Background
The concept and initiative of ‘Green Podiatry’ was introduced previously [1], followed by a Sustainability panel review prior to COP26 [2]. This commentary is linked to two previous commentaries and outlines new research from the Intergovernmental Panel on Climate Change (IPCC),1 The World Economic Forum,2 and academics [3, 4], to outline practical ways of positively incorporating CC into the clinical setting, as COP27 approaches.3 We all need to act to avert the existential threat before us. Podiatrists should be well versed to reduce carbon footprints!
Three key principles to consider are: Climate change is irrefutable; Talk with Patients about ‘Green Podiatry’; We must listen to important groups.
Climate change is irrefutable
‘It is unequivocal that human influence has warmed the atmosphere, ocean and land. Widespread and rapid changes in the atmosphere, ocean, cryosphere and biosphere have occurred’: the latest IPPC report summarises the impact of climate change from thousands of scientific papers. This report covers many topics, including: water systems, food systems, Indigenous knowledge, oceans, cities, health, poverty and inequality. The 3000 pages present three salient points [1] (Supplementary files 1, 2):
1.
Climate change is already harming people’s health
2.
More action is needed to protect health
Talk with patients about ‘Green Podiatry’
Health professionals are in a unique and trusted position to speak with patients about the impact of CC on health, and it is timely. Covid-19 made 47% of Australians more concerned about CC [6], and three times more worried about CC than about Covid-19 [6]. Women, young adults, the affluent, and ages 35 to 54 years, showed most concern about CC. The middle-aged may worry because they are parents, and naturally want a secure future for children. Concern among younger adults (18 to 34 years) is understandable, given the existential crisis before them.4
As individual citizens we share lifestyle challenges, providing a great opportunity for podiatrists to ‘lead by example’ on the key factors that both mitigate CC, and improve health (Supplementary file 3).
We must listen to important groups
a
Students and young people
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93% saying the government was not doing enough to address CC
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75% said they would vote for political leaders taking bold action on CC
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11% felt their vote mattered
In 2021, Australian teenagers successfully sued the Minister for Environment5 regarding the government’s duty of care to future generations on CC.6 This decision was later overturned, with the Minister abrogating responsibility via Federal Court appeal. Six months later, the government lost the federal election, with a ground swell of ‘green’ and ‘teal’ votes.7 CC was a decisive election issue8.
Globally, ‘Fridays for Future’ (‘Greta effect’), continue as a youth CC initiative [7]. Children and young people are worried, and addressing this is key to managing eco-anxiety (https://www.climatecouncil.org.au/guide-parents-managing-eco-anxiety-your-kids/ [8‐10]). Children´s rights, mental health, and CC are future challenges for children now, and in subsequent generations [11].
Podiatry students in the UK (University of Southampton) have investigated and reported on a sustainability agenda. Their work was presented at the Royal College of Podiatry (RCPod) conference, July 2022. Results of an online member survey (n = 75), found:
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93.3% thought sustainability within Podiatry was important
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73% thought the topic was important for business
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Respondents identified both barriers and opportunities enhance sustainability.9
b
Indigenous people
“Walk with us in a movement of the Australian people for a better future”.11
Accelerating climate action: the role of health professionals and systems
“The climate emergency is a multidisciplinary, multisectoral, crisis that transcends professional and organisational barriers. Health professionals can help bring sharp focus to the urgent reforms required from individuals, organisations, and governments” [3].
I share the view that sustainability in practice, begins with embedding CC in university curriculums [4]. The NHS has ambitious targets to reach net zero over the next two decades. Clinicians will require knowledge and support to achieve this goal, as part of the NHS responsibility for achieving climate targets [12, 13].
Green Podiatry – Pillars for Practice
Green Podiatry is founded on: 1) exercise, 2) evidence, and 3) everyday actions13 (Table 1). Calculation of your carbon footprint, at work and at home, is illuminating, and provides a baseline for targeting change eg,
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walk to the shops rather than drive
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use public transport
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walk/cycle to work (even once/week), and encourage patients similarly (https://www.footprintnetwork.org/).
Table 1
The three pillars of Green Podiatry for clinicians. Assess carbon calculations – work (UK) https://www.gpcarbon.org/#/; and at home (Australia): https://www.wwf.org.au/get-involved/change-the-way-you-live/ecological-footprint-calculator#gs.u5agd1
Green Podiatry Pillars | ||
|---|---|---|
Exercise | Evidence | Everyday |
Feet as C-neutral transport Walk, ride, swim, run, dance ⦁ Good for people ⦁ Good for the planet ⦁ Evidence-based | Stop treatment which is not evidence-based eg Bespoke foot orthoses for paediatric flat feet | Supply chains are the major healthcare emission ⦁ Use less of everything ⦁ Reuse, repair ⦁ Recycle, reform (circular economy) ⦁ Buy from local sources ⦁ Adopt active travel for work (even once/week) |
Feet for exercise should be the primary podiatry focus for every patient Use wearable technology to measure physical activity General advice ⦁ Screen time ⦁ Diet ⦁ Sleep ⦁ Exercise ‘dosage’/age | Use ‘choose wisely’ questions with patients: 1. Do I really need this test, treatment or procedure? 2. What are the risks? 3. Are there simpler, safer options? 4. What happens if I don't do anything? 5. What are the costs? Attend online webinars, reduce your travel emissions, especially long flights | Energy ⦁ electrify with renewables ⦁ e-records, telehealth Minimise single use items Collection bins: ⦁ Paper ⦁ Plastics ⦁ e-waste ⦁ Footwear to recycle |
Such simple changes are good for health, good for our planet, and raise awareness of both [19].
1.
Exercise
Podiatrists need to focus on foot health for carbon–neutral transport. Physical activity is easily measured with wearable technology (phones, watches, fit-bits) and ‘dosed’, eg adults: 300 min moderate-vigorous physical activity/week, and more if sedentary14 [19]. This is essential primary HC for podiatrists to champion, and a great antidote for non-communicable diseases (eg diabetes, arthritis, obesity, depression, cancer, heart disease). Exercise may allay ‘eco-anxiety’ in children, with cycling fostering children’s well-being, and independent transport [20].
A ‘green shoe list’ [www.evidenceessentials.com; https://angelaevanspodiatrists.com.au/green-shoes/ accessed 4 Jul 2022] acknowledges that exercise involves feet, and footwear. Podiatry needs transparency from footwear manufacturers, to avert ‘green-washing’ for commercial gain15. Aware manufacturers increasingly use natural materials, including raffia palm and banana skin fibres [21]. Footwear can be repaired and recycled (access local footwear recycling16), and dedicated companies offer ‘take back’ programmes,17 and even shoes for lease18.
The Green Foot Orthoses Project (GFOP) is a new initiative,19 and foot orthoses use must be supported by diagnosis, and evidence. Repairing orthoses further extends product life.
2.
Evidence
We can encourage ‘health’, over ‘healthcare’. In the lower limb, knee arthroscopy [22], and customised foot orthoses for paediatric flat feet [23], are interventions no longer evidence-based, and clinicians should stop using them. HC, needs to focus on evidence based care, and dispense with unnecessary treatments, imaging, tests [24, 25]. We can engage patients in ‘Wiser Healthcare’ to avert overdiagnosis [26], and excessive HC.20 Podiatrists are in prime position to promote healthy feet for physical activity which aids health [27], is evidence based [19]and provides carbon neutral transport [14].
3.
Everyday
The first commentary outlined changes for podiatrists to lessen GHG emissions [1]. Fossil fuels comprise 98% of plastics, and approximately 40% of plastics are single-use.21 HC is a large user, especially hospitals,22 where use of PPE and single use items creates enormous waste. Pegna and McNally [28] have suggested a pause:
‘We are constantly told that for ‘infection control reasons’ we must wear and use single use items. But where is the evidence for this?Is there evidence that single use items are always safer than reusable ones?
Is there evidence that disposable drapes are better than washable for infection prevention?’
The NHS, and CAHA support the Global Green and Healthy Hospital network to reduce environmental impacts of workplaces.23 Supply chains cause most emissions (approximately 70%), and RCPod, APodA could partner with suppliers, footwear manufacturers, waste hubs (eg Treadlightly24), to access ‘green’ supplies, and circular economy waste cycles.
Conclusion
Ultimately, we each share the responsibility to work and live as ‘green’ as we can. What we do as podiatrists – reduce waste, reduce unnecessary treatment, promote and live ‘green podiatry’—and as citizens – buy local, buy less, choose renewable energy, vote thoughtfully, divest fossil fuel investments, manage waste – is important for every aspect of health.
Two suggestions for podiatrists are to: 1) adopt the three pillars of Green Podiatry, viz., exercise, evidence, and everyday practices; 2) promote feet as carbon–neutral transport, and physical activity as evidence based and health enhancing. Podiatry has a great opportunity for positive legacy.
Acknowledgements
Not applicable.
Disclaimer
I am not a climate change expert, but an engaged earth-dweller, envisaging a podiatry (and whole of health care) community which can act to avert climate change, to better the health of our planet, and ourselves.
Declarations
Ethics approval and consent to participate
N/A.
Consent for publication
Not applicable.
Competing interests
Conflicts of interest
- Director, Australian Podiatry Association.
- Research Lead, Walk for Life, Bangladesh.
- Chair, Sustainability Panel, APodA conference, 2021.
- Green Foot Orthoses Project, UNSW.
- Sustainability Steering Group, Royal College of Physicians and Surgeons of Glasgow
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