Climate change policy as prescription for British health care?

Will tackling climate change make us healthier — and save the NHS?

Since Michael Moore pumped up Britain’s National Health Service in Sicko, there’s been a fair amount of debate on both sides of the Atlantic as to whether this iconic brand represents a model for other health-care systems in the world, or an unsustainable drag on Britain’s ailing national budget. Several recent studies have intensified this debate.

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A report out this month from McKinsey & Company, commissioned by the British government and leaked to the Health Service Journal, suggested that Britain’s NHS cut costs by trimming 10 percent, or 137,000 of its 1.4 million employees. The British government and its labor unions quickly rejected the proposal. With an election only months away, politicians are reluctant to talk about cuts to the service. Some are even promising to “ring-fence,” or safeguard, the NHS, an approach that augers much bigger cuts elsewhere.

At the same time, two ongoing public studies are attempting to create a strategy for sustainable healthcare. The first, “Post-2010 Strategic Review of Healthcare Inequalities,” was commissioned by Prime Minister Gordon Brown himself. Researchers quickly identified “the wider determinants of health” — food, housing, physical activity, education, and especially environmental quality — as key to the equality gap. (As part of this larger study, my organization, Forum for the Future, is developing a vision for what a sustainable health-care system would look like in 2025 — a national service that functions within environmental limits and helps British citizens live healthier, more environmentally sensitive lives.)

This week, the NHS launched its own study. Titled “Fit for the Future,” the study’s exploration of possible scenarios for the health-care system in 2030 is driven by a range of potential responses to climate change.

The NHS report shows that the impacts of climate change will be more far reaching than a the usual handful of new tropical diseases or the odd heat-wave death. Carbon-intense medical treatments and patterns of service delivery, such as hauling supplies to all those big hospitals on ring roads, will become prohibitively expensive. Immigration driven by climate change and an aging, obese, diabetic, and asthmatic population will combine to put even more pressure on medical services.

Clinicians and service managers involved in the “Fit for the Future” study concluded that the NHS must focus on prevention — encouraging exercise, healthy diets, and a healthier environment — rather than clinical intervention. Currently, the NHS spends only about 4 percent of its budget on preventive medicine. Shifting to a more preventive model will require the NHS to convince its clientele to take more responsibility for their health.

Whether the NHS can effect such a change at a time when resource constraints are so severe remains to be seen. But the twin impacts of tight budgets and global climate change may finally compel the NHS to shift focus in ways that have made sense for years but have languished for lack of political support.

At roughly £90 billion ($150 billion), the NHS is the biggest single item in Britain ‘s public spending bill. The NHS is also Europe’s largest public-sector emitter of greenhouse gases. Cutting carbon from the health-care service will save a lot of money. Add to that the evidence that low-carbon lifestyles are actually healthier, and you reach a strange conclusion — that tackling climate change might be the best health — care reform of all.