Sustainability and Occupational Health - Tutorial 3 Flashcards

1
Q

What is the definition of sustainability?

A

The ability to be “able to continue over a period of time”

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2
Q

What are some examples that the “person in the street” might think about relating to the ability of being “able to continue over time”

A

Is my bank balance positive at the end of every month?
Is servicing my car, which costs a lot, worth it in the long run?
Can I keep up this diet long term?
My knees are sore, maybe I should change sport
This job is exhausting me – I’m not sure how long I can do it for

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3
Q

On what three levels does sustainability relate to healthcare?

A

Global sustainability
Sustainability of the NHS
Personal and Career Sustainability

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4
Q

Why is global sustainability important to healthcare?

A
Material inequality 
Population and consumption 
Resource depletion 
Climate change 
Loss of biodiversity 
Crisis in healthcare
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5
Q

How is material inequality important to global sustainability?

A

World’s wealthy are getting richer while at least half of the world’s population live on less than £1.30 per day
UN estimated in 1998 that the Millennium Goal of basic education for all could be attained by additional global investment in £3.8 billion, in 1998 in the USA £5 billion was spent on cosmetics

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6
Q

How is population and consumption important to global sustainability?

A

The world population is growing
In 2011 it was 7.9 billion, 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 world has by way of material goods and food

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7
Q

How is resource depletion important to global sustainability?

A

By 2005 it was estimated that we had consumed half of the earth’s extricable reserves of oil and gas and that they are likely to be completely depleted by the end of the 21st century
Water is also becoming more scarce
We will be more dependent on alternative sources of energy in the future

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8
Q

How is climate change important to global sustainability?

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 CO2 in the atmosphere and increased greenhouse gases
Produced the greenhouse effect by a change in the gas concentrations - impacts on food production due to regional floods and droughts
Changes in the environment re incidence of infectious diseases e.g. risk of malaria
Deaths from heatwaves and droughts leads to changes in human migration from affected areas
Climate change will affect all countries but will have greatest impact on those who have the least access to the world’s resources and who have contributed least to carbon emissions

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9
Q

How is loss of biodiversity important to global sustainability?

A

Increased rate of animal extinction due to depletion of areas of habitat

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10
Q

How is crisis in healthcare important to global sustainability?

A

Crisin in chronic health problems with increasing ageing population, increase in chronic diseases such as diabetes and obesity
Crisis in cost of healthcare in developed countries, getting increasingly worse
No evidence that spending more money on healthcare actually improves health
Crisis in healthcare use of energy e.g. 3% of carbon footprint in England is due to NHS-related activity

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11
Q

What has been the change in the number of reported weather-related natural disasters since the 1960s?

A

Globally, the number of reported weather-related natural disasters has more than tripled since the 1960s

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12
Q

How many deaths every year do weather-related natural disasters result in?

A

Over 60,000 deaths, many in developing countries

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13
Q

What does the Intergovernmental Panel on Climate Change (IPCC) state in relation to evidence for global warming?

A

State that evidence for global warming is unequivocal and there is very high confidence that the increase in global average temperatures since the mid-20th century is due to human activity

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14
Q

In the last 150 years, how many of the warmest years on record have occurred in the last 13 years?

A

12

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15
Q

How many excess deaths were recorded in the heat wave of summer of 2003 in Europe?

A

More than 70,000 excess deaths

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16
Q

How does high temperature exacerbate cardiovascular and respiratory disease?

A

High temperatures also raise the levels of ozone and other pollutants in the air that can exacerbate cardiovascular and respiratory disease

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17
Q

What percentage of the world’s total carbon footprint is accounted for by the poorest one billion people?

A

Around 3% of world’s total footprint

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18
Q

The loss of health life years as a results of global environmental change is predicted to be how many times greater amongst poor African populations than amongst European populations?

A

500 times greater

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19
Q

By the end of the century, how many of the world’s population could face severe food shortages?

A

Half of the world’s population

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20
Q

What could increase food insecurity greatly within the next 2 decades?

A

Declining crop yields

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21
Q

What number of the world’s population live within 60 miles of a shoreline?

A

1/3

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22
Q

How many of the world’s largest 20 cities are located on a coast?

A

13

23
Q

If sea levels rise by up to 13m by the middle of the next century, as some scientists predict, how many people could be displaced in environmental mass migration?

A

More than a billion

24
Q

What is the global reduction in greenhouse gases target by 2050 compared to 1980?

A

50%

80% reduction in emissions for high income countries

25
Q

What are some ways in developed countries to reduce the greenhouse gases?

A

More house insulation
Better ventilation and heat recovery
Switch to electric heating
Reduction in household temperature by 1 degree Celsius

For India there is a 10 year program to introduce 150 million low emission cook stoves

26
Q

What percentage of all fossil fuel greenhouse gas emissions are accounted for by transport?

A

25%

27
Q

How can we cut fossil fuel greenhouse gas emissions?

A

Walking
Cycling
Less vehicle use

28
Q

What would reduce particulate air pollution and deaths?

A

Changing methods of electricity generation to reduce CO2 emissions

29
Q

What percentage of greenhouse gas emissions are accounted for by agriculture and food production? What percentage of this is from livestock farming?

A

10-12%
80% from livestock farming

Reducing production of foods from livestock reduces greenhouse gas emissions

30
Q

What are some actions that could be taken to benefit global sustainability?

A

Increase use of renewable energy sources (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

31
Q

What are the ways to look at sustainability in the NHS?

A

It could be looked at in relation to the topics just covered - low carbon clinical care and environment

It could be looked at in relation to the ability of the NHS to continue over time

32
Q

What are some ways to promote low carbon clinical care and NHS sustainability?

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

33
Q

What does the NHS carbon reduction strategy, based on natural targets set by the Climate Change Act 2008, commit the health service to?

A

More than 80% reduction in emissions over the next 30 years - so the health sector will be forced to reduce its carbon emissions

34
Q

What is the greatest part of carbon emission from NHS England?

A

From purchasing of goods and services

22% from purchase of pharmaceuticals

35
Q

Sustainability is not just about more efficient use of energy in buildings but also

A

of equipment and consumables

36
Q

What will low carbon clinical care do?

A

Be better at preventing conditions
Give greater responsibility to patients in managing their health
Be leaner in service design and delivery
Use the lowest carbon technologies

37
Q

Specialities should aim to tackle underlying causes of disease, what might these be?

A

Social, economic and environmental determinants of health

38
Q

How could we help reduce the financial, social and environmental effects of unwanted pregnancies?

A

Make effective contraception more widely and easily available worldwide

39
Q

How could we be leaner in service design and delivery?

A

Combine clinics for diabetes, cardiovascular and stroke
Use lean principles to eliminate duplication and poorly targeted investigations
Reduce number of steps in patient pathway of referral to treatment by channeling 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 unused drugs has a marked environmental impact considering reported figures of almost 50% non-compliance
Use 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

40
Q

What could the commissioning of NHS services by any qualified provider be perceived as?

A

Gradual privatisation of services

41
Q

It has been suggested that we should remodel the WHO definition of ‘what is health’ proposed in 1946. What is the current definition and what has it been suggested that we should change it to?

A

A complete state of physical, mental and social well-being and not merely the absence of disease

to

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

42
Q

What is resilience?

A

The ability to quickly return to a previous good condition

43
Q

What are some positive factors that might contribute to a sustainable 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

44
Q

What are some challenges to a sustainable 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

45
Q

What is an occupational and environmental history?

A

A chronological list of all the patient’s employment with the intention of determining whether work has caused ill health, exacerbated an existing health problem or has ill health had an impact on the patient’s capacity to work

46
Q

What are the components of the 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?

47
Q

What is a fit note?

A

Replaced the sick note in April 2010
Evidence of assessment by a doctor as to whether a patient is fit to work in general - it is not job-specific
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, it 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)

48
Q

What is the role of occupational health?

A

Ideally and uniquely placed to support and help people stay in work and live full health lives
They play a key role in ensuring the health and wellbeing 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

49
Q

What can occupational health services do?

A

Advise on measures to reduce/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 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

50
Q

What does modern occupational health require?

A

A multidisciplinary approach where doctors work alongside a range of associated healthcare professionals including nurses, ergonomists, hygienists, occupational health advisors, physiotherapists, psychiatrists, psychologists and therapists

51
Q

What is the generally accepted theoretical framework about work and wellbeing, based on extensive background evidence?

A

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

52
Q

In what ways is unemployment generally harmful to health?

A

Higher mortality
Poorer general health, long-standing illness, limiting long-standing illness
Poorer mental health, psychological distress, minor psychological/psychiatric morbidity
Higher medical consultation, medical consumption and hospital admission rates

53
Q

How does re-employment affect 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