Sonia Roschnik has long worked in health and social care. She has worked for the Sustainable Development Unit (NHS England & Public Health England) since 2008 bringing together a keen interest in the natural environment with her work as a health professional. In 2015 she took up a position at Sustainable Health Solutions and returned to the SDU this year as its Director. She shared with Zoë Arden what she has learnt.
In the UK we are lucky to have a Sustainable Development Unit. We’re lucky to have the NHS. A system with common values, a recognition that this is a contribution to society broadly. In many countries, hospitals are private with a very different ethos.
Working in different parts of the world in sustainable health gives you fresh eyes and new perspectives. I can ask more relevant questions and look at challenges with insights gained from other parts of the world and what they are doing.
The NHS mindset is disease, and necessarily so – healthcare rather than health – it is only responsible for 20% of our health. But people, communities, environment have a huge influence and much more a cornerstone of health, but we don’t value them as much, we value the high-tech aspects of healthcare.
One of the things I feel we are in danger of doing is being very disease deficit focused. If we could be more asset focused, we’d naturally value our environment more. And we’d value what people bring to it a lot more. I’d like to turn it on its head. Health is about wellbeing, it’s quite a different concept to absence of disease or absence of problems in your life.
The pinnacle of sustainability in health might be to avoid bad health from the start. Prevention is absolutely key. Air pollution work is a good example of that. The healthiest hospital is the one that doesn’t exist, because it is not needed. Needs not just to be about healthy individuals but healthy communities – the concept has really taken off that communities are essential to wellbeing. The evidence of what works in wellbeing is very powerful and we need to support that.
In the way we deliver care we can ensure we do that in a less environmentally damaging well – there’s a whole host of things around that that could be done.
Health sector contributes to air pollution and there’s a lot more we could do to reduce our impact. We could change our fleet and looking at what it could take. You might have clean air zones around suppliers. Great Ormond Street Hospital for Children in London has done a lot of work on preventing idling in the area, focusing the campaign around children’s health and that was very powerful.
Many people are concerned about things like plastics, there is increased public consciousness. Some might say it’s not the right thing to focus on but it’s a good point of entry to a wider consciousness. Carbon – we still hold on to that – but it is not a word that resonates with the public in the same way as plastics. How can you capture that as a point of entry to a wider consciousness to how we live and what our environment is about?
You need to think out of the box about unlikely allies. Yes, society is an unlikely ally on plastics but possibly could be distracting as there are some plastics that can be useful, we need to differentiate between what are right solutions and what are not, we need time to get it right. I was going to say industry is potentially an unlikely ally – they want to be the suppliers of the future and so engaging in the longer-term conversations of what it can look like is important.
You need to be prepared to take a few risks and say this feels like the right way to go. What you say and how you do it is quite visible. Coming across that we don’t have all the answers and to invite people on the journey is important.
My postgrad in Systems Thinking taught me not to be frightened by how complex and necessarily messy everything is. We like to reduce things to a comfortable linear pattern with an input and an output, and that feels good, but it doesn’t mean that its right. System thinking really helps you consider that your point of interest might be quite tangential to what you think of immediately. Suspend belief, be curious, try to have an enquiring mind, you approach things in a different way, you try and consider all different elements at play.
It is important to remember you are just one person among all of this. Need to consider different worldviews. I’m always listening out for signs and symptoms that things are moving or changing.
There is much that we can learn from other parts of the world. Some countries are going to ahead on some aspects: e.g. Africa and apps, even for mental health – the NHS needs to be poised to learn from others!