https://www.mq.edu.au/__data/assets/pdf_file/0006/1254147/Learning-health-systems-2.0-AIHI-2023.pdf
Braithwaite J, Pichumani A, Crowley P. Tackling climate change: the pivotal role of clinicians. BMJ.2023; 382:e076963. https://doi.org/10.1136/bmj-2023-076963
Coiera E, Braithwaite J. Turbulence health systems: engineering a rapidly adaptive health system for times of crisis. BMJ Health & Care Informatics. 2021; 28:e100363. https://doi.org/10.1136/bmjhci-2021-100363
Other resources
Links to other resources including media coverage, presentations or documents of relevance
VideoProfessor Lesley Hughes asks: Climate change, how worried should we be? AIHI Webinar, August 2021 https://youtu.be/v0crC1snidw?si=aV_uvMT2KIgYu3Lt A/Professor Stefi Barna: Improving patient care at a low environmental & social cost. PCHSS Webinar, December 2021 https://www.youtube.com/watch?v=erln4YJEjz0 Professor Jeffrey Braithwaite - Exploring the nexus of climate change, human health and healthcare systems. PCHSS Webinar, December 2021https://www.youtube.com/watch?v=1wdRk2i7RWk&list=PLPcIBwZ1c4-zzC4GGIx0FgS6UgJEqORTK |
MediaBraithwaite J, Zurynski Y, Smith CL, Hughes L, Climate change, human health, and health care systems. MJA Insight+, 2021. https://insightplus.mja.com.au/2021/45/climate-change-human-health-and-health-care-systems/ Smith CL, Zurynski Y, Clay C, Braithwaite J, Measure, monitor and mitigate - the three M's needed to achieve climate resilient, carbon-neutral healthcare systems. The Health Advocate, 2023. https://issuu.com/aushealthcare/docs/the_health_advocate_-_november_2023/30 Coiera E, Can digital health help curb sector's climate impact? Wild Health, 2022. https://wildhealth.net.au/can-digital-health-help-curb-sectors-climate-impact/ Coiera E, Telehealth for climate change, the latest on IBM Watson, & hospital billing transparency, Stat news, 2022. https://www.statnews.com/2022/11/22/health-tech-climate-change-data-hospitals/ |
External linksWHO Climate Resilient Healthcare Systems Climate and Health Alliance (CAHA) Global Green and Healthy Hospitals |
Project status
Current
Related streams of research
- Complex Systems and Implementation Science Research Stream
- Climate Change and Digital Health Research Stream
- Health System Sustainability Research Stream
Centres related to this project
Content owner: Australian Institute of Health Innovation Last updated: 12 Nov 2024 1:50pm