B.C. surgeon Dr. Andrea MacNeill challenges health systems: go green!
Andrea MacNeill, MD, FRCSC, is on a mission to build sustainable health care systems.
A surgical oncologist at Vancouver General Hospital and BC Cancer, Dr. MacNeill is founder and principal investigator at the University of British Columbia (UBC) Planetary Healthcare Lab. Through this lab, she and a team of experts are examining the environmental impact of health care services and delivery, and how to minimize their footprint and maximize their efficiency.
“How is the care we deliver every day negatively impacting the environment and thereby causing that cascade of events that actually worsens or adversely affects human health? And how can we rectify that paradox in the way we do our day-to-day operations?”
It’s a tall order but one she is actively working to fill.
Build sustainable health systems
Dr. MacNeill has been researching the environmental impacts of health care for over a decade. In addition to her medical training, she holds a Master of Science degree in Environmental Change and Management from the University of Oxford.
In 2017, she published an influential paper on the impact of surgery on global climate. A year later, she co-authored a study of national greenhouse gas emissions contributed by the Canadian health care system. More recently, she co-authored a framework for sustainable health systems.
This framework is based on three foundational principles:
- Reduce demand for health services (e.g., prevent disease, promote health).
- Match the supply of health services to demand (e.g., ensure appropriate care and resource stewardship).
- Optimize the efficiency and environmental performance of health care delivery (e.g., reduce emissions, coordinate care delivery, offer virtual care, promote a circular economy, implement green infrastructure and operations).
These are all areas under investigation by the UBC Planetary Healthcare Lab.
“We’re not advocating for anything that could potentially compromise the quality of the care that we’re giving our patients. All of these agendas are parallel and in many cases are synergistic,” affirms Dr. MacNeill.
A living laboratory to advance planetary health
The lab’s partners include experts in environmental engineering and public health, health systems, health economics and behavioural sciences. The lab also has a close partnership with Vancouver Coastal Health, where Dr. MacNeill serves as regional medical director of planetary health.
“We are fortunate to have the opportunity for a living laboratory,” she says. This means that sustainable best practices identified in the lab can either be tested in real time or lab partners can access real time data within the health ecosystem.
“We know that the supply chain is our single biggest source of health care emissions. So, some of this work is outside of the purview of the individual clinician and does require systemic change.”
Despite this, Dr. MacNeill says there is still a role for individual clinicians to drive change.
“I know there is a fairly pervasive sense of helplessness around this, but I think people do underestimate their power.”
What do we mean by Planetary Health?
The concept entered mainstream academic scholarship with the 2015 report of The Rockefeller Foundation–Lancet Commission on planetary health.
Says Dr. MacNeill, “It specifically captures the relationship between human and environmental health. It is the way in which our health and wellbeing is entirely dependent on having healthy ecosystems to sustain them.”
Reduce strain on the system
Globally, it is estimated that 25-30 per cent of health care services are unnecessary or low-value care, says Dr. MacNeill. Clinicians can make an impact by identifying and avoiding excessive interventions. This reduces strain on the system and frees up access to essential care. Moreover, it reduces risk of harm to patients, and avoidable expenditures and materials use. Likewise, clinicians should be on the lookout for underuse of necessary services. This leaves patients vulnerable to preventable or advanced disease.
“We have an enormous opportunity within the scope of our day jobs to have a significant impact on the environment, and that’s where appropriateness of care comes in.”
Choosing Wisely Canada has many resources to support this work. For her part, Dr. MacNeill is helping design a program for Vancouver Coastal Health to partner with clinicians to identify inefficiencies in their specialties and consequently design appropriate interventions. This is an exercise she’s already done with Ottawa colleague Husein Moloo, MD, FRCSC, and co-published as a framework for colorectal surgeons.
One example that came out of their review is to participate in, and build capacity for, colon cancer screening programmes so that pathologies can be addressed earlier and with less resource-intensive interventions.
“Obviously, that’s better for patients. It’s better for the system. Better for the environment,” says Dr. MacNeill. “And that’s what we want to replicate with every speciality and have people be on the lookout for opportunities in their own practices.”
The health care community is getting mobilized
With a quality improvement mindset, there are many opportunities to practice more sustainably and Dr. MacNeill is encouraged by an increasingly engaged and mobilized clinical community.
One example is CASCADES, an emerging network led by Fiona Miller, PhD, of the University of Toronto’s Dalla Lana School of Public Health. The University of British Columbia is a partner institution and Dr. MacNeill’s lab hosts the Regional Coordinator for Western Canada.
“CASCADES is a knowledge mobilisation network that takes the best practices that individuals like me are generating and contributing to the literature, and then disseminating them throughout the sector to help people implement them.”
This is something that excites Dr. MacNeill, as she sees that the interest is there.
“My biggest challenge right now is that I can’t keep up with the demand of people saying, ‘How can I be part of this?’ Or ‘here’s a problem in my clinical practice; we need to fix this somehow.’ But what a great problem to have.”