Dr. Myles Sergeant on Reducing Healthcare’s Carbon Footprint

This episode is hosted by Dr. Anna Gunz, with guest Dr. Myles Sergeant

Episode Summary: 

• Discussion about the importance of sustainability in healthcare and practical steps to reduce its environmental impact. 
• Highlighting key areas such as reducing food waste, optimizing energy use, and addressing the significant carbon footprint of medications. 
• Emphasis on the role of the healthcare supply chain, which accounts for 80-85% of the sector's emissions, and the need for more sustainable procurement practices. 
• Dr. Sergeant shares advice on starting sustainability initiatives within healthcare facilities and expresses optimism that these challenges are solvable with collective effort. 

Recording Date: 2022-11-24

Episode Production & Management Team:

Jakob Wilk, Emma Cornell, Abby Walker, Olivia D'Andrea Brooks, Emily Douglas, Danielle Pineda

Show Artwork: 

Laney Beaulieu

Transcript

Anna Gunz
We're here with Doctor Myles. Sergeant, who is a family physician who has worked with vulnerable populations, including people experiencing homelessness and or addictions and the elderly over the past 25 years. His work involves recognizing the intersection between environmental issues and health.

He's dedicated to addressing climate change issues, and as co-founder of Partnerships for Environmental Action by Clinicians and Communities for Health Care Facilities, also known as Peach Ontario, as well as the charity trees for Hamilton, which he founded in 2012, and the not for profit Shelter Health Network in 2005. Welcome.

So there's so many things that I want to talk to you about, so we'll have to see how much time we have. But first, I have always been so interested in your work with trees. So how did you end up finding a tree? NGO while you were a busy clinician and a father, as well as managing all your kids?

What drove you to do this?

Well, we moved to a farm about 20 years ago, and I was determined to do something on the farm and not simply rent it out. And I thought, you know, what am I passionate about? What am I interested in? And it was trees that always loved trees as a as a kid. So we started planting trees. And at first I thought it might be a tree farm, but I fell in love with the trees.

Couldn't sell them. And, in terms of starting a not for profit again, my work downtown in the inner city in Hamilton, there were days in the summer which were extremely hot, and I would be working at one of their shelters, and sometimes the air conditioning wasn't working. And I you know, one of those days you're just looking at the clock and you can't wait to get to the clinic because you're sweating.

And if that ever happens to you and, you know, I'm just I just can't wait to get home because I'm going home to air conditioning and trees and all. You know, the great things in the west end of the city. And, so I thought, look, if this is good for me and my family, it's good for the community.

There's a lot of information now about, heat islands in the city. And the problems are association between disease and living in hotter areas of a city. So, I mean, it was sort of a natural thing. I was learning a lot about trees at home on the farm. And, I spoke to someone who's a mentor or name is Lorraine, who would come to the farm.

She worked for the, the government Ministry of, environment and would help, landowners with various projects. And I said, is there a need for a charity in Hamilton? And she said there was. And that's how it started.

Anna Gunz
Now, my understanding is you also started planting at the hospitals.

Myles Sergeant
Yeah. So I have just realizing your first question about how did I have time, you know, I think that I'm trying to look back because it's been 11 years now. I, I think in the first few years it might have averaged out to 3 or 4 hours a week. And of course, you need to do paperwork and, and, you know, to show your taxes and all that sort of thing.

And then, of course, the busy seasons are spring and fall, particularly April and October, when we're actually doing tree plantings. So I don't know that it was a ton of time. And initially when we were only doing a few plantings per year. Yeah, I know in terms of planting at the hospitals, we realized pretty early on the people in our group and our small board were all interested in the intersection between human health and trees, and you could certainly make the argument that every tree planted in the world is beneficial to human health or the global aspects of trees and the local aspects of trees globally, of course, you know, helping

the whole oxygen CO2 balance and and locally just so many benefits. And, there have been studies done which show that when someone's in hospital and they're looking outside at trees, they do much better in every, every outcome you can measure. And maybe the most important one is getting home sooner. So that was kind of an obvious thing.

When I do my talk, sometimes they show a photograph of the Hamilton general. There's a website. I think it's postcards.com or some such thing which shows postcards of the Hamilton hospitals from, you know, the late 1800s, early 1900s. And back then the hospitals were beautiful and they had all sorts of trees and gardens. And so somewhere in the last 100 years, we sort of lost the plot as far as I'm concerned.

And so, again, you know, tying those things together, making a hospital beautiful, making it a place, you know, potentially an oasis, a place that no one wants to go to a hospital. But let's make it as nice as we can and let's make the views beautiful. And hopefully that, is

Anna Gunz
Well, and I think you're using the word healing, which, I mean, we're traditionally physicians. Were healers in somewhere in the last hundred or more years. We've moved further and further away from that. The conversation is health, but we're really talking about illness. So I totally agree with you in terms of the fact that you sort of had this medical industrialization of health care and through that, we've really lost the healing power and the power and the importance of nature and healing, is immeasurable.

So that's wonderful work. I couldn't agree more.

when you were working on your NGO and I know you've had a more recent work, with green teams and then developing peach, but before all of that is trees and your tree NGO, was that something that you would discuss with your patients over the last ten years?

Or is this sort of a separate part of yourself and a separate part of your practice?

Myles Sergeant
Well, I think initially it was separate. And as we were, you can imagine again, it's been 11 years now, and I think we've done 70 community plantings now in the first few years. We were just starting to develop partnerships and figuring out, you know, where the opportunities were. And as we did develop partnerships both with conservation areas and in big places like, Royal Botanical Gardens as well as hospitals and long term care facilities, we started to think about volunteer groups and doing things by themes.

And, so one of the themes was health care workers weather. I mean, there was one planning, I think we had 16 family doctors out at a conservation area. And we we typically do bring medical students and residents out for them to learn the benefits of trees and nature. And so I have an unusual career as a family doctor.

At this stage, I only do inpatient medicine, I work at a complex care hospital, and I also work, at an inpatient addiction facility. And I think that the executive director of the addiction facility saw, you know, an opportunity for us to bring the guys in the facility out to plant trees. And so we started doing that probably a few years into us running the charity.

So we would, well, it wouldn't be me, typically, but, you know, the the director, one of the lead counselors, would ask the guys in the house who wants to who wants to go plant trees today? And then they'd come out and to the conservation area, and I would be there, and they kind of be surprised to see me.

And we plant trees together. And in those guys, at least the place that I work at are are typically guys who've lost, lost everything because of their addiction and typically ended up being homeless and often have started, with addiction as young as 10 or 12 years old and barely know what life is like without addiction. So it's it's extremely rewarding to see, the guys having a great time and realizing how much they love the outdoors and realizing how great it is to give back to society.

So, so that's been a fun thing. I think we've probably done that 8 or 10 times now with that group.

Anna Gunz
That's wonderful. You're sort of ahead of the curve with, horticultural therapy and healing. Now, there's so much sort of medical traditional evidence to back up what you've sort of intuitively found your way doing.

Myles Sergeant
Well, I would say that, I, I would agree. I'm ahead of the curve. I don't think I'm that far ahead of the curve in anything that I've done. You know, as soon as you think you've thought of something which is completely unique and original, but it's a it's a big world out there. There's usually someone who's done it before you.

And, you know, so a lot of these things that I've done, I mean, you if you look back at the literature, some of the literature that I quote goes back 30 years in terms of the benefits of nature for, for humans. So, yeah, it's been around for

Anna Gunz
Well. And beyond that, and you know, that relationship between land and people is so embedded in indigenous cultures as well. It's the

Myles Sergeant
Yes.

Anna Gunz
sort of the behind backwards ness of our mantra,

modern medicine.

I'd really like to hear more about Peach.

What was the gap that you saw and the vision that you had that led to the development of peach? And that it would be wonderful if you could talk a little bit about the organization and and what it was intended to do and, and where you see it now.

Myles Sergeant
Okay. Well, the the beginning for me was the fact that we had done the tree charity. That group of people. There's five of us in that board. We've done the tree charity for ten years. And so at the end of the ten years, which is just over a year ago, I was thinking, you know, what else can I do?

Or where where can I go from here? And look, you know, we've done a lot of good, obviously, with that charity. I think at that point we've done about 60 community plantings and gotten a lot of volunteers out, put a lot of trees in the ground in important places. But when you think about climate change, it's it's hardly even a drop in the bucket.

And I'm at a stage of my life, in my career that I could put more time into this. And not everybody has that luxury. So I really was looking around for the next thing to do. Another mentor of mine is Linda Varon, who was being part of the Canadian Coalition for a Green Health Care. So I, I started to chat with her about what might be next and where the gaps were.

And although the coalition has been around for, gosh, I'm going to say 22 years, and does this type of work, I think she felt there was, a need for clinician leadership to really, you know, get into the hospitals, long term care facilities, etc.. And look, once again, this is not, an original idea. This is essentially looking at what the NHS has been doing with their sustainable health care system for the last ten years and saying, how can we implement some of those concepts here?

So I think that's where it starts. And and looking around at the other big, you know, how health greening groups out there and realizing no one was doing precisely this. So, so if you want me to go into now what we were doing, I think that I might have a vision of where something's going to go.

But I think in this complicated world, you need to adapt. And in the beginning, we were thinking, this is a grassroots project, and we would look at all the great projects and things that are happening around the province. And there's lots of what I call, you know, climate superstars out there, around Ontario and in all kinds of areas.

I mean, I'm not just talking about clinicians here, I'm talking about the food sector, the building, energy sector, transportation, etc. so to meet those people, see what they're doing at their facility and then to mobilize those ideas. So another key person or group is Saujani kind of Sammy, who's a PhD in knowledge translation, and she's just been a key person all the way along.

She, had co-founded starfish, which has been around for quite a while now. And so she helps to, you know, put those ideas out there in a way that people can understand easily. So that's what we were doing. We were collecting the stories, putting them up on a website, you know, pushing them out on social media and in the beginning I would have thought again, grassroots were hopefully getting nurses and docs and clinicians interested in this.

And, and to take action. But, I mean, as you know, since we started this project, wave four of Covid hit a month later, and then there was wave five, six, seven. So it's been a very tough time, obviously, to to get people on board. And so the the surprise has been the fact that leadership in many places has been interested in taking these ideas on and pushing them forward.

And so, look, we still look for the grassroots, help and people who are interested. But we have since then made a, a guide for leadership. This is now going to be part of Accreditation Canada, for hospitals, and it will be for long term care as well. So leaders are going to need to know how to do this for their facilities.

So I think, again, one of the best things we've done is create this, guidebook. It's a 14 page infographic, very easy to read. And because we are in a climate emergency and we need to teach people to go after what we consider to be the big items, in the middle of that infographic, there is a page with checkboxes on it with 20 items that look, we could have a great debate about what the biggest 20 items are.

We were going after the biggest 20. Hopefully we got 20 of the top 25 in there. And again they come from all different sectors. So within food it would be decreasing waste and having more plant rich menus within buildings and energy. It's, you know, having an energy manager, in the hospitals, it's decreasing your upper operating room ventilation rates overnight.

Medications. Massive. The medications are 25% of our carbon footprint in, in Canada. And it's really all about the production of medications. And I think you can make a good argument that we do over prescribe as physicians. So there's opportunities there. So I could go through this whole thing, but probably best for people just to take a look at it.

Anna Gunz
Where can they find that?

Myles Sergeant
It is on our website under projects on the Peach Health Ontario website.

And this was done, by the way, in collaboration with the Canadian Coalition for Green Health Care. So it would be on their website as well, the Leadership Guide for Sustainable Health Care.

Anna Gunz
Fantastic.

So, for people who are in the health care sector, who are interested in sustainability, who are aware of the climate crisis, what advice would you give them? Getting started, if that's. I think, the hardest thing. There's so many people who care and they care so much, and it's really hard to know which direction to go or who to talk to, or whether you can make a difference.

Do you have any words of wisdom that you could pass on? After all the work you've done?

Myles Sergeant
Well, I would say don't be afraid to get started. As you know, there is a study done by, Fiona millar in Toronto looking at the US and group of hospitals and 1600 employees and 96% felt their facility should be doing more to green their health facility. I think you've done a similar study, Anna. So the bottom line is, the majority of health care workers care about this and want to do something.

And I know that's psychologically, one of the things that holds people back is the idea that they will be perceived as a tree hugger, but it's just not the case anymore. People people understand this. So, I think that you start out by finding allies and and so the green team at my hospital really started by the first tree planting that we did.

And, you know, there's a there's a group that we work with called trees for life. And they, and on their website you can find something called trees for health. And you can reach out to them and they will help you plant trees at their, facility. So it may sound like a monstrous task and undoable task, but, look, you can reach out to them.

We're partnered with them. You know, we want to help people plant at their facilities. And the point of this is that that was, that was an opening for a green team getting people out and finding out who's interested in planting trees. And then we get out there and we talk together about what other things we can do.

And that ended up leading to, having a green team. But again, I think it starts with finding allies, which gives you more confidence. I suppose the other thing I would say is, you know, to look at the resources out there, like the Canadian Coalition website, our website, Cascades website, and learn what the big items are. And in my mind, one of the biggest items is the supply chain.

I spoke about medications within the supply chain. There's a study done in The Lancet a year ago looking at the national health system again in the UK and their carbon footprint within health care and transportation ends up being 10%, which is smaller than you'd think of. Of course, every percent counts when you're trying to get to carbon zero buildings, and energy ends up being 10% again, smaller than you'd think.

So what is the big piece of the pie? It is the supply chain. And in that study, I think it's roughly 65% supply chain, which shocked me at the time. And now I get it there being studies done more recently, which suggests it's actually 80 to 85% of the problem. So I just tell people to try to go after the big issues.

And of course, so supply chain is the big one. So what is supply chain. It's really all the things we consume. So when you think of a big health facility long term care hospital, you know all the gloves coming into the building, the mass coming into the building, MRI machines, office furniture, computers, everything that we buy, has to be dug out of the ground, shipped around the world for manufacturing, shipped packaging, shipped to the hospital, used and then shipped to, the dump, essentially.

And that's what we call the linear economy. And, you know, I think the big change that society needs to make is to move to the circular economy. Again, that's something you could Google

You know, a bit of a complicated concept to understand, but it's it's basically the idea, if you can imagine someone supplying I mean, let's, let's go with a computer, a computer for you.

Are they designing that computer from the outset to be something which has a second life, can be used in some secondary way and not thrown out? Is the computer being designed to be able to be used for 1015 years, or is it being designed to be thrown out in three years and outdated? Are the replaceable parts for that computer?

Are you building that computer from recycled, material, like are or are you digging it out of the ground? So these are the kind of concepts which which sound radical, but they are starting to happen and they need to happen. So influencing that, I know that sounds hard. I think that, you know, one of the biggest projects we're doing is meeting with the procurement leads of the big hospitals or some of the big hospitals around the province, and trying to get sustainability added to the language within, RFP is a request for proposals.

Right now, RFP is like any sector or generally to do with cost and quality, but we need to add in a factor of sustainability. Ideally, that would be as high as 20 to 30%. I can tell you right now we're kind of negotiating it around 10%. But it's a start. And so that and that filters down to suppliers to say, hey, look, if you're going to be competitive on this bid, you need to show that you're a sustainable company and it's a sustainable product.

And then that company has to go to their suppliers all around the world and say, look, we can't be a green company unless we're buying from green companies. And this to me is the great hope. Again, this being 80% of the issue and to me, a potentially solvable issue.

Anna Gunz
Yeah. Absolutely.

Is there anything else that you can think of that you'd like to say about this issue?

Myles Sergeant
Well, again, in following up about this idea about the supply chain and how you can impact it, so you can impact it through the facility you're working at by one buying less, to trying to buy used or recycled, if that's possible. And three, by buying smarter and looking at the companies you're buying from. And there is actually a way of doing this.

There are a few companies in the world that are not for profits that have been around for a while that essentially look, well, I just mentioned one CDP, which is the Carbon Disclosure Project has been around, I think, since 2000, CDP net. I have no affiliation with them. But back in 2000, they were asking companies around the world to disclose their carbon footprint.

And you can imagine most companies had no clue or maybe no interest. And it was a very small operation. They now have over 20,000 companies reporting their carbon footprint, their forest footprint and their water footprint. So you can look up companies, whether it's a pharmaceutical company or a, medical devices company, and see how that company rates. And you might not be able to find out the specific product that you're buying, but at least you can look at the company and see how well they're doing.

So I mean, that's one major thing that we can be doing, as a society. And the other thing is, is in our personal lives, we can be making the same decisions. And we we need to be supporting industry, which, sells reused goods. And whether it's, it's clothing or other other things, I mean, this is really the way we need to go.

I used to go to, what is it called, a collar to have my, dress shoes, re healed. And Fauci during Covid, he closed his shop, and I don't, I don't know where the closest cobbler is now, but it's actually those kind of industries we do need to support. And there are websites out there in terms of buying things.

There's websites for, you know, shoes, for example, and and looking up your favorite shoe company and seeing how well they're doing. So I think this is a big impact people can make as individuals.

Anna Gunz
Wonderful.

Thank you so much for being with us today. The last question I have for you is, where do you find hope for the future? Given everything we know about the world today in the climate crisis.

Myles Sergeant
Well, I suppose I'm an optimist by nature. So that that might help. I'm also with doing this work. Of course, you find other people who are hopeful and are working hard, and I find the people who are willing to chat on the weekends, in the evenings, which I know sounds crazy, but there's a lot of work to be done.

So I think working with some of these people gives me hope. I know there's a lot of people out there who are passionate about this. And again, as I'm saying, I think that some of these things are solvable problems. And, you know, I don't completely understand why more people aren't doing this type of work. And I think that's one of the reasons people don't see it as a solvable problem.

But I absolutely think it is a solvable problem.

Anna Gunz
Thank you.