Targeting puffers and politicians

Prime territory for primary care to reduce its climate impact is to be found in the area of pharmaceuticals, says Christchurch specialist GP Dermot Coffey.

“[GPs] can focus on deprescribing, increasing patients’ pick-up of medications, and correct disposal,” says Dr Coffey, co-convenor of Ora Taiao – New Zealand Climate & Health Council.

He suggests aiming to prescribe only for the duration necessary, and analysing older patients’ medications to see which can be stopped.

The single biggest impact GPs can make to lowering their practices’ carbon footprint comes via asthma treatment. Dr Coffey has frequently made the call for prescribers to switch from metered-dose inhalers.

Last month’s inventory of New Zealand greenhouse gases shows 88 per cent of metered-dose inhalers sold in New Zealand contain a propellant that generates greenhouse gas emissions.

Each metered-dose inhaler of 200 puffs is equivalent to driving a Corolla for 500km, says Dr Coffey.

He points out the alternative, dry-powder inhalers, carries a CO2 cost that is less than 10 per cent of that for metered-dose inhalers.

He also suggests asking the local pharmacist whether they have signed up with a safe disposal system.

“It would be good to get a nationwide disposal system for all pharmacies…because studies show the metered-dose inhalers are on average half used when people think they’re empty. When they’re chucked in the bin, gas is released.”

Pharmac largely decides the range of medications general practice can prescribe from, with Ora Taiao and others calling for the agency to be required to consider carbon contribution in its funding decisions.

Dr Coffey says that primary care generates emissions via blood tests and radiology tests ordered, referrals made, and patients’ procedures carried out in other settings.

“Where possible, we should limit the tests we do,” he says.

He calls it a primary care physicians’ ethical obligation to advocate for changes beyond the consultation room. This can mean lobbying local politicians to provide more opportunities for walking and cycling, and to get rid of coal-burning.

Physical inactivity and air pollution are factors behind many illnesses and deaths, says Dr Coffey

The GP can also advocate for central government to do more to reduce poverty, which prevents many people from buying healthy foods that are lower in carbon emissions.