Climate and the nursing profession
The health and well-being of people, indeed their survival, depends
fundamentally on a healthy environment: clean atmosphere and water,
fertile soils, pollution-free oceans and biological diversity.
Nurses believe that everyone has an obligation to protect and preserve
the environment for the benefit of human health.
Nurses have a shared responsibility to sustain and protect the
environment, whilst fulfilling their role of promoting, restoring and
maintaining health in people.
Nurses have a role in protecting the health of individuals by:
• Seeking to preserve a healthy environment which is fundamental to
the health of all communities and future generations;
• Utilising expertise and providing leadership to assist communities
to apply the principles of public health in building healthy
communities;
• Participating in partnerships to lobby and advocate for actions to
reduce impacts on health through environmental changes.
Definition
The interdependence and the interconnectedness of human health
with the health of the natural environment is a relationship formally
acknowledged by the World Health Organization (WHO) as interrelated
with the conditions and resources needed for health. The Ottawa
Charter for Health Promotion states that; “The fundamental conditions
and resources for health are peace, shelter, food, income, a stable
ecosystem, sustainable resources, social justice and equity” (World
Health Organization 1986, Prerequisites for Health, para. 4).
Background
In 2012, 12.6 million deaths, representing 23% of all deaths and 22% of
the disease burden were attributable to modifiable environmental risks
(World Health Organization 2016a).
The WHO has identified that changes in climatic conditions can have
three types of health impacts:
- direct impacts e.g. heat waves
- health consequences of changes to ecosystems and biological
processes e.g. mosquito borne infections, agricultural food yields - health consequences of populations who are disrupted or
displaced
The threat from environmental degradation to human health and survival
has been recognised and expressed by the scientific community
(Union of Concerned Scientist) and by the United Nations Environment
Programme (UNEP). Human activity is the main cause of environmental
degradation.
Changing landscape patterns and biodiversity may be a key contributor
to the outbreak of disease. Human-induced land use changes are
primary drivers of a range of infections, and land use changes, food
production and agricultural changes account for almost half of all global
infectious disease emergencies that are transmitted from animals to
people (World Health Organization 2016a). Stable ecosystems are
vital to sustaining human life. The loss of biodiversity and changes to
ecosystems can result in outbreaks of infectious diseases, risk food and
nutrition security as well as protection from natural disasters (Romanelli
et al. 2015).
Described as the biggest reserve of biodiversity on the planet, oceans
and other waterways provide food, medicines, biofuels and other
products. They support the breakdown and removal of waste, support
climate change mitigation and are valuable resources for tourism and
recreation. The Food and Agriculture Organization stated, “the health of
our planet as well as our own health and future food security all hinge on
how we treat the blue world” (Food and Agriculture Organization of the
United Nations 2014, Foreward, para. 4).
Just as humans impact the environment, the environment impacts
humans. Human activity influences the physical environment with
resultant impact on peoples’ health. Higher temperatures increase both
mortality and morbidity (Australian Institute of Health and Welfare 2011).
Australia is already the driest inhabited continent on Earth and drought
is an important feature of its highly variable climate (Steffen 2015). The
relative risk of suicide can increase by up to 15 percent for rural males
aged 30–49 as the severity of drought increases (Steffen 2015). The
number of weather related natural disasters has tripled since the 1960s
and these disasters claim 60,000 deaths each year (World Health
Organization 2016b). The environmental influences on the determinants
of health include the natural environment, the built environment and the
individual’s responses to environmental influences (Veitch 2009).
The design and structure of the built environment is an important
determinant of lifestyle and health. There are direct associations with
illness and mortality, such as motor vehicle accidents, as well as
indirect associations, such as encouraging physical activity. The built
environment may also affect mental health and child development
through a lack of green space, overcrowding and environmental noise
(Australian Institute of Health and Welfare 2011).
That humans impact the environment is undeniable. This impact can
be both positive and negative. We have a responsibility to affect the
environment in a positive way when possible and reduce our negative
impact at every opportunity.
Health in All Policies (HiAP) is an approach to public policies across
sectors to improve population health and health equity that takes into
account the health implications of decisions, seeks synergies, and
avoids harmful health impacts. It provides a means for considering the
impact of policies on people’s health and health equity regardless of the
primary aim of the policy in concern. Good health enhances the quality
of life, improves workforce productivity, increases capacity for learning
and strengthens families and communities. In an HiAP approach,
the aim is that health is an outcome of all policies (World Health
Organization 2013).
The link between increasing air pollution and mortality has been
well-documented (Cohen et al 2005; Xu et al. 1994). Air pollution is an
important global risk factor for disease, with ambient particulate matter
ranking 5th on the global ranking of risk factors for total deaths from
all causes in 2015 (Health Effects Institute 2017). The United Nations
Sustainable Development Goal 3 refers to improving health through
improving environmental conditions. Specifically, target 3.9 states “By
2030, substantially reduce the number of deaths and illnesses from
hazardous chemicals and air, water and soil pollution and contamination”
(United Nations Statistics Division n.d., p. 4).
Healthcare contributes to the negative impacts on the health of humans
and the environment through unhealthy practices such as poor waste
management, use of toxic chemicals, unhealthy food choices and
reliance on polluting technologies (Health Care Without Harm 2017).
However, Health Care Without Harm (2017, What We Do, para. 7) also
identified “that due to its massive buying power, and its mission-driven
interest in preventing disease, the health care sector can help shift the
entire economy toward sustainable, safer products and practices.”
Rationale
The Nursing and Midwifery Board of Australia (NMBA 2008, p. 1) Code
of Ethics for nurses includes the following value statement: “Nurses
value a socially, economically and ecologically sustainable environment
promoting health and wellbeing.”
Human health and the well-being of present and future generations
are dependent on restoring and protecting the integrity of the natural
systems that support life in the natural environment, and minimising
the human impact that negatively affects ecologically sustainable
development.
Human survival depends upon the will to take effective action now, to
create and sustain a natural environment, which will support health and
life on a long-term basis.
The International Council of Nurses (ICN) has called on all nurses
to be involved in national and multi-sectoral measures to lessen the
burden of climate change on the population, particularly those groups
in the population who are vulnerable to disease and injury because of
low income, limited access to primary health care, infirmity and age.
Interdependence and interconnectedness of living things with the
natural environment is already conceptualised in nursing theory, which
integrates the concepts of person, nursing, health and environment in
the concept of holistic practice.
References
Australian Institute of Health and Welfare 2011. Health and the environment: a compilation of
evidence. Cat. no. PHE 136. Canberra: AIHW.
Australian Nursing and Midwifery Accreditation Council 2008, Code of Ethics for Nurses
in Australia, .
Cohen A et al. 2005, ‘The Global Burden of Disease Due to Outdoor Air Pollution’, Journal of
Toxicology and Environmental Health, Part A Vol. 68, Iss. 13-14.
Food and Agriculture Organization of the United Nations 2014, The State of World Fisheries and
Aquaculture, http://www.fao.org/3/a-i3720e.pdf.
Health Care Without Harm 2017, What We Do, < https://noharm-global.org/content/global/ about#What>.
Health Effects Institute 2017, State of Global Air 2017 Special Report, Boston, MA,
< https://www.stateofglobalair.org/sites/default/files/SOGA2017_report.pdf>.
Romanelli, C., et al. 2015, Connecting global priorities: biodiversity and human health: a state
of knowledge review, World Health Organization/Secretariat of the UN Convention on Biological
Diversity.
Steffen, W. 2015 Thirsty Country: Climate change and drought in Australia, Climate Council of
Australia, < http://www.climatecouncil.org.au/uploads/37d4a0d2a372656332d75d0163d9e8b8. pdf>.
United Nations Statistics Division n.d., Global indicator framework for the Sustainable
Development Goals and targets of the 2030 Agenda for Sustainable Development,
.
Veitch, C. 2009, ‘Impact of rurality on environmental determinants and hazards’, Australian
Journal of Rural Health, Vol. 17, Iss. 1, pp. 16-20.
World Health Organization 1986, The Ottawa Charter for Health Promotion. First International
Conference on Health Promotion, Ottawa, 21 November 1986,
http://www.who.int/healthpromotion/conferences/previous/ottawa/en/.
World Health Organization 2013, Health in All Policies – Framework for Country Action,World Health Organization 2016a, Preventing disease through healthy environments:
A global assessment of the burden of disease from environmental risks,
http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf
World Health Organization 2016b, Climate change and health: Fact Sheet,
http://www.who.int/mediacentre/factsheets/fs266/en/.
Xu, X. et al. 1994, ‘Air Pollution and Daily Mortality in Residential Areas of Beijing, China’,
Archives of Environmental Health, Vol. 49, Iss. 4, pp. 216-22.
The Australian College of Nursing recommends that:
• The Australian Government fully adopts and
implements the June 2017 Climate and Health
Alliance’s Framework for a National Strategy on
Climate, Health and Well-Being for Australia.
• All Australian governments apply a Health in all Policies
(HiAP) approach and consider the UN’s Sustainable
Development Goals for all policy making decisions.
• Nurses become informed advocates on evidencebased
climate-related human health risks and build
knowledge based on the specific climate related
risks impacting their work and communities.
• Nurses seek and support evidence-based
research, education and policy initiatives and
strategies by governments and/or community
groups to address environmental issues.
• Health care providers incorporate sustainability
in their strategic plan and promote awareness
of environmental health issues through
continuing education/in-service programs.
• Accrediting agencies ensure there are environmental
standards for the accreditation of health care agencies.
• Nurses utilise expertise and provide leadership
to promote health systems adaptation and
preparedness. This will address the impacts of
climate and strengthen nurse workforce capacity
to support public health interventions.
• Embed climate and health education in nursing
education programs including continuing
professional development programs.
Next review: December 2018
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