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Citizens’ survey on the climate emergency and sustainability Strategy in Scotland

Written by NHS Scotland

Categories: Climate Resilient Health Systems, Low Carbon Sustainable Health Systems, Net zero health systems, GHG emissions baseline assessments, Country experience, Europe

Country: United Kingdom of Great Britain and Northern Ireland

Citizens’ survey on the climate emergency and sustainability Strategy in Scotland

Context

The climate and ecological emergency is a health emergency. Human health is inextricably linked to the health of our planet and its natural systems. Climate change presents direct risks to human health such as extreme weather events, while also undermining the conditions thatare necessary for good health. In Scotland, the warmest summers on record have been observed over the last years, with multiple heatwaves and wildfires directly threatening the health of its people. Similar patterns are seen around the world, with numerous repercussions on human livelihoods and health, including through greater food and water insecurity resulting from climate disruptions.

Importantly, environmental and climate action can have co-benefits for health if delivered with the right intent. For example, eliminating fossil fuels can improve air quality, and positively impact health. We have a moral obligation to help tackle the greatest threat to human health by reducing our impact on the environment. Responsibility rests with us all.

To play our part in tackling the climate crisis, NHS Scotland is aiming to become a net-zero health service by 2040 at the latest.

We want to maximise our contribution to reducing emissions from the manufacture and supply of medicines and equipment and from staff, patient and visitor travel. The level of those emissions is determined by clinical decisions and models of care and so the involvement of all health professionals in efforts to improve sustainability is essential to success. We need to establish a culture of stewardship within NHS Scotland, where resources are safeguarded and responsibly used to provide environmentally sustainable healthcare. There are tools that we can use to make the NHS more environmentally sustainable and improve patient care. Health services and clinicians can also play a role in advocating for health promoting, environmental action in other areas such as transport and access to nature.

The Scottish Government’s Sustainable Care workstream wanted to seek public opinion on what matters to them when balancing patient care and safety with environmental sustainability.

Through the Citizens’ Panel, the public have endorsed NHS Scotland’s Climate Emergency and Sustainability Strategy. They expect patient care and safety to be delivered having due regard to environmental sustainability. This feedback is being used to inform future direction of the Sustainable Care workstream. It is also being shared with the programme for potential wider action.

 

Implementation process

The NHSScotland Climate Emergency & Sustainability Strategy aims for an environmentally and socially sustainable health and care system that improves the health and wellbeing of people living in Scotland. This includes becoming carbon neutral by 2040 or earlier if possible.

The Citizens’ Panel survey is the first national population opinion survey focused on issues relating to climate change, sustainability and NHSScotland. Respondents were informed that their feedback will be considered in future planning to address building a health system that cares for people and the environment.

Methods

The Citizens’ Panel is a ready-made, representative sample of the Scottish population (1,028 members from across all 32 local authority areas) allowing quick access to public views. This gives NHSScotland a sustainable way to engage a representative cross section of the population as new surveys do not need to recruit a new sample of the population. The panel does have to be refreshed from time to time to ensure it is robust and representative. Panel members’ views are gathered via electronic, postal and interview survey according to members’ preference, ensuring an inclusive approach to engagement.

Feedback on the NHSScotland Climate Emergency and Sustainability Strategy was sought between November 2023 and February 2024, achieving a 57% response rate (589 responses). This level of return provides data accurate to +/-4% and is robust at the overall Panel level.

Results

Three quarters of Panel members were very or fairly concerned about climate change (75%), 18% were neither concerned nor unconcerned and 7% were very or fairly unconcerned. Of most concern to Panel members in relation to damage to the environment were the loss of wildlife and biodiversity (63%), and this was followed by waste (56%) and air pollution (50%). Just 4% of respondents said they were not concerned about any damage to the environment as a result of climate change.

Respondents were asked about the impact of climate change and damage to the environment on their own personal health, their family’s health and the health of Scotland’s citizens. This revealed that over half of respondents were of the opinion that climate change and damage to the environment poses a great deal or a fair amount of threat on the health of Scottish citizens (58%) and on the health of Panel members’ families (52%). However, just under half of respondents were of the opinion it has a great deal or fair amount of threat on them personally (48%).

Respondents were more likely to consider climate change to pose a great deal of threat in 40 years time (62%) than right now (12%). Panel members were asked for their opinions concerning responsibilities and priorities in relation to climate change:

  • 81% agreed that patients have a responsibility to help NHS Scotland to reduce its impact on climate change and the environment. 
  • 75% agreed NHS Scotland has a responsibility to reduce its impact on climate change and the environment.
  • 55% agreed NHS Scotland should make reducing its impact on climate change and the environment one of its top priorities, although 20% disagreed.

The vast majority of the Citizens’ Panel are in favour of NHSScotland pursuing a strategy towards achieving Net Zero. Panel members acknowledge the importance of considering risks from environmental damage, including climate change, in healthcare provision and suggest moving towards a Net Zero approach to reduce environmental impact.

 

Lessons learned

Challenges

By 2040, NHS Scotland wants to have achieved ‘Net Zero’. The goal of achieving Net Zero emissions is a crucial part of global efforts to combat climate change and limit global warming to below 2 degrees Celsius above pre-industrial levels. Our efforts to reduce emissions need to be as rapid as possible, since earlier mitigation reduces the scale of change required and, as climate 13 breakdown progresses, impacts on critical infrastructure will impede emissions reduction efforts. We recognise that, where possible, changes should be prioritised and action initiated before 2025-2030 to ensure effective delivery. The cost of inaction or delay will dwarf the cost of action on climate and biodiversity, and increase the burden of chronic disease and the need for increasingly urgent actions to limit emissions. Desîte the urgency to act, a key finding of the survey was the lack of public awareness around the NHS Scotland objective to achieve Net Zero:

 

Success factors

  • The Citizens’ Panel Report was seen as a helpful measure of public opinion. It is beneficial to policymakers to see what matters to the public when balancing patient care and safety with environmental sustainability, especially when 8 out of 10 people surveyed felt NHS Scotland has a responsibility to reduce its impact on Climate Change and the environment.

  • The Scottish Government’s Sustainable Care workstream is using the evidence and data gathered to inform current and future practice. Public opinion will continue to be sought as NHSScotland strives to decarbonise.

 

Recommendations

The Citizens’ Panel Report is a helpful measure of public opinion at a point in time. The programme should however look to receive continuous feedback from the public as we move forward, to make sure what we design and deliver continues to support patient care and safety while taking all necessary action to achieve Net Zero by 2040.

Based on our findings, the following recommendations were made to the Scottish Government and NHS Scotland:

  1. Consider the results of this survey and people’s support for NHS Scotland to reduce its environmental impact in medical equipment, travel and goods and services.
  2. Act on the findings that people are willing to take actions to reduce the environmental impact of NHS care such as medicines use.
  3. Increase awareness of NHS Scotland’s Net Zero objective through the likes of TV and social media campaigns.
  4. Enhance awareness of climate change's impacts on individuals (present and future generations), making it more personal, thereby boosting willingness to adopt adaptation and mitigation practices and enhancing the population's resilience.
  5. Conduct deliberative engagement to understand where the boundaries sit in people’s willingness to change e.g. what inconvenience is too much when having to use different medications and understand how people think they can help NHS Scotland become more sustainable.

 

Key resources

 

More information

For more information, please contact Gary McGrow, Social Researcher, Healthcare Improvement Scotland gary.mcgrow@nhs.scot

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