Healthcare's Role in Climate Change with Irish Doctors for the Environment

[00:00:00] Speaker A: This is Constructive Voices. Constructive Voices, the podcast for the construction people with news, views and expert interviews. [00:00:10] Speaker B: Hi to you. This is Jackie de Burker here for Constructive Voices. I'm very excited to bring you the second episode of Youth Month here in Constructive Voices. It's our first ever youth month of November 2025. The built environment, and of course the environment in general, are inextricably linked to our health and well being. We with so much media coverage on climate change and biodiversity loss, it is hard to ignore these facts. Places and people are also connected in various ways. The people who live in nature blessed places have a higher chance of good health than those whose homes are in concrete jungles with little or no nature. Here at Constructive Voices, we've investigated these topics in earlier episodes with guests such as Dr. Nadine Khala and Jane Findlay. But did it ever occur to you that when you have a health issue, your treatment may be bad for the environment? It's possibly the last thing on your mind, but anyhow, this is the topic that Kira O' Brien investigates in their interview with Dr. Lisa McNamee of Irish Doctors for the Environment. A not so fun fact, by the way. Healthcare is the fifth largest greenhouse gas emitter. Over to you, Kieran. Thank you very much. [00:01:19] Speaker A: This is Constructive Voices. [00:01:22] Speaker C: All right. Hi, Lisa, thank you so much for joining us. Can we start off with you telling us a bit about yourself and how you became involved with Doctors for the Environment? [00:01:32] Speaker A: Hi, Kira. Thanks for having me. So, my Name is Lisa McNamee. I am a medical doctor and a GP by training, and I'm currently one of the Irish Doctors for the Environment committee members. And I'm also the program lead for Sustainability and Planetary Health with the Irish College of gps. So I got involved with Irish Doctors for the Environment a few years ago through Dr. Sean Owens, who some of you may have heard of, who is a brilliant advocate for those doctors being role models in their community for decarbonisation, but also for, you know, actually looking really hard at their own medical practice and seeing how they're contributing to climate change. Sometimes in healthcare, we're not focused on very aware of the impact of the things that we do on a daily basis and how much they can drive carbon emissions. So I think once my awareness of that had been awakened, thanks to Sean Owens, that's really when I started getting involved and then I've gotten progressively more involved over the years. [00:02:53] Speaker C: Amazing. So I was going to ask you there about your kind of inspiration to connect your medical career, but you've already highlighted this. So I wonder, is your, like, does your environmental advocacy go beyond your medical career? Did you start in that before? Was it just with Irish doctors, the environment or how did they. How did they come together? [00:03:14] Speaker A: Well, I suppose before I became a doctor, I was an arts graduate originally. I did French and classical history in Trinity and I worked as a filmmaker for a number of years before coming into medicine. So I was always very interested in the environment and in environmentalism and climate change and so on. But I suppose I didn't really have an awareness when I started medical school of the impact of healthcare. Specifically, just for context, I suppose that, you know, if healthcare was a country, it would be the fifth largest greenhouse gas emitter on the planet. And that really shocked me. I think when I realized how big an impact it had, that really, really motivated me. I think because of my film and comms kind of background, I was very aware once I had this information that as somebody who has a natural interest in the area and wasn't aware of it, that it was something that I really needed to keep communicating to others because it's just not information that's readily available for lots of reasons, you know, in medicine we tend to be very focused on patient outcomes, as it should be. But I think that climate and carbon piece wasn't something that was built into any medical school curricula. That's certainly not any that I encountered at the time. I really, really felt passionately that if you're not even giving doctors and nurses, my other healthcare staff, the information of the impact of what they're already doing, how can we possibly improve the situation? So that really motivated me to get more involved. [00:04:57] Speaker C: Amazing. So I wonder then, like you've talked then about, if it was a country, it would be the, I think you said the fifth largest. So in what ways does the healthcare system contribute to environmental destruction? [00:05:13] Speaker A: So in a huge number of ways. So some of the most obvious ways that we'll all probably have encountered are around transport emissions. So, I mean, a huge proportion of the emissions that we would see in any healthcare system would be actually transporting staff and patients in and out of hospitals. You know, sometimes the transport routes aren't great. Staff are often not motivated or they're not incentivized as well to, you know, to leave the car at home, particularly if they're working in rural centres, we see a huge amount of transport emissions from medications, from consumables that we would use in healthcare. And then there's quite a lot of plastic waste. So I suppose, for obvious reasons, a Lot of, you know, consumables that we would use, say during surgical procedures or intimate procedures are single use. Now there are scopes for making some of those maybe compostable or there are re engineering programs where parts of them can be taken and used again once they've been sterilized. But you know, we are creating an absolutely enormous amount of plastic waste, a huge amount of medications as well. So we see a huge medication impact that's particularly worrying. And something in that we see a lot in primary care where I work is a huge proportion of the prescribing that's done both on kind of a maintenance basis. So you go in to get your repeat prescription from your GP or initiated prescriptions. And I think, you know, if I had one bit of advice to give to doctors generally or anybody really who's taking a medication, is to do kind of what we call regular medication reviews. And in those reviews, you know, to be asking things like does this person still need this medication? How much longer might they need it for? Because we're really, really good in medicine that's starting medications, but we're not so great at stopping them. And that's a huge problem because often what happens is people end up on medications in the long term that are not really meeting what we call kind of risk benefit criteria. So, you know, the risk can start to outweigh the benefit of the medication, even if it was really beneficial to the patient at the time it was started. So that's another huge source of carbon emissions is medication waste and medication overuse. Another area that we see a huge proportion of, of carbon emissions from healthcare are things like anesthetic gases. So there have been pilot studies done in this country actually over the last year, reducing some of the anesthetic gas usage, like nitrous gas that's used in anesthesia and that has an enormous carbon footprint. So we're seeing individual departments and within the HSC looking at how can we reduce the use of particular gases and substituting them with other things that are a little bit less, that are a little bit less destructive, basically. And when we look at things like particularly asthma and respiratory conditions, because in Ireland we have a huge proportion of the patients we would see, particularly children who have asthma, would be using short acting bronchodilator inhalers. So a lot of them would be on say a blue inhaler, ventulin inhaler, and again that would have a large carbon footprint. You know, for example, you know, some of those inhalers are, you know, the equivalent to driving 250km in your car, every inhaler. But they're also, you know, equivalents available that are much, much, much carbon footprint. One that comes to mind is Salamol, you know, and again, it's an equivalent medication according to the Medicines Agency, but it's just something that we would see a lot of overuse of. The other thing is that if you have a respiratory condition and the respiratory condition isn't well controlled and you're using a lot, a lot of inhalers throughout the year, you know, that is not a good signifier for your long term health, but it also has a huge carbon footprint implication. So we would love if patients who, you know, for example, are really having to use quite a lot of inhalers will go to their GP and say, hmm, actually, is there any way I can get better control of this? Because it leads to a better outcome for the patient and the carbon footprint goes down enormously as well. [00:10:06] Speaker C: I think that asthma thing is so interesting, especially with you talking about how treating asthma can fuel climate change. But then I'm also thinking about, we hear things about air pollution and how climate pollution can also cause asthma or make it worse or whatever it may be. So from your perspective, what are the most pressing health impacts of climate change that you're seeing now? [00:10:32] Speaker A: Well, I think in Ireland, you know, we have a very unique, you know, population in terms of, we do have a high rate of respiratory disease, so we're quite vulnerable to things like air pollution. Particularly, as you've mentioned, we do see increasing rates of air pollution these days. And I think that that's something that, you know, most medics are very aware of, but it can trigger, you know, worsening of things like asthma or copd, which is chronic obstructive pulmonary disease, which again, we have a high rate of in Ireland. And the big issue, I suppose, globally is that, you know, as climate change gets worse, we are seeing higher rates of not just general kind of air pollution, but, you know, kind of peaks of air pollution. So, you know, it's not a consistent thing that the air quality, you know, really, really varies from one day to another. And in some cities worldwide, you know, we're seeing really clogging smog and huge amounts of particulate matter, which are tiny, tiny, tiny bits of pollution basically that sit in the lungs and are really, really irritant to lung tissue. So even if you've got quite healthy lung tissue and you've got no respiratory disease, you can still, on those really, really smoggy days, actually become unwell or feel unwell, but if you have an underlying medical condition, like asthma or like copd, you can actually end up having an asthma attack or an exacerbation and become really, really unwell. There was a case, a very sad case in the UK recently of a child with asthma who unfortunately passed away. And it was the first case that I'm aware of in Europe, where the coroner had attributed air pollution as a significant factor in that child's death. So, sadly, it is something we expect to see more of over the coming years and decades if climate change isn't addressed. [00:12:36] Speaker C: Yeah, it's terrifying. It's absolutely terrifying. And that it's so many other things as well. With the air pollution, we hear about the heat waves being particularly bad for vulnerable populations. And I know myself, I've been hearing recently about the plastic pollution and microplastics and how that could impact health. And it's so scary, the unknown. Do you have any, I don't know, any insight on the microplastic issue and how that might impact future health? [00:13:07] Speaker A: Absolutely. And I think it's the combination of crises or the constellation of crises all kind of coming together, isn't it? So I think, you know, particularly you mentioned heat stress as well, microplastics. So heat stress is something that we see in terms of quite similarly to air pollution in that it has peaks and troughs. So places on the planet that are kind of naturally hot, becoming sort of intolerable to kind of that 50 degrees sort of period where you really can't, you know, work outside, you really, really struggle to be outside in direct sunlight. You know, for people with heart failure, for elderly people, for, you know, anybody, you know, without kind of a source of water and shade, even without medical conditions, would be extremely difficult to survive in those conditions for any length of time, for children, for pregnant women. So that is a huge issue. And it's something we're going to see, sadly, across more and more of the world, which will obviously continue to drive huge amounts of migration into cooler climates. And that causes its own difficulties, both for the people who are leaving and for the countries that it will go to. But also the microplastics issue is truly frightening. You know, we are seeing microplastics and different types of microplastics, you know, in brain tissue, crossing the placenta, crossing, you know, into fetal tissue and being present kind of in all levels of human and plant tissue as well. So there is no location on the planet at the moment that really, we know, is free from microplastics. We found them, you know, at depth in the oceans. We found them in Antarctica. So it really has given you kind of a sense of the spread of what was a revolutionary human technology. But now we're only really getting to the beginning of what the health implications for that may be, you know, in terms of kind of isolating microplastics as a factor on their own. It's quite tricky because there are so many, I suppose, confounders to try and say, well, are they responsible for, you know, fertility declines? Are they responsible possible for, you know, increased disease processes? I mean, we don't actually have good evidence for those. I mean, they have been implicated certainly in health conditions, but we don't, you know, those haven't been confirmed. But again, it's very, very difficult to get good data on these kinds of things because I suppose they're so ubiquitous. They're absolutely everywhere and they're in all types of tissue. Now, do we think that they're good for us? No, probably not. But do we have robust data to link them with specific conditions? Not to my knowledge at this time. [00:15:57] Speaker C: Yeah. I was reading something that said they tried to do a study, but they couldn't find a control group. And I just thought that was so frightening that we've impacted the world so much that we can't even see what it was before. So I guess now, like, look, you've convinced me, I'm sure you've convinced anyone listening that we need to do something about it. So what are the changes that you're calling for in global healthcare to reduce this impact? [00:16:20] Speaker A: Absolutely. So, I mean, from an IDE perspective, you know, we have been looking at a few key areas that we felt were the highest yield to focus on, particularly initially. But, you know, they're just kind of projects that have either occurred to us because we are doctors working in a specific area, or we felt we'd have the highest impact. So a couple of the projects I think I've just alluded to, one, was around the anesthetic gases and making changes there. Health Innovation Hub Ireland have been instrumental in looking at the green tech call that they had last year, where I was one of the clinical advisors for that project. And what they did was they found companies who were looking to reduce waste in the healthcare system, and they were supporting those. We have an inhaler recycling project that's coming up that's mainly focusing on the plastics involved in the inhalers themselves and kind of GP and patient education on the carbon footprint of different inhaler types and Then some colleagues of mine are involved in other projects that are looking at plant based diets in hospitals and in healthcare. We know that proper nutrition is really essential if you're unwell with either a chronic illness or recovering from an injury or a surgery. And it's really, really important that the food and nutrition that you're getting is really building you up after an event like that. But we do know as well that certain foods have a much higher carbon footprint than others. So essentially, you know, kind of at the top of their list in terms of carbon footprint are things like red meat, processed meat and dairy. And we know that if we reduce those in the diet, that we reduce the carbon footprint, but that generally we also improve people's health as long as we're replacing them with, you know, healthy alternatives like plant based foods. So that is a project that a colleague of colleagues of mine, Dr. Sean Owens and Dr. Johnny Almond, are working with a team of dietitians and with HSC Climate Office to try and I suppose bring that to the fore and try to improve diets both in hospitals and improve patient awareness of the impact that their diet can have both on their health and recovery, but also on their carbon footprint. That's one particular project that I'm really interested in. The other things that we're involved in are things like active transportation. So I suppose we mentioned that the big chunk of emissions that come from, you know, mainly cars traveling into work in terms of the health service. So we encourage, where possible, that healthcare staff in particular are able to use public transport, walk or cycle where it's possible and safe for them to do so. But also in terms of patience as well, you know, if patients are able, particularly if they're attending their GP or routine outpatient appointment, that they're able to take the bus or the Lewis or the train, or if they're able to cycle their bike or walk down to us. And, you know, sometimes people can be under quite, you know, a bit of time pressure and so on, or maybe there isn't safe cycling infrastructure locally. So if you find, well, that's well and good, you know, but actually there isn't a safe cycle lane near me. What we would really be encouraging people to do is to advocate for that safe infrastructure would be to literally write to your local counselors, to write to your local TD and say, why isn't this here? Why isn't it safe for me to bring my child? Or why isn't it safe for me to get to my GP or so on, on my bike? So that kind of thing. And we find that, you know, generally people, if you make it, you know, kind of personal to their own situation or what they could, you know, achieve in it, because sometimes people get very overwhelmed with the scale of the problem. And as we're talking about, you know, microplastics and heat stress and air pollution and transport emissions and diets and so on, it can feel really, really overwhelming. So, you know, I suppose if I was to kind of give advice to somebody getting started in this area or just becoming aware of it really, really would be to pick one thing to start with and find out a little bit more about, because it can get very overwhelming. But I think if you're involved in it and, you know, if you're involved in a project or you're able to make some sort of positive change and see the carbon impact that you've had, that's huge. And that's really motivating as well. [00:21:07] Speaker C: Yeah, I definitely agree with you that it is overwhelming. And I think for most people, healthcare by itself is overwhelming enough. And then to think about something as existential as climate justice on top of that is. It's overwhelming. I can definitely think when I got my wisdom teeth removed, you can be damn sure I was having jelly and ice cream straight afterwards, feeling sorry enough for myself, not thinking at all about the environment. [00:21:29] Speaker A: Absolutely. And look, that's completely reasonable. And I think, you know, the approach of idea is very much, you know, it's never about shaming individual choices. And this is why I was kind of talking about the safe cycling infrastructure. You know, like, it's very easy to say, yes, you should cycle to this and you should cycle to that. That will suit some people, it will not be possible for others, you know, it just won't be. So, you know, find out what you can do in your own environment. And like, sometimes people will say, well, that's fine. I'm working in Tullamore Hospital, I live rurally. It's not going to be possible for me to do that. Well, then we've had chats like that with people, you know, and colleagues of ours, and we'd say, well, is it possible for you to carpool, you know, a couple of days a week? And, you know, because often what's happening is, you'll see, particularly healthcare workers, you know, it's just them in the car. Yeah, they might be just taking a journey and, you know, it could be 20km, could be 40, and it's just them both ways. And we say, okay, is it possible for you to carpool Is it possible for you to take another car off the road, you know, for that period of time, you know, even if it's a couple of days a week, that would be enormous. That would be a big shift. You know, if it was two days a week for the year, that really adds up. And I think people really underestimate, you know, those tiny changes if enough people are doing them. That's fantastic. It's absolutely brilliant. [00:22:47] Speaker C: Yeah, sure. Even we hear about like with over or understaffed rather hospitals with people leaving very long shifts, being very tired. I can imagine carpooling is good even for just car safety. If you've worked a 12 hour shift, driving home mightn't be the safest option. [00:23:05] Speaker A: Absolutely, absolutely. And I think, you know, particularly, you know, after night shifts and things like that, even from a safety perspective, we would recommend people leave their car at home. You know, there's, there's unfortunately articles every year about doctors having come back from long shifts, not just in this country, but in others and you know, just having, having accidents or near misses and like anecdotally, you know, having chatted to friends and colleagues over the years, like it is an issue. So, you know, if you're able to get the bus or something like that, it is just a huge, huge deal. Safer getting you home after a long shift. [00:23:43] Speaker C: Yeah, that makes, that makes a lot of sense. So I guess you've given there some practical advice to, to doctors. We want to become more sustainable. Do you have anything else that they can do more in the job maybe, or something that they can get involved in themselves? [00:23:59] Speaker A: Yeah, absolutely. I mean, I think at any level, if you're working as a doctor, the biggest thing I think you can do is just have an awareness of whatever area of medicine you're in, what the highest carbon footprint is of your practice. Like for most doctors, that'll be medication for some people, for some surgical specialties and so on, it might be the tools that you're using or the plastics or something like that. But for the vast majority of doctors, whatever their specialty is, it's going to be prescribing. And we also know that prescribing is one of the biggest sources of harm to patients. Medication induced harms, whether that's, you know, unexpected side effects or interactions when they're on multiple medications, which we call polypharmacy. So one action that I would probably recommend to all doctors is really that, that regular medication review when clinics are really busy. It can be difficult to dedicate every time, you know, to have time to do dedicated medication review. But it's so important and I think particularly we would have increasing numbers of patients, say over 65, who would be on 10 or more medications and actually sitting down with the patient and sometimes with their pharmacist as well, you know, because doctors are not going to know every single possible combination interaction, you know, for thousands of medications, sitting down with the pharmacist and really seeing, like, is there anything there on that list that maybe could be contributing to the patient's symptoms or maybe isn't really giving great benefit, you know, any longer and maybe could be stopped? Because we know it decreases the carbon footprint, but we know it really, really decreases the risk of patient harm. So I think that's really important. Like, we do see a lot of medications that are started for the long term prevention of things like high cholesterol. Like we have a lot of statin usage in this country. And you know, statins will reduce your cholesterol and will reduce your risk of, you know, things like heart attack and stroke in the long term, which is extremely positive. But you know, if you have somebody that, you know, maybe has a life limiting condition, you know, is it really reasonable to keep them on a long term medication like a certain statin that's really an individual conversation with that patient, you know, if their life expectancy is, you know, sort of five years, six years, you know, really a statin is beneficial over, over a longer period than that, you know, to prevent kind of future events like stroke and heart attack. Like, is it reasonable to keep them on a preventative medication like that that they have to take every day to. Those are the kinds of conversations we would have as gps, just, just routinely anyway. But the carbon benefit is kind of just a side benefit to it, but it is something to be aware of or particularly, you know, if somebody is, you know, in their 90s. Again, is it reasonable to keep them on a preventative tablet, you know, that that really might be causing them irritation, having to take it every day. You know, there's a risk of side effects with every medication and maybe not giving them a great long term benefit. So again, you know, it's not black and white, but it is, you know, just those kinds of conversations do need to be had. [00:27:22] Speaker C: Yeah, and that's great advice for doctors, even nurses, pharmacists, and I suppose that patients or just general people can bring something like that up in their own appointment and say, do I actually need to be on these medications and kind of get their doctor thinking about it themselves. Is there any Other. [00:27:42] Speaker A: Sorry, Absolutely. Because most people don't like taking medication anyway. Like, it's rare that you will find someone that's like, yes, I would love to start taking more medication that potentially has side effects. Great, sign me up. I'd love to do it. And not only that, I'd love to do it forever. You know, so they don't necessarily want to do that. And I think, you know, sometimes it can feel. It depends on the dynamic and the relationship you have with your doctor, whether people feel comfortable, you know, kind of querying things. But I really would encourage people to do that because, you know, even if it's the case of you write down, you know, a list of questions that you have before you go into your appointment, I think that's really helpful and can help structure things. Because sometimes people find, particularly if they have, you know, multiple health conditions, it can be really, really hard then at the end of a consultation to say, actually, do I still need this? Or so on, you know, so I think, you know, I would really encourage patients to do that as well and to say, look, you know, I'm happy to keep taking it if I need to, and there's a benefit. But, you know, where are we with this? Do I still really need it? Or, you know, because some medications, unfortunately, we will be recommending that people stay on for good because taking you off them, you know, certainly could cause major problems. But sometimes that's not the case. And I think, you know, talking to them about, which is. Which is just really important. [00:29:03] Speaker C: Yeah. So, Giovanni, other than. So we have writer list of questions going in. Ask them if you need to be on that medication. The question thing is so vital, I think. I don't know myself. When I walk into an appointment, everything that was in my mind for the last week has just absolutely disappeared because it is a. It is kind of scary thing. It's a bit intimidating. So I think, for sure, writing everything down before going. [00:29:25] Speaker A: Writing things down is really helpful. [00:29:26] Speaker C: Yeah, yeah. Really, really helpful. Is there any other practical advice you'd give to your average person? [00:29:33] Speaker A: Yeah, absolutely. I mean, I think the big problems that we see in terms of chronic disease at the moment, particularly in primary care, a lot of them are related to diet and lifestyle. And that's not the fault of an individual. Like, we live in a very, what we call obesogenic environment, which, you know, is kind of the foods that we're eating, the level of processing in the foods, the busyness of modern life, it's really not conducive to, you know, eating well to preparing your own food, to kind of avoiding ultra processed foods and so on. So we do see a lot of people carrying say extra weight. We do see a lot of people in the kind of pre diabetes or diabetes realm with high cholesterol, maybe with high blood pressure, you know, and, and that causes a lot of long term issues for people. So if I was talking to people in kind of their 20s and their 30s, my biggest, biggest kind of bits of advice would be around diet and lifestyle. If your job is very pressured, you know, but it's desk based, it's getting that movement in the day is so crucial and it can be really, really difficult to do particularly in a lot of professional careers and like a lot of doctors struggle with this as well. You know, like you're sitting down at a desk for kind of minimum eight hours a day but like getting up to move and stretch regularly, giving your eyes a break from the screen and just getting those steps, steps in, in the day is just so important. Just keep your body systems healthy and well. And the other thing is just the, the ultra processing of our food, it really has, you know, we're eating so many foods that are not real foods that it's, it's, it has a really detrimental effect on our metabolism in the long term. And you know, I suppose some, some of the impacts of that are really well known and really well documented and others were sort of still finding out about, you know, but, but trying to kind of integrate whole foods into your life as much as you possibly can, you know, it really, really will stand to you as you get older. And it is so tricky to do what I would suggest if people are listening to this and thinking an absolute horror, like I only eat meat and dairy. I eat loads of takeaways and processed foods and so on, you know. And like when, when would I possibly have time to, to do all this other stuff? I would really say to start very small and with a couple of swaps, you know, to try and make it easy on yourself. Everyone is so busy, everyone has multiple commitments. You know, if you can make it easy on yourself to make a healthy choice, it will be there in your moment of weakness, shall we say. Like if your cupboard is full of chocolate and crisps, like that will be what you go to when you come back tired. You know, if there's a fruit bowl, there's plenty of water hanging around, you know, you, your desk in the day it will be easier to do. But you know, I would say most people are kind of who are eating fairly well, but still struggling maybe with weight or cholesterol, you know, making very small changes, like, you know, you know, kind of common meals in the Irish diet, like if you're having a spaghetti bolognese as a family, you know, half the amount of mince that you put in it, increase the amount of kind of fresh chopped, chopped tomatoes or you know, put in some lentils to replace half that mince, you still get the taste of the mince, but, you know, you're, you're really, really reducing, you know, the cholesterol in it and you're also reducing the carbon impact of the meal as well. So like you can make small changes. It doesn't have to be dramatic, like nobody's asking anyone to, you know, go vegan or anything like that, you know, which obviously, you know, is a much more kind of climate friendly diet, but it's not realistic for most people. So what I would say is do what you can. If you realize, oh, I can make a swap here, and it's a meal we have every week, that's fantastic, that has a huge impact. Because what we want to see is people making changes they can live with, not ones they feel they're suffering with. [00:33:46] Speaker C: Yeah, I love that. And I know a lot of people, especially my age would think about. So like I'm early 20s and there's loads of like these kind of diet fads and all that have kind of been replaced with fad foods. So like acai being a big one at the minute, matcha, pistachio, like those big foods. But then people talk about, well, they might have brilliant or even avocados five years ago. You know, they have these really healthy foods and they have this really good impact on your diet. But because they're being transported and because they're a fad, they're putting pressure on, on agricultural systems. So what do you think then about those kind of very foreign foods that are, are still very good for us, but that transport issue is coming into it? [00:34:33] Speaker A: Yeah, absolutely. So I suppose the farther something comes to you, then you are looking at those transport carbon emissions. We know that generally meat and dairy, even if they're local, have a higher carbon footprint. But you know, at the end of the day, like if you're just eating avocados that are coming from South America, that has a huge carbon footprint as well. So like if you're in the supermarket and you're looking at grapes and there's some from France and there's some from Australia, you know, really factoring in those transport miles when you're shopping, if you're able to, would be fantastic because we know that particularly air miles, which a lot of, you know, easily spoiled foods like fruit and so on, are often transported by air and they have, you know, a much higher carbon footprint. So it's something to bear in mind if you're shopping. The farther away comes from, the better. Sorry, the worse in terms of the carbon footprint. But yeah, if you're, if you're able to shop local. And the other thing about it is picking things that are in season. So you'll notice that a lot of kind of farmers markets and so on, they'll have a real glut of certain fruits and vegetables at different times of year. So some of the national newspapers will do a kind of Watson season at the start of each growing season. And it's actually lovely because if you can eat more seasonally, it really, really will help in terms of the carbon footprint. You're putting a lot less pressure on agricultural systems, on water systems across the world as well. [00:36:10] Speaker C: Yeah, very interesting. I'm having loads of these. Oh, my God. I should have thought of that moment that, like, these are things in your daily life that you just don't think about. And I'm wondering, have you had any of those kind of aha moments in your career where the climate health link, like, really hit home for you? [00:36:28] Speaker A: Yes. And they're not always good moments, are they? They're so like, oh, dear. Yeah, so my, My biggest one is flying, which, which upsets me, actually, because I love flying. I'm. I'm a real sort of aviation nerd, generally. I love to fly. I am an aviation medical examiner, qualified. I'm really interested, like, space medicine research and so on. But flying has a huge carbon impact. It has a huge carbon footprint and, like, really, really enjoy, you know, kind of traveling. I enjoy, you know, going to conferences abroad and meeting colleagues internationally and working on these kind of things. And it's. It's forced some really hard conversations about what is justifiable. And, you know, like, when I look at my flying, say five or six years ago versus now, it's. It's completely uncomparable. Like, I just don't fly nearly as much at all. And, you know, like, I still fly sometimes, but even that, like, I really struggle with, because I know that most of the global population does not fly. And in my view, it probably is one of the most discretionary forms of climate impact or carbon footprint that I personally have. So it's something that I really struggle with. And I Often will sort of rationalize, you know, if I go to a conference one year, that's abroad, okay, well, I can't, I can't travel long haul now for the next few years, you know, and that's awful in some ways because it, like it really, especially from a medical perspective, like, and I'm sure a lot of careers are like that. Like if you're looking to build your research lab or your network and all those, like those face to face interactions with people are really important. So you know that you're making a personal sacrifice on it. But it, but it, like, in my view it's completely necessary and I could probably do more on that, you know, but it's really tricky, you know, it's, it's really all about trade offs as well because like, you know, there are so many people globally who don't fly at all and it is a tiny number because we're on an island. It is very tricky to say to people, okay, well, actually flying has a huge carbon footprint, you know, particularly if you're nipping away for a weekend away, you know, a few times a year. Those short hops really, really, really add up. You know, obviously long haul is much more, you know, impactful if you're doing it a lot. But a lot of people would, you know, in Ireland particularly, you know, have occasional, you know, say maybe once a month, once every couple of months, they might be heading off somewhere if they have the budget for it. But it is a huge problem. And I suppose when you look at, you know, aircraft fuel and all those kinds of things, you know, they're not really taxed, you know, in that same way that you would have, you know, duties on, you know, car fuel and so on. So it is a bit of a loophole because it's international, it's not based on national laws and national taxation. So that's a huge problem. But it's also a very emotive one. And it's very difficult to have that conversation with people, particularly people who travel a lot for work without coming across as very, very judgmental. When you're talking about health, it's sort of easier because most of the climate impacts that you can achieve in healthcare often also have a good health impact. You know, the link with flying, for most people, it's not as straightforward. There's no personal benefit to them. It's a, it's a negative to them generally. So it's quite tricky to have that conversation. It's something that IDE has been very outspoken about and I probably am the most aviation enthusiastic, as far as I know, out of the whole group. So I think for me, it's something that I really struggle with. [00:40:30] Speaker C: Yeah, I'm thinking myself like, I'm, I'm so bad for flying. I'm, I'm good for vegetarianism, I'm good for public transport. For the flying. Yeah, it's really. And I was talking to a friend of mine yesterday, we were saying that maybe if you're going to a work conference to book a couple of extra days staying in that place there and call that your holiday rather than also going somewhere, somewhere else. [00:40:52] Speaker A: Yeah, so that's what I've done in the last few years is to try and basically drag the family with me conferences. But yeah, it's really tricky and I think, you know, everyone has to kind of find their own sort of compromises that they can live with. When I'm talking to medical colleagues, you know, and they're organizing conferences, I really encourage them to have a hybrid option, you know, really, really encourage them. Now that's not without a cost implication for them, but it's also very inclusive, you know, like I often find, like I'm a parent as well and like, you know, you can only have so many conferences in the year, like sometimes that you really want to attend, but, you know, you can't, you just can't like justify, you know, you're like, well, look, this is time away from my family. So again, it has to be justified from that angle as well. And at least if you have a hybrid option, you know, you are offering people the chance to still get the knowledge that they need or present their work without having the carbon footprint impact. But also, you know, to maybe attend part of the conference if they've just had a baby or something like that and they're not excluded. So that's, that's another nice kind of impact of it as well. [00:42:05] Speaker C: Yeah, I really like that. I'm thinking there that. I'm thinking, you know, flying might be something people aren't willing to get off, give up. I was thinking, God, like people, I don't know if you told someone on their period that they can't take painkillers because the amount of painkillers that especially adolescent, like people who menstruate take is, is quite significant. And we talk about reusable sanitary pads and menstrual cups and all of this, but we don't talk about the impact of, of the painkiller that you're taking. Is there any. Would you give advice? Is there any painkiller that might be better over another. If I'm taking ibuprofen, should I be taking paracetamol, anything like that? [00:42:46] Speaker A: From a climate perspective, I would say when it comes to painkillers, we tend to be very directed by what works for the patient because often what will happen is particularly people who are, I suppose very climate conscious will say, well, I can only have this because it has a bigger impact or less of an impact. We tend to try and stay away from that for painkillers. And the reason is that we don't want people to be in pain because we know that that has other knock on effects and it's just uncomfortable for the person involved as well. But I would say that generally, like if you're having very debilitating, very painful periods, you know, it may, the painkillers may not be the solution to that. It may be something like reducing your periods in the first place or giving you better control of it, or even might be an underlying condition like endometriosis that might need investigation. So sometimes, you know, we will see patients in our clinic who have very problematic, you know, periods and we're able to assist with that, whether that's through contraceptive pills to give them more control over and reduce the flow of the period as well, which can be, reduce the pain too, and then negate the need for painkillers. Or sometimes people can get intrauterine coils, which I suppose were more common, you know, in people in kind of their 30s and 40s who'd maybe had babies previously. But actually now there are coils on the market that are designed for, you know, women and girls who've never had, who've never had a baby. So like, there are certainly other avenues around kind of period control and reduction that might reduce the need for painkillers also. [00:44:32] Speaker C: Okay, but if you're taking a couple of painkillers once a month, you wouldn't be too concerned about the clients? [00:44:37] Speaker A: No, in the grand, in the grand scheme of things, for medications prescribing, I would not be concerned about that. No. [00:44:43] Speaker C: Okay. I think a lot of people would be very happy to hear that. [00:44:48] Speaker A: We can get kind of fixated on, on absolutely everything as well. And you know, I think it's important that if you're in pain that you, you do take that painkiller because I suppose if you're in pain and you're not taking your painkillers, you know, obviously it has knock on effects for your work, for school, for, you know, potential, you know, inflammation, disability, all that kind of thing down the line. So I think, yeah, it's, it's worth, it's worth making that small, small sacrifice of it going forward. [00:45:17] Speaker C: Yeah, I, I like that quite a lot. Thinking of now pivoting the conversation a bit towards neurosustainability. So over the coming weeks and months, Constructive Voice is going to be doing some work around neurosustainability. So I wanted to ask you for your input on it. So we hear this idea of neurosustainability being like this emerging field that links brain health, behavioral science and sustainability. So it could be something like how your built environment affects your brain health, stuff like that. So how important do you think this concept could be in shaping both health and environmental policy? [00:45:56] Speaker A: I think it's a really interesting area because I suppose we know that our cognitive health or brain health is both influenced by our environment. And I mean, you know, our built environment, sure, our emotional environment, our work environment, our home environment, all of those things. But also that if we are mentally unwell or feeling unwell in ourselves, in terms of mood, in terms of anxiety or stress, like that has a recognizable impact also on our physical health. So we're much more interconnected than I suppose, than was previously thought. And this growing awareness of the impact of cognition and cognitive health on immune physical processes, metabolic processes and so on. So there's a lot more interaction in that than we think. And when we're talking about, you know, things like gut health, we're talking about the ultra processed foods. You know, there is increasing research looking at, you know, the impact of gut health on the mind and on cognition. And it's really, really interesting and it's a really developing field at the moment. But it is interesting to see that in primary care we're seeing a lot of, really, for the first time in the last couple of years, a lot of social prescribing. And a huge amount of that is it's not necessarily aimed at people who have a mental illness, but it's really aimed at anybody who is sort of disconnected from nature or maybe disconnected socially. Because we know that people who are very well connected to their environment, to a natural environment out in nature, whether that's, you know, forest walks, whether that's on a farm, whether that's involved in growing food or gardening, and also very, very well connected socially, they tend to do better in terms of mental health in the long term, particularly when they're faced with, you know, very difficult, maybe situations in life or upheavals or challenges. So in terms of social prescribing, we are seeing an awful lot more of that. And I suppose in terms of neurosustainability, that would be the area that I would see kind of primary care having a role in. When you look at things like hospital design or primary care clinic design, increasingly there's an awareness of the value of biodiversity. I know that the HSE has a project at the moment looking at their sites across the country, you know, to identify areas where biodiversity could be improved. Because we know that that connection with nature is good for staff well being, it's good for patient well being and that's really, really important, particularly when people have been very unwell or potentially have been in hospital to boost their recovery and their wellness. [00:49:04] Speaker C: Yeah, I love that. I love seeing those courtyards with the different foliage in like nursing homes and stuff. I really do think it's so nice for people who are, who are there long term to get that access to nature that they can't have so much. Really interesting you mentioned as well, gut health. And I think sometimes we talk about like the link between gut health and mental health, which I hadn't heard much about and I'm not sure the state of the, of the research in that perspective, but is there a climate link there with if the ultra processed foods obviously having a higher environmental impact, if they're moved around and use machinery and plastic packaging and the gut health and then your mental health as well? [00:49:53] Speaker A: Absolutely. I think, you know, when you're looking at gut health, there's so much so, so many levels to it, if that makes sense. You know, you can have, at a basic level, if you are, if you are under a lot of stress or pressure, people don't tend to absorb nutrients from their food as well. Sometimes. You know, anyone who's ever had a really, really stressful exam can attest to the fact that they might have bloating, stomach upset, sensation of butterflies in their stomach, you know, or even constipation or diarrhea. Like our, our gut is very sensitive to stress hormones particularly. So it's, it's, it's something that we know there's that connection anyway. But I suppose when you're looking at kind of the types of food that we eat as well, that kind of processed food and so on, we also know that, you know, depending on what you eat, the bacteria in your ghost change. So if you are eating, you know, mainly plants and you've got a very, very good, you know, very well balanced diet, the chances are you have a healthier gut microbiome than somebody who is eating A huge amount of processed foods and that has a huge impact. You know, certain foods have been linked to the huge increase in, you know, younger people presenting with bowel problems up to and including bowel cancer. And some of those foods have been marked as carcinogens, which are, you know, cancer causing agents. And that's obviously really concerning. There's lots of different, I suppose, avenues that kind of link to your gut health. But, but huge amount of it is the type and quality of food that we're having and also kind of the stressors and exposures that we have as well throughout the, throughout our lives. The other thing that is really important for gut health is movement. So when you look at, you know, as I think most of us have jobs where we're sitting down for a lot of the day, not getting a whole lot of exercise and those sedentary sort of lifestyles, unless we're getting up and moving, you know, quite a bit. What you kind of end up getting is an increased risk of problems with your gut as well. It can lead to things like constipation kind of slows down in terms of its processing, which can lead to inflammation in the gut as well. But also it can lead to conditions like diversity reticulosis, where you get out pouchings of the bowel which can then become inflamed and infected and so on, can lead to abdominal pain. So some of those can be genetic, some of them can be related to sedentary lifestyle or diet and some of them can be a combination. So it can be hard to pin, you know, all kind of symptoms on the one thing. But there's definitely, definitely impact from diet on it. The other thing you'd see is that, you know, we're seeing a huge increase globally in type 2 diabetes. And we know that a lot of ultra processed foods have a really high sugar content and that is thought to be a huge contributor to the increase in type 2 diabetes cases that we're seeing along with excess weight, along with genetic factors, factors as well. But that's a huge issue. And you know, diabetes has a huge amount of different effects on different body systems, but you know, it can also impact on the brain. It can increase your vascular risk, which is, you know, your kind of risk of, you know, damage to your blood vessels in the brain, damage to your blood vessel in your eyes and kidneys and so on over time, which obviously impacts your mental health, you know, in the long run because things like vascular dementia and so on are more common. So it's really, really tricky to I suppose draw a straight line from, you know, this particular food is at fault here, but it is just the environment that we're living in at the moment where a huge proportion of the foods that are on sale affordably or that are available to people, you know, have a high fat content, have a high sugar content or are very processed with a lot of non kind of naturally found ingredients. And these all have an impact on I suppose, our risk of disease development, but also on our gut and mental health. [00:54:42] Speaker C: I love the, the trend throughout what you're saying that really with healthcare, climate justice, we don't have to give something up, we actually get something as well as helping the environment. So we get our active travel in, we get our better diet, we get our better mental health, connecting with nature. I absolutely love that because it is a tough thing that it's mostly we have to give something up or we have to sacrifice for climate justice. So it's really nice to hear that from you and I've really loved talking to you today. So I might ask you one more question before we finish up, which is where can people learn more about doctors for the environment and how can people get involved. [00:55:21] Speaker A: Involved. So it would be great if you wanted to get involved. We are mainly medical doctors, but we include students, we're happy to include any allied health professionals. And then we sometimes also have events for the general public. So there's no barrier. You don't have to be a doctor to support what we're doing or to get involved. But mainly the best way is through either our social medias. So we're generally at id, ide, which are doctors for the environment or on our website. That would be the handiest way to get us and that, that would be great if you wanted to reach out. [00:56:00] Speaker C: Thank you so, so much. Thank you for joining us today. It's been absolutely amazing to talk to you. [00:56:05] Speaker A: Great listen. Thanks Kira. It was lovely to chat to you. [00:56:08] Speaker C: Thank you. [00:56:09] Speaker A: This is constructive voices.