A healthy planet
Public health advocate Dr David Galler is taking on climate change, writes Teuila Fuatai
Middlemore intensive care specialist David Galler is coming up 30 years at the hospital. How will climate change fix our health?
When I meet Dr David Galler at the Hospital Rd entrance of Middlemore Hospital, one of the first things he asks is whether I caught the train in.
I give him a few seconds to be disappointed about my transport choice before I mumble that, without the car, I wouldn’t make my next interview in West Auckland.
No, the fast-talking intensive care specialist, dressed in a bright green and purple Mena shirt and shorts, is not a train fanatic. Rather, his attentiveness to travel method is one of the ways he gets those who’ll listen to think, and practise, more sustainable ways of living.
As we make our way towards one of the hospital coffee shops, Galler goes over his morning spent at Manurewa High School. The Counties Manukau District Health Board is giving some nearby land to the school for a community garden.
“They’ve got a huge range of programmes — technical programmes, health programmes, a hauora programme — and they want to have their own gardens, set up community kitchens and encourage better choices.”
He says, with certainty and the authority of nearly 30 years at Middlemore behind him, that shifting health practises to align with climate change goals and achieving net zero carbon is the key to addressing the types of chronic illnesses that lead to so many people ending up “here”.
I’m starting to feel a little unsure of where our chat is really going.
I’d been interested in interviewing Galler after reading his book Things That Matter: Stories of life & death a few years ago. He spent a year working in Samoa while his partner, Judge Ema Aitken, head of the Alcohol and Other Drug Treatment Court at Auckland District Court, was on secondment to the country’s Supreme Court.
During Galler’s 12 months as a
visiting specialist at Samoa’s main hospital in 2015 and 2016, the mortality rate in the hospital’s intensive care unit reduced from about 80 per cent to 18 per cent. Many of those patients were children.
“The ICU was largely a place where people were sent to die.” However, there were also a lot of babies and young children who would come to hospital with acute respiratory disease and nasty, drug-resistant infections that could be helped.
“We started to take a few of the kids to the ICU and put them on ventilators and managed them as best we could. Slowly, we started to get a little bit of success, and more people became interested and there were even nurses from Middlemore who came and helped. We slowly built a service to look after that particular group of people.”
I was keen to hear from the doctor who’d tackled things head-on in Samoa and worked relentlessly towards changing the drivers of poor health which severely affected a lot of families in South Auckland.
I wasn’t, however, prepared to link health and the problems of social deprivation to net carbon zero by
2050. Galler takes a step back.
“In a way, a hospital — apart from things like doing hip replacements and knee joint replacements, those things you get from wear and tear — is potentially a failure of everything that’s come before it,” he says.
“Many of the problems we’re addressing in this hospital, just about everything that comes through this door, is a preventable complication of something that’s preventable in the first place, Look around and most of the people have multiple morbidities. Obesity, diabetes, kidney disease, hypertension, heart disease and gout — the South Auckland full house. That’s what everybody’s got.”
As the busyness of his “second home” whirls around us, the 63-yearold rattles off the all too familiar shortfalls of the health system in combating diseases which are really symptoms of poverty and hardship.
“Health can’t fix most of those things. Health cannot fix the issues that relate to those determinants of wellbeing,” he says.
“But health cleans up the consequences. We don’t actually create health here; we just treat illness. The things that create health are communities, primary prevention policies and society, and we don’t seem to have a strategy to do that here.”
He believes that can be changed by getting healthcare wonks into climate change and carbon reduction.
RESEARCH PUBLISHED in the Lancet Planetary Health journal last year found the carbon footprint of Australia’s healthcare system made up 7 per cent of the country’s overall carbon emissions.
It is about 3 per cent in England and 10 per cent in the US.
While it is yet to be measured in New Zealand, Galler says eventually the whole healthcare sector will need to make solid commitments to reduce its carbon footprint if the country is to achieve net carbon zero. Some of that work is under way at individual organisations and OraTaiao: New Zealand Climate and Health Council, but a lot more buy-in is needed for sustained, overall carbon reduction, he says.
Tackling the drivers of ill health, “which we’ve been trying to do for years” is part of that. For example, much-needed infrastructure and policy changes to make the roads more walker and cyclist friendly would cut vehicle emissions and air pollution, Galler says.
In Middlemore, where much of “our bread and butter” is dealing with the complications from one, more or all the South Auckland full house diseases, the benefits of increasing the opportunities for physical activity in the community cannot be understated.
“It’s massive, absolutely massive. And there’s loads of research around how that links in with wellbeing and mental health,” he says.
Galler goes on to cover off the policy changes needed to make junk food less accessible, something he and other high-profile public health advocates like the University of Auckland’s Professor Boyd Swinburn have lobbied for over the years.
“If I was talking to a family with children, I’d be talking about eating well, exercising, not eating too much junk food, not smoking, not drinking too much. That advice is about trying to help people make the right choices. As healthcare providers, we can write prescriptions and tell people to do things . . . but it’s pretty clear that we struggle to influence people to make those kinds of choices.”
The climate change agenda provides a timely opportunity to reframe the issues and hone in on things like regulation for nonnutritious food, he says. I ask if it’s going to be enough, given the statistics around childhood obesity. Figures showing nearly 200,000 children living
in poverty also come to mind. “It’s complicated,” says Galler. “I sometimes think that people don’t have that sense of how it all fits together.”
His own peers are a good example. “We’ve got lots of people who go through medical school who are really good at certain aspects of what they train in,” he says. “They’re really good at being surgeons, or radiologists, but that doesn’t mean to say they’ve got an interest in health.
“Many of them are ill-equipped to get into the area of health promotion — that’s been left to another branch of medical practitioners entirely. But actually, all of us need to be engaged in it.”
Siloing off “the medicine” from a person’s lifestyle, and effectively health and wellbeing, isn’t really giving better patient outcomes, Galler says.
Furthermore, the practicalities of working in an overburdened sector must be considered when reorienting policy around climate change.
Between 2012 and 2017, Counties Manukau DHB reduced its carbon footprint by 21.5 per cent. The reduction came after the organisation joined up to Enviro-Mark Solutions, enabling it to measure and target carbon emissions.
“A lot of that was the easy stuff, around managing your lights, managing power, having computers on sleep mode,” Galler says. “It was a lot of the low-hanging fruit which we did to get those big gains.”
Moving into areas like food waste reduction is another step up, particularly because that type of initiative requires investment. Earlier this year, the Counties DHB projected a $53.5 million deficit for the current financial year. Asking for $240,000 for worm bins is probably not going to stack up with what the board are up against, he says wryly.
Regardless, Galler is setting his hopes for the health sector, particularly its impact in the communities he serves, on the climate change agenda.
In the work that I do I see people’s potential, he says.
“You see extraordinary stories of recovery, extraordinary stories of people making something out of nothing, and extraordinary stories of people who are up against the wall and deal with that in the most dignified kind of way.
“Actually, a lot of them are living in poverty, they’re not working, and their lives aren’t what they could be — for themselves, for their families and for their community. That takes an enormous toll on them and an enormous toll on society because their ability to put their shoulder to the wheel of the nation is reduced.”
With a glint in his eye, and after a few disparaging comments about the “sick houses of rotting and moulding buildings they’ve given us”, Galler switches back to his original point: “Health is about the health and wellbeing of people, and how that impacts their potential.
“And, quite simply, everything that you do to reduce carbon has a health co-benefit.”