GPs have the toolkit to focus on what’s good for patients and the planet

It is a paradox of modern medicine; we strive to do our best for our patients and our communities, yet if the global healthcare sector were a country, it would be the fifth largest global emitter of carbon.

The Lancet has described the climate crisis as “the biggest global health threat of the 21st century”. As we do our work as healthcare professionals, we must be mindful not only of our present concerns but also the bigger picture. We know that small changes can have a big effect, and what is good for the planet is good for ourselves.

The Irish College of General Practitioners, the kindly and expert body giving guidance to family doctors like me, has issued a very welcome Glas Toolkit. Glas means green in Irish and the toolkit is a kind of small guidebook for running our practices and managing our patients in a sustainable and healthy manner which will be good for our patients and the planet.

Anyone on an inhaler may consider discussing with their doctor the type of device and way they use it

Inhalers are an example. The hydrofluorocarbons which are found in multiple-dose inhalers have a global warming potential at 1,000-3,000 times that of CO2. Each one of Ireland’s most commonly prescribed inhaler, the salbutamol MDI, equates to up to 28kg of carbon, which is the equivalent of driving from Tralee to Dublin (280km). If the inhaler type is changed, (not the drug), there is a carbon footprint of less than 1kg CO2 per inhaler, the equivalent of driving only 6.5km. It is a bit like changing from a diesel car to an electric one — there is a more planet-friendly alternative.

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Anyone on an inhaler may consider discussing with their doctor the type of device and way they use it, how they dispose of it and if they are using it appropriately and in a manner that suits them best.

The Glas Toolkit is easy to download from the ICGP website and many practices have already signed up for it. In fact, it could be used as a template for all kinds of small businesses. There is an important section on how to get your staff and clients to buy into making changes. In essence, you put somebody in charge to set targets, reduce costs, reduce waste have regular meetings, and set dates for achieving goals. Every GP practice is hectically busy, so proper planning is essential.

Doctors have been encouraging mothers to breastfeed for years. The health benefits are well known, but I did not know (until I read it in Glas) about the environmental harm caused by breast milk substitutes. Breast milk has zero or minimal waste. Formula feeds are predominantly composed of cow’s milk. Dairy and meat production account for a large proportion of the greenhouse gases of the food industry which in turn accounts for almost a third of greenhouse gases. The average water footprint of whole cow’s milk is about 940 L/kg: one kilogram of milk gives about 200 g of milk powder, meaning the water footprint of milk powder alone is roughly 4700 L/ kg1. Methane production from livestock is second only to production by the oil and gas industry,149 and methane traps heat in the Earth’s atmosphere 30 times more potently than carbon dioxide.

Many drugs are prescribed for a reason that is no longer needed and may be doing the patient damage

Cows’ milk is not nutritionally adequate for a developing infant; therefore, supplementation is mandatory. Additives are necessary: eg, palm oil, coconut, rapeseed, and sunflower oils; fungal, algal, and fish oils; and minerals and vitamins. The use of these resources has an added and indisputable effect on the environment.

Readers who have chronic illnesses such as diabetes, COPD [chronic obstructive pulmonary disease] and heart failure may be familiar with the chronic disease check-up. This is a wonderful part of general practice called Chronic Disease Management, The prescriber goes through their medicines and as often as not will reduce or stop what is no longer needed as well as prescribing more appropriately. It is called deprescribing.

Many drugs are prescribed for a reason that is no longer needed and may be doing the patient damage. A palliative care nurse told me recently that she still goes to houses where cupboards are stuffed with unused and unopened medicines, all of which were made in a factory, transported, and packaged, often at huge financial and environmental expense. Exercise is one of the best prescriptions of all, with an all-cause mortality reduction of up to 30 per cent and GPs will encourage exercise and social prescribing.

General Practice is shifting the emphasis from firefighting disease to healthy lifestyles and sustainable models.