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By ISQua Thursday. Aug 17, 2023

Workshop to develop a new ISQua Green Paper on high quality and environmentally sustainable healthcare Featured


in the run-up to the 39th International Conference of ISQua in Seoul, 2023

 ‘Technology, culture and co-production: looking to the horizon of quality and safety’


Workshop to develop a new ISQua Green Paper on high quality, environmentally sustainable healthcare


The horizon of quality and safety in healthcare is rapidly becoming obscured by one of the biggest threats to public health: the escalating ecological crises. It is not just the global warming of the planet, it is also the loss of biodiversity and the widespread pollution of the air, the water and the soil that seriously affects our health in multiple ways. Recent climate science demonstrates that several vital planetary boundaries are being breached, even to the extent that this cannot be reversed. The scientific evidence is unequivocal: the natural systems that support all life on earth are in clear and present danger.


As healthcare professionals we are confronted with the consequences. No matter where we live, we will observe an increase in health complaints and diseases that directly or indirectly arise from environmental or climate causes. We already see more cardiovascular diseases, respiratory diseases, infectious diseases, cancer, mental health problems attributable to environmental degradation. Of course the incidence, prevalence and severity vary with where you live on the planet; extreme weather events like flash floods, storms or heatwaves are more likely to occur around the equator. Low-resource countries with fragile health systems will suffer harsher consequences. Same for vulnerable people in both low- and high-income countries: mothers and babies, children, the elderly, and patients with chronic disease. Social determinants of health play a compounding role – as those with less income, education, housing or work opportunities are less able to cope with the climatic “shocks”. The environmental determinants of health put people in a precarious situation: those who live in coastal areas will have to flee from the rise of the sea-level. Food insecurity, conflict and forced migration crawl upon the lives of millions. The impact is enormous. The cost as well.


So what can health professionals do when we realise that our health depends on the health of the planet? Unfortunately, the health sector contributes substantial greenhouse gas emissions, pollution, waste. If global healthcare were a country it would rate as the fifth most polluting country in terms of greenhouse gas emissions. Do we have a moral obligation to ring the alarm bell and prioritise to work on ‘greenifying’ our clinical routines and models of care? We have the ability to prevent (mitigate the causes of climate change), treat (adapt to what cannot be prevented) and advise patients and colleagues to promote health (raising awareness on the health impacts). If we look at our products, processes and services we see many opportunities for making healthcare more sustainable.


ISQua was one of the first scientific and professional healthcare organisations to explicitly address this global challenge and take action accordingly. The ISQua Declaration on Climate Change at Cape Town in 2019 was very clear: working towards sustainable healthcare is part and parcel of our mission to improve health worldwide. Simply because green care is better care. Because we don’t want healthcare to harm people. This effort is perfectly suited to the quality improvement (QI) lens. We can use the same concepts, tools and approaches. Think of accreditation, co-production, theories of change, the use of PDSA cycles (plan-do-study-act), process mapping, or de-implementing low-value care.


ISQua is leading the charge at this year’s international conference in Seoul. Dr Adi Vyas and Dr Hans Ossebaard will lead a Workshop (Monday 28th August 2023 from 12:45 to 13:30) dedicated to how we can redesign our health systems in order to be in harmony with the natural environment. We are developing an ISQua Green Paper on this theme and we would like to consult and engage with the ISQua membership at the Workshop. We will address subjects like:


  • how to equip ISQua members with knowledge on the threats to health from climate change, and to the solutions to address this from quality improvement and patient safety perspective;
  • setting out the position of ISQua on the role of health systems in responding to the eco-crises;
  • advocating for environmentally sustainable (green) interventions to transform health systems;
  • strengthening quality and safety in healthcare through the lens of environmental sustainability.


ISQua wants to take pole position in what is nothing less than a transformation in already revolutionary time in the Anthropocene.


  • Join us at the Workshop, come share your experiences in order to brighten up our horizons and work together for a better world.

Adi Vyas / This email address is being protected from spambots. You need JavaScript enabled to view it.

WHO Collaborating Centre for Climate Change and Health Impact Assessment, Curtin University, Australia


Hans C Ossebaard / This email address is being protected from spambots. You need JavaScript enabled to view it.

National Health Care Institute | Athena Institute, Vrije Universiteit Amsterdam, Netherlands


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