So, while greening our hospitals and clinics is important, we clearly need to change models of care. While it might be difficult to define or measure low value or harmful care, it is clear that many laboratory tests are overused. 

The bulk of general practice emissions lie within prescribing and clinical practice - 60% is due to clincial ie pharmaceuticals and chemicals and gases from inhalers.

The propellants used in metered dose inhalers (MDIs) contain hydrofluorocarbons (HFCs) that are potent greenhouse gases. Their warming potential is 1-3000 times greater than carbon dioxide, so even a few grams of these agents in each canister can make a difference to our climate.

Choosing health interventions with low environmental impacts, such as lifestyle and psychosocial interventions before pharmacotherapy where appropriate supports both holistic and sustainable healthcare practice.

Food choices and healthy eating are important lifestyle interventions with multiple benefits for both patients and planet. The EAT–Lancet Commission report indicated that food production is responsible for up to 30% of global greenhouse gas emissions and 70% of freshwater use. Food sourced from animals, especially red meat and grain fed livestock, has relatively high environmental footprints per serving compared with other food groups, affecting greenhouse gas emissions, land use, and biodiversity loss.

The imperative to act on climate change and transition to sustainability must be founded on clinical knowledge and science. There are numerous pathways by which climate change impacts human health. These include direct effects such as heatwaves, droughts, and extreme weather through to indirect effects on air quality, water and food supply and quality. 

Physical activity plays a very important role in preventing and managing non communicable diseases - particularly cardiovascular diseases and type 2 diabetes and osteoporosis. Inactivity is a major risk factor for mental as well as physical ill-health.