Photo: Dr. Andrea MacNeill, Regional Medical Director, Planetary Health
It was an awareness of the ecological impact of surgery, combined with a lifelong passion for the environment, that spurred surgical oncologist Dr. Andrea MacNeill's championship of meaningful change in the health care industry.
“I was struck by the visible waste in the operating room as a resident and felt there had to be a better way," she explains. “I learned that only a decade prior, hospital incinerators were a leading source of dioxins – a carcinogen – and was distressed by the paradox that in the process of taking out someone's cancer, we were creating more cancers."
A surgical oncologist at Vancouver Coastal Health (VCH), she also holds the inaugural role of VCH Regional Medical Director of Planetary Health and is a clinical associate professor at UBC. Andrea's goal is to introduce and encourage personal, institutional and regulatory responsibility and actions across VCH that will create a culture of real, positive difference in sustainability. To her knowledge, VCH is the first health authority in Canada to explicitly acknowledge planetary health in its overarching strategy and to make such a substantial commitment to embedding it across the organization.
In 2018, Andrea led a study of the levels of greenhouse gas and other pollutant emissions in the Canadian health care system, making Canada only the third country to do so. The methodology from this study is now a cornerstone of the Lancet Countdown's annual reporting on national health system emissions for over 40 countries.
In addition to her role at VCH, she's maintained an academic practice and in 2021 launched the UBC Planetary Healthcare Lab – a collaborative of experts and thought leaders from engineering, health economics, policy, public health, and behavioural psychology to work closely with VCH in a living laboratory model with ready access to real world data and accelerated uptake of best practices.
Health care, she says, is responsible for five percent of emissions in Canada, and VCH has both the opportunity and moral responsibility to take a leadership role in creating solutions to decarbonize our activities.
The business case for VCH taking a planetary health approach to care and operations is strong. By reducing our carbon footprint, the health sector stands to benefit more than any other industry as we bear the cost of treating the increasing burden of environmentally-mediated disease and, by extension, reap the benefits of better population health.
“The heat dome of 2021, historic wildfires and atmospheric rivers have forced a reckoning with the inevitability of climate change impacting our ability to deliver health care," she says. “Out of necessity, VCH is ahead of the curve. Our remarkable public health group has done ground-breaking work on predicting future climate events, identifying vulnerabilities, and helping us prepare for them."
Andrea believes that there are opportunities in every role across VCH to make decisions that reduce the impact of our work on the world around us – from our personal actions, to institutional choices, to driving systems-level change.
VCH enjoys a high level of workforce engagement around planetary health. Individuals like Dr. Rashmi Chadha, a pain and addiction specialist at VCH, have been instrumental in mobilizing physicians and nurses in advocating for a just transition from fossil fuels and protecting nature. The Energy & Environmental Sustainability team has achieved impressive reductions in greenhouse gas emissions and energy use across VCH facilities and is advancing a circular economy strategy. As an organization with considerable purchasing power, VCH has an opportunity to address its own footprint while driving positive change throughout the supply chain.
Andrea has a vision of Vancouver Coastal Health and its facilities as not only places for reactive care, but 'anchor institutions' whose commitment to planetary health contributes to improved health and wellbeing in the broader communities we serve.
There will be many opportunities for medical staff to become involved both through their own areas of practice and corporate initiatives, Andrea says. She is co-constructing with Quality and Patient Safety a Planetary Health Quality Improvement initiative which will provide institutional support for people who want to improve processes of care while reducing our environmental footprint.
“Hospitals can become forces of social good for their communities and create positive value for people. I've been overwhelmed by the enthusiasm and support for this new role. We are very fortunate to have so many people who want to be part of this transition and to see VCH lead the way toward low-carbon, sustainable, resilient health care."
