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Hi, everyone. My name is Henry Burke. This is Helen, Please. And we're part of the committee and we're going to be sharing a sustainable global surgery. Uh, session. So I think we all agree that was fantastic. Talk by Dr Park, and we've got more excellent talks to come. First up is Dr Richard Nixon, who's joining us here today. He's a consultant in Critical Care Medicine, an honorary senior clinical lecture at the University of Extra an HS, England Clinical Entrepreneur. The design of C, C, P D. Match waist and pollution lead for the Intensive Care Society Sustainability Working Group and a member of a number of working groups, uh, in Durham County Council, NHS England and the UK Ocean Decade Committee. Richard co founded Healthcare Ocean as his main interest is global gold. 14 Life below water. I think that's what he's going to be talking to us about today about how anthropogenic activities, including healthcare, procurement, container shipping, molecular pollution, adversely affect the marine environment. His goal is to ensure oceans, coasts and inland waterways never help oceanic health. So my affiliations, there's quite a few now. This is quite a niche space, so my the invites have really grown. I am a critical care consultant by trade. This is what I look like in Covina. We've got a few scars from that. Uh, the important thing is is that I am a cold face clinician. Okay, so I'm about 90% full time, and that's incredibly important to drive change. But I co founded Healthcare Ocean with these two amazing people George the Sermon and Laura Fleming. I know what you're thinking right now. Richard does look amazingly like Kevin the mini in, and it is absolutely true. I can't get away from this uncanny resemblance. I put the little light hearted it's in because this is all really grim. Okay, this is called Rhyme of the Last Fisherman. Okay? And the state that our oceans, our in our in a phenomenally poor state, this is really bad news. And I'm going to go through the bad news. And during the last time I gave this talk at Newcastle, someone actually left in a panic attack. So I'm warning you now. This isn't good news. The good news comes later and I will come to it. So critical care consultant. I use a whole load of stuff, and I became really interested in where this stuff came from, where it went to and the impact of the oceans of its procurement. It's delivery, it's use and its disposal. Why the oceans? Well, deep down in the marine biologist, that's what I wanted to be. This is my favorite childhood marine mammal. Yangtze River dolphin. Christ sake. Look at that face. It's beautiful, isn't it? It's extinct. When I was a child, I wanted, I said to my parents was seven years old. I want to save the Yangtze River dolphin. It became extinct 2006 due to the pollution due to the damning and due to the shipping within the Yangtze River in China. My watch, my plan, it my responsibility, my failure. And that changed my life when I realized that a few years ago. So we're used to the usual narrative. Global carbon outputs have gone up to, uh has gone up and yada. We're all going to get, uh, this is going to lead to mass migration, definite unimaginable scale or within the lifespan of Children born since the millennium. What I wasn't hearing about was oceans Acidifying at a terrifying rate. Their pH is dropped by 0.13 units in 100 and 50 years. That's a 33% rise in hydrogen ion concentration. And yet we're not talking about this, and this is incredibly serious. It is the lowest pH the oceans have been for millions and millions of years. I became really fascinated when I learned about this in this point of acceleration since 1950 I found out that this this point of acceleration coincided with an exponential rise in container shipping. The first container went on a ship in 1956. Since that point in time, human population has tripled. Humans and their livestock now comprised 96% of mammalian biomass on the planet. And we are phenomenal consumers, and we want to stay healthy. So that means healthcare are phenomenal consumers, too, and we are also producers of enormous amounts of waste. David Attenborough described at 26 about Holocene the 11,000 years, you know, over this side here just before this, that we've got the ice age that was about 600 breeding individuals of humans on the planet. We have a billion at 1880 billion. Okay, the human population is rising, and so is our CEO to output. One of the pollutants, one of the pollutants that we produce, whatever metric you look at, it has gone exponential since 19 fifties. It's called the Great Acceleration the last 70 years and as a result, we're having a massive impact on the planet. We are now in the Anthropocene. We are leaving a geological impact, which is actually in some cases, plastic pollution. I was very interested in these four metrics over here, including ocean acidification, which you can see and the most worrying one. Here, marine fish capture it splattered because the C's are running out of fish. As I mentioned, ocean acidification is incredibly bad. It's often called global warming. Climate changes evil twin, and it's responsible, along with warming for the destruction of ecosystems like these coral reefs, which aren't reporting on nearly as much as land or atmospheric based pollution, Ocean acidification preceded the last five mass extinction events. We are now seeing oceans Acidifying faster than the end per me um, mass extinction event, where we saw the loss of a vast proportion of the world's biomass in some reports, up to 96% of marine biomass were lost during that extinction event. We are Acidifying erosions, faster than that extinction event. That's how worrying this is. Okay, so we all know that the the Earth is this is the PCR six. We know the Earth is warming. This is where we are on this is where we should be. We talked about the atmosphere and global surface temperature changes, and it's pretty well established. If we hit four degrees on business as usual, pathway SSP 5 to 8.5 that we will hit four degrees about 2085. And that is beyond adaptation. That is where civilization for calls to pieces We are on at the moment SSP 5 to 8.5. We are on that pathway. We need to be on a completely different pathway. But we are on this pathway at the moment. Despite all the pledges and all the cops, what we don't talk about is ocean acidification. Okay, It's often sorry it's widely recognized. That Ph is 7.95 is beyond adaptation. This is where the carbonate based life starts dissolving and we get an absolute runaway scenario. When does that happen? 2045 40 years sooner than what we commonly talked about in terms of global warming. So whilst we're looking at carbon whilst we're looking at global warming with the oceans Acidifying, they're going to catch us out if we don't bring these into conversation right now and that's if we've got it right. If we got it wrong and we might have it wrong and suddenly the permafrost in the boreal forests or amounts and releases methane, this could happen a lot sooner. So where's the healthcare connection here? When I first made the connection with these things Container ships. These are the lifeblood of our society. They deliver 90% of our good globally, 80% of NHS supplies. These are they under gone exponential growth. But they have a massive impact on the environment. They produced a lot of noise. This is one thing that people just don't think about. You know these things the trundle around on the oceans that produces phenomenal amounts of noise that affects all species within the oceans, especially whales that rely upon sound like we use our eyes. They lie upon sound to navigate, find their food, avoid their prey, find their mates, look after their young. This is these up here. These are all shipping routes around the world. You can see they cover a lot of the world. This here's a blue whale trying to feed in one of those shipping routes just off the west coast of chili. And these are all ships it's trying to avoid. You can see how difficult and dangerous it can be. These are ships around the UK, one of the business shipping areas in the world. Got to be a biscuit here, home of fin whales, very deep basin. This is where they breed and feed, and when they share a space, you can get things called ship strikes. This is the road kill of the shipping industry, and about 20,000 Wales die each year because of ships strikes. Wales are very important to the ecosystem that ecosystem engineers. They sequester huge amounts of carbon that gets captured and, uh, sequestered on the seabed when they die. They are part of a very intricate cycle, which I'll go onto, but also they're intelligent animals and to be hit and dragged along about the ship until you die must be absolutely hideous for them. And also they live in societies and these whales. This could be a matriarch that holds the society together and teaches the young how to feed. So there's massive ecosystem implications. So noise. I'm sorry. I apologize. Underwater radiated noise is just one form of pollution. But we talk about all sorts of pollution, mainly carbon. We've got this real carbon focus, haven't we massive carbon focus. But we have an awful lot of pollutants in addition to carbon carbon. Also, it's not just the CO2 in the atmosphere, but it's this this this particular carbon. This is the Arctic and ironically, as the sea ice melts in the Arctic due to global warming, it opens up further roots for for seafaring traffic and the dark particulates absorb more sunlight. And therefore, uh, the the ice melts melts quicker, so carbon has more than just a CO2 effect on global warming. But we also have all these other pollutants. We've got underwater radiated noise as I just talked about sewage and agriculture straight, which massive impacts, and we have all these physical impact as well. And this is all really important because all focuses in on this topic here of molecular pollution's within the oceans that impact upon the ocean, biomass and diversity and reduces the carbon sequestration capacity of the oceans, which then leads to the acidification. Everything funnels in to this kind of molecular pollution level, which is so important. And what happens then? It impacts upon the land, the atmosphere, all of nature. Human health, health care system. Whoops. So do we. Do we need to be worried? Yes, of course. We need to be worried because one virus coated brought global health care to its knees. Climate change, multiple viruses, bacteria, protozoa, starvation, heat related illness. You name it. We have got a whole pile of pain coming, and we know one virus destroys the healthcare system. So why this Focus on pollution, you know, where's the link now to the ecosystem? Well, say hello to your caucus. Discovered in 1986. And David Attenborough mentioned this in frozen Planet, to which I just happened to watch the last episode last night and David at Ensberg were David Attenborough. Those words. This is probably the most important microorganism on the planet today along with diatoms and coke. A little falls. They produce at least half the world's oxygen. So every other breath you take, it's not coming from trees. It's coming from these cyanobacteria and phytoplankton, and these are being poisoned by molecular pollution. We have lost 50% of oceanic biomass in 70 years. Since the great acceleration. These phytoplankton, they get the nutrients from, uh, swellings near seamounts. It gets blown off land as well, and also a critical part of the delivery of micro nutrients to the photo zone. The higher zone in the in the ocean, where photosynthesize is whale pooh. This contains nitrates, phosphates and iron. Enables phytoplankton to bloom and grow. So you can see the connection between the biggest creatures, the smallest creatures, container shipping. Everything starts linking together. Now it's no use. The microphones got quiet. Was I talking too loudly and they turned me down? Overstayed my welcome already. But this phytoplankton is absolutely no use. If it stays in the photo zone because the CO2, we'll just we'll just follow a diffusion gradient to go back into the atmosphere and at night. Fortunately, this amazing things happen. All these lantern fish and copepods and squid. They make great up from about 400 m down from the miso pelagic zone and they feed on all this phytoplankton. This is the greatest mass migration on the planet. It happens daily every single day, and it moves a vast amount of water vertically up and down. I've even heard it cited that it moves more water than the moon does through gravity and tides. All this feeding all this death, all this excrement gets sucked down into the ocean with all the lantern fish Okay, as they moved down in daylight. And this is marine snow. This is your carbon, your CO2 being sequestered in the deep oceans and sediments. And it's so important because the oceans here they do an enormous amount of sequestration. The risk is as we lose biomass, phytoplankton, biomass. This sequestration becomes less and less and it's even been hinted. Bet that the oceans could become a source of carbon rather than the sink in future. In the near future, we're talking decades. So how does health care impact upon the oceans? We talked about ships, noise. They released a gig, a ton of CO2 every year, so that's a big challenge. They discharge. They're building tanks, very oily, into the water, etcetera. There's lots of impacts of ships, but also the pollution. The macro waste that we produce on a daily basis. This is my I T u. This is some of the waste we produce. Now, if we process it correctly, it goes up in smoke. We still don't really know what the impact of that smoke is. But we do know that if you live around the medical incinerator you are properly, you know, going to have a nasty illness as a as a result of that. Or you have a higher chance of a nasty illness, including vast amounts of cancers. If we don't get it right, then it ends up in the ocean. Ultimately, all ocean pollution tends to start on land, so it gets end up in one of these great Pacific garbage patches, and then we've got the molecular pollution. And this is a car tire. One of the biggest sources of, uh, plus micro plastics in the ocean. And electric vehicles do not solve this. In fact, they make it worse because electric vehicles tend to be a bit heavier, and all this gets washed down the storm drain straight into the rivers, and then the oceans have done it again. We also have all the chemicals we use to re process devices. These are endoscopy chemicals. My hospital uses nine chemicals to re process a reusable endoscopy device. Uh, that goes straight down into the, uh into the common foul sewage drain. So again, we have to take this into account what we're thinking single use versus reusable, all the drugs and metabolites that go through patients. They go down, the floor sinks, they go out to the local sewage treatment works, and they get discharged in the river being processed by dilution. That's the main processing for these compounds. The trouble is, that's not very effective. And we've seen from recent papers from Wilkins and etcetera that the world's rivers are absolutely stuff full of pharmaceuticals and metabolites that have an impact on the rivers on people and oceanic ecosystems. And if we look at the trajectory oopsy daisy of that again, um, look at the trajectory Here, this is Ph decreasing. This is our current position of losing 50% of all Marine life since 1950. And if we carry on when we hit a pH of 7.95, somewhere down here 2045 we get the overgrowth of dinoflagellate and the nasty is this Poisons. The ocean is poisoned, the atmosphere poisons the land, and it's game over. Very recently, it's the last couple of weeks. The Bering Sea has lost about two billion crabs over a couple of years. Jurors out whether this is acidification, warming or overfishing. But it looks like it could be the shrinking of the cold pool, which is a result of increased fresh water melt in the Arctic. That is very serious. This could actually be a tipping point happening now. So what? Why are we in this position? You know, this is ridiculous, isn't it? I mean, how have we got ourselves into this position where we are facing mass extinction? Read this book. Absolutely brilliant. It explains the 19 seventies 19 eighties. Okay, absolute game changer. I'm just going to play something here. Uh, the quick video. I've given them a heads up, which again, kind of just just examines our kind of madness and the crazy way that human face. Excuse me. What year is it? It's 22 84. Oh, my God. The pandemic. Almost over. Brexit ongoing a chest to not even close. Jesus. Can I Can I get a drink of water, please? Negative. The last drop was drunk in the year 2040. Tell us, what was water like? Oh, my God. It was amazing. We had a lot of it. Probably didn't look after it as well as we could have. We, uh we have a lot of fights. You just chuck it all over each other. We used to drink it all the time. We turn the tap on and we just wait for it to be the perfect temperature. And then we'll take a clean glass. And for some reason, we would rinse it out again with. But you had no idea you were destroying the planet. Know we knew. Then what did your leaders do to stop Earth from dying? They put a 10 p charge on plastic bags. Then why did you travel in a row planes when you knew the pollution was irreversibly heating up the planet? My God, this is going to sound bad to go somewhere hotter, okay? I mean, I've got to kind of put these things in because I don't want people to get too depressed because we're going into the hope it now. But, you know, in 10 words, you know, this really sums it up, and there is hope. I went to 26. I was invited speaker in the blue zone. Uh, we talked about cars, cash, colon trees, which I think is the single syllable words that Boris Johnson could actually remember. Yes, we need to reduce emissions. Absolutely hugely important. We need to reforest but deforested. A phenomenal rate in cop. 26 year we deforested 10.1 million hectares of tropical rainforest alone. That's 20 billion trees. One billion trees would offset all the NHS is carbon output and it's supply chain. So we lost 20 NHS is worth of sequestration capacity. We've got to use our land better. We've got a population, and then we got to check, and everyone wants to innovate and kind of get a text to kind of get us out of this mess. This is a new if you read Nathaniel Riches book. You'll realize that from 1979 you know, the White House felt that we could check our way out of this. Uh, I would disagree. This is 1983 when the report was published. And CO2 is just going up and up and up and up. But within this graph, within this keeling curve, there is incredible hope. Hope Oopsy Daisy. This is the human added so two on the top. Okay, 17 gigatons a year. This is nature's ability to cope with huge amounts of carbon fluxes every year due to the growth and loss of leaves on trees. But it has to be through a healthy biosphere, healthy ecosystem. If we look at the zeros, one of zeros grass. We got this bit down here. Research, innovation, an offsetting six million tons worth. Well, I would argue, this is nature based solutions. Nature has been innovating for billions of years, and it's really, really good at it. And actually, if we leave it alone and make it healthy, it will do the job for us. But we've got to address the pollution that we put into nature and stop damn well poisoning it. So oceans do they offer us hope? Yes, they do ocean store 40 trillion tons of carbon. That's 16 times more than than 50 times more than the atmosphere. But we challenge oceans all the time. With all the stuff we put in. The solution to pollution is not dilution. It accumulates. We have forever chemicals that end up in the oceans. But what do oceans give us? Give us so much? They're very forgiving and they bounce back very quickly. And they do this. They can extract vast amounts of go to second video one minute long from the man himself. If you don't believe me, believe this guy. Phytoplankton. Simple microscopic plants that are the pastures of the seas. There are thousands of different kinds, and together they produce half of all the oxygen in the atmosphere more than all our forests and jungles combined. And by absorbing carbon, they are our greatest ally in combating climate change. Plankton are the foundation of almost all life in the ocean. For in those places where the currents bring nutrients to the surface, they multiply in astonishing numbers, turning the ocean green. That line absolutely critical. Okay, and please remember Quito plankton there. Biomass doubles every three days. There's a gig aton in the oceans at any one time, but it turns over every eight days. That's 40 50 gigatons a year. Photo synthesizing sino bacteria there to help us. And what do we do? We poison it. We think about trees. This little margin up here, it takes land biomass decades to double in quantity. Trees are not. The solution were deforested at a rate we can't keep up with. The only thing that will get us out of this mess in time, I'm afraid, is the oceans. And so healthcare Ocean, which I co founded. This is why we do this. Because if we don't get oceans into our healthcare strategies and in our thinking, I'm sorry, but I cannot see the numbers stacking up. So part of the, um, Ocean Decade Committee, I think the UK Ocean Decade Committee 1 29 Ocean decade committees. I think I'm the only health care professional there, which is crazy, because why are we doing this? We're doing this to actually improve improve our chances of survival. You know, we're quite a selfish species. Are we? So actually, we want to save the world that we can save our lives and lives of our Children, and they pretty much defined what healthy ocean is. We can influence this through healthcare and if we get it right, we can improve fish stocks to feed billions. We can increase blue, carbon, sequester, sequester coastal, go to increased biodiversity, the number of Wales, the phytoplankton and the sequestration capacity of our ocean. And I know I'm over running, so I'm going to speak even quicker so But we have to collaborate to survive. All crossed the line together on none of us cross the line at all. There is no place anymore for people to be fighting and working in silos. We have to collaborate public, private sector. So we work between academia, the environment, healthcare and government. We inform our healthcare suppliers 80,000 of them about why we need to bring oceans into our thinking. And we then link between human health care systems and our suppliers to help drive that change through the industry. And we use policy procurement notes 6 20 to do this because our suppliers, this is in law, have to support environmental protection and improvement. And that's what we use as a leverage and We will drive that change for MHS, England's Evergreen supply of framework to economically reward those supplies that change. So what can you do at home and work? I call this the sixties. It's not just about driving fossil fuel cars less. It's about traveling less full stop because of the pollution that you get from car tires. Reduce your consumption in general, you know, try and keep stuff forever. If you can watch what chemicals you use, understand the impact of those chemicals. Please don't go on cruises. You know, these are just dirty container ships with a disco and a few king prawns. You know, Don't do it. You know, Look at this. This is these are heavy fuel oils polluting beautiful areas. So please, if you gotta cruise book to go on it and just treat it as your last one because until these ships change, they are not ecologically sound charities. This is more about collaboration. There's some great small charities out there, and the final C is crap. Get the rubbish out your system, collect it, put it in your municipal waste. It's better in the municipal waste than, um in the other system in the environment. And this is an amazing website and platform, which is designed by a lady called a Me Bre, who is also on the Ocean Decade Committee. From an integrated care system point of view, we have to realize that healthy people are the lowest, have the lowest demand for healthcare and produce the lowest carbon. We have to have blue plans written into our green plans. We have to think about waist and pollution. We have to start educating people at every level. And when we say we got zero emission ambulance, we have to accept the fact it's not really zero emission because we haven't taken into account higher emissions. And of course, we have to generate, uh, a circular economy system level examples. This is what we work with. Healthcare, ocean level. And I'll skip through these because I'm well over time. But we are driving the healthcare supplier sector to really understand this shipping step. So we have this. There's this international collaborative called Cozy and we we successfully secured Phillips as a sign up to cargo owners for zero emission vessels, the first healthcare supplier in the world to do so. And we broke that through healthcare, ocean. And then what we do is we market the hell out of it. So this is 24 7, the shipping blog, and we just make sure that we absolutely through the power of communication, articulate why they need to take these steps. So just reflection of action system levels were doing this healthcare, ocean level regional. This is all about integrated care systems education As to why we need to include oceans thinking and the individual, you can, uh, the the actions you can take at home. These are my what, three words. Pollution. Massively important. We need to understand that collaboration. We'll cross the line together or no one does it all. And nature, If we don't have nature in our plans, then we will fail. Simple as that. Thank you very much. Thank you so much, Doctor Dixon. I think hopefully we've managed to avoid any panic attacks. Um, got a few questions, uh, one of which is whether you consider becoming a marine biologist. But I think personally, I'm quite grateful that we work in a massive organization. A lot of people have these interests and crossovers. That means that everybody's looking at the different, uh, angles. Um, we have a question on metal. Um, and so from your description of all the things that you're involved in, you're involved in lots of stuff at the national level. A trust base level, but from Mohammed as if you're here. And, um, he's asking, kind of kind of about maybe some impactful practical things that we can all be doing in our own workplaces. Um what? Whether you have any data to back up, maybe what? The most effective small changes we can be making whilst we're also getting involved in these advocacy, um, larger scale changes within our trust. Uh, yeah, the workplace. The workplace level changes are the hardest. Um, it's it's, um if I have more time, I could talk through these in more detail. The system level changes are actually surprisingly easier because you can talk in the language of economics, which, if you if you don't care about health, then most businesses care about economics. On an individual level, you've kind of seen the sixties there, and what I would do is I would simply copy and paste the sixties into your work environment. So you've got to be looking at reducing your waist and pollution. That is the best way that you can actually influence change within your work environment. It's not a perfect solution yet. It is really, really hard to do at the moment. But certainly that's that's the angle I would take. Thanks. I think that's answered quite a lot of the questions because a lot of people really obviously been fired up by this talk about how they can make some changes. I had a personal question, which is that I think, probably trainees. A lot of us are moving between different hospitals, and that's a large source of our commuting because we can't really afford to move house every six months. Um, do you know whether NHS England is looking at changing that, or is there is that something people are trying to do? Um, uh, not that I'm aware of. I was I would, uh, walk bike, train, and then people wanting to know whether there's a kind of healthcare oceans trainee. We're getting involved in the healthcare issues as a trainee. Yeah. I mean, what I would suggest is we are We are really disorganized. We formed just two years ago, we went from kind of standing start to 26 to UK Ocean decade in a very short space of time, without really having any thoughts about how we manage the interest that we gain. Um, so what we say to people is Follow us on Twitter, Follow us on Facebook. Send us an email vote by the website. We record your name if we finally get our act together and turn ourselves into an organization that isn't just speaking and trying to drive changed systems level, then we have a data bank of people who we know are interested in this area. That's brilliant. Thank you so much for your time. I think it was very inspiring talk and everyone just thank Dr Kicks in again.