As the nation's largest organisation, the NHS has power to damage or protect the environment and to advance the cause of sustainable development, says Anna Coote

Environment secretary David Miliband recently stated that climate change was not just an environmental issue. It was, he said, a symptom of a problem caused by inequalities and injustice on a global scale.

He is right. And it helps to remember how things are connected. Just as illness cannot be prevented by the NHS single-handedly, so global warming cannot be tackled by green measures alone. Preventing ill-health and reducing health inequalities requires partnerships between different levels of government, communities and individuals - all working to address the determinants of health: income; jobs; education; housing; transport; social cohesion; equal opportunity; security; power and autonomy.

If we seriously want to tackle climate change we need an approach that combines social justice and sustainable economics with good governance and sound science. That is because climate change is a consequence of human behaviour and, in order to alter behaviour, we need to address the opportunities and incentives that individuals, governments and organisations have for behaving as they do.

As well as an environmental issue, global warning is a health issue and the consequences are potentially catastrophic. Extremes of heat and cold, violent storms, flooding, drought, damage to crops and livestock: all these threaten the essentials of life on which health depends. They can also trigger mass migration and armed conflict.

Green revolution

Thanks - variously - to the Stern report last year on the economic consequences of climate change; former US vice-president Al Gore's powerful polemic An Inconvenient Truth; and to Conservative leader David Cameron and Mr Miliband's jousting for the green high ground, knowledge about the gravity of climate change is making an impact on health professionals.

The NHS Confederation has taken up the cause; the UK Public Health Association has had the issue high on its agenda for several years and is hosting a symposium on public health and sustainable development in Edinburgh this month; the BMJ has launched its carbon council to advocate action on climate change among clinicians, precisely because it poses such grave risks to health; and the Healthcare Commission has commissioned research into how it can use its regulatory powers to assess sustainability in the NHS. All this suggests a genuine shift in attitudes.

Health protection

Surely, no other part of the public sector can have a stronger incentive to tackle climate change than the NHS, whose fundamental aim is to safeguard and improve the health of the population?

And surely no other public service has more power to damage or protect the environment, or help or hinder the cause of sustainable development. Every second the NHS spends more than£1,000 on goods and services. It is the largest organisation in the country, employing more than a million people and serving more than 300 million meals for patients, staff and visitors.

The NHS wields considerable influence as a landowner and partner in urban planning. It is in the middle of the largest capital development in its history: by 2010, more than£11bn will have been spent on 100 new hospitals and more than£1bn on new primary care buildings. Nearly one in 20 journeys in the UK is associated with the NHS and more than one in eight of these are taken by car or van. So, as an employer, purchaser, caterer, landholder, builder, cause of travel and manager of energy, water and waste, the NHS has substantial powers and resources to safeguard the environment and the nation's health.

The Department of Health launched a good corporate citizenship website last year to help NHS managers to promote sustainable development. Produced for the DoH by the UK Sustainable Development Commission, it is designed to help managers understand what good corporate citizenship means and why it is important; to assess performance through an online test; and plan for improvement. It provides supporting materials around six themes: transport; procurement; facilities management; employment and skills; community engagement; and new buildings.

Crucially, it shows why sustainable behaviour makes business sense: it saves money; improves staff well-being and productivity; stimulates local economies; and reduces demand for health services by preventing illness.

Since its launch, more than 19,000 people have visited the website and 150 leading NHS organisations have taken the online test. A year-end review, published in April, points out that trusts have made direct savings.

North Bristol trust has improved its transport service for patients while reducing the volume of traffic and saving more than£240,000 in the first six months. A new wind turbine for Antrim Area Hospital is set to save£90,000 a year in energy costs. Royal Cornwall Hospital is saving£12,000 a year by more careful waste management.

The review highlights good practice in other areas. Barts and the London trust has provided 300 jobs for local residents. And NHS North West has been helping local organisations to tender for contracts, so that businesses stay in the area.

All this can be seen as a promising start - especially in the context of the new operating framework for the NHS. This sets out two important principles to underpin future activity: to keep people healthy and work to reduce health inequalities; and to strive for the most effective and sustainable use of resources. How long will it be before managers know their performance ratings depend on using resources sustainably in order to reduce carbon emissions and safeguard the nation's health? -

Anna Coote is the commissioner for health at the Sustainable Development Commission.