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Just warming up and we're now back. Um So welcome back, everybody for those who have been with us all day and for those who are just joining to have the final keynote session of the share conference today, we're very privileged to have Doctor Henrique Falseto de Barros all the way from Brazil and it's noon for him, but it's 4 p.m. for us here in the UK. But we do have people from all over the world joining us today, whatever time zone you're in. And uh um he is a family doctor in a rural community in southern Brazil as well as being a professor in a um Brazilian University and is a member of the Lancet Commission on sustainable healthcare. Thank you very much for joining us for your keynote talk today. Well, thank you, Heather and thanks everyone that uh is here and uh it's a privilege to talk to you. So, um I'm gonna talk today about uh climate change and uh climate smart health care uh system. And I always like to start with this uh slide uh which talks about World Health Day. Uh that was about our planet and our health in 2022. So this is a really hot topic. Very important. OK. I'm waiting to pass my slide here. Ok. So, uh it's very sad that in my state, we had the worst climate extreme event in the history of Brazil. So the whole state which is a very big state with over 10 million people. We had a flood that uh lasted one month. It's actually still going, it started in, in the beginning of May, maybe you saw it in the international news and this is a representative picture and it speaks for itself 1000 words we say in Brazil. So this is this year. So I live in the Southern Brazil uh in the green, the green is Brazil, right in South America. The slides take just a little bit to, to load. Uh This is the New York Times picture of a patient uh in the in the emergency room being taken out by boat. And this is where I take my students. So uh when we have a picture like this and uh when you have a system that is literally literally under water, uh we have to think about healthcare uh climate smart systems and we have to think uh about the job of healthcare professionals uh including to mitigation, adaptation, resilience, and education. Now, when we think about climate change, we need to think about planetary health limits, which is really my interest. So I like to think uh in a more general sense. So, uh you see your a diagram that is really uh innovative and it communi communicates very easily. You can see in the red box climate change and you can see that we have crossed the red line and now we're going uh through uh a really dark color and it's getting worse and worse. Uh We also have um the six math mass extinction. We have problems with land system change, uh biogeochemical flows, which is basically uh fertilizers and novel entities. We could include the uh air pollution uh which kills over 4 million people just from the outdoors pollution. We have microplastics now being f found in uh the in uh human milk and semen and uh heart placenta. So it's really bad. And now the this is a map of my region and of the flooding in May. And I wanna mention that whenever we talk about climate change, we need to talk about the postal code because many times the postal code is more important than the genetic code uh code. And why is it so important because uh the region that we live have uh special environmental determinants of health uh unique, which is uh the physical geography, right? And we have uh a good uh unique social determinants of health for every region. So I like to think of postal cult, right? And so on the on the right you see in um in gray, you see all the area that was flooded. And in red you see the most poor people and in green, you see the richest people and you will notice that most of the flooding was in the red uh communities. So postal code matters and even the, so the floodings were so huge that even rich people got affected one way or the other. They got without light, without food, without water. Uh re really hard access to everything. But since they have, they're richer, they have a better health status access to healthcare facility facilities and so forth. So uh even richer people uh were affected, but they had more resilience, loading the slides. When we also talk about the postal code, we can see who causes it and who suffers it. So the US uh historically has accu accumulated much more CO2 and uh other greenhouse gas emissions in the atmosphere as well as Europe, Germany here in the center. So you see they are very uh hypertrophic uh in relation to other countries such as Brazil, which doesn't have that uh that much uh accumulation uh in Africa here, but who suffers it? So you see the US will suffer much less Europe as well, Brazil. Uh a little bit less than uh uh uh it would be expected, but Africa will be highly affected and we see now in India problems with water and uh extreme heat waves. So postal code Mars now, why does it matter to my patients because this is a cartoon, a Brazilian cartoon. So I'll translate. So the patient walks into the office and says, what do I have? Is it regional or global? Well, let's examine and then the doctor examines and uh this shows that we're all interconnected uh through nature. This is a good way of thinking the about the uh planetary health limits. So we have the family, I'm a family doctor. So that's how I like to see it. And about 20% of our health of our health status depends on the health care delivery uh services, but most of it, uh most of our health status depends on social determinants and on uh environmental determinants. So this is why it's so important to, to talk about uh these things. Now, when we talk about uh uh healthcare, we need to uh avoid causing harm. But we know that healthcare systems uh cause more than 4.4% of the uh greenhouse gas emissions. And the model of the, the United States of the America uh uh is responsible for 1/4 of all the pollution globally. So, from healthcare systems, so the model there which is uh hospitalized, highly fragmented is not a good model um throughout the world. Uh all all healthcare systems, almost a third, many times, a third of overdiagnosis and overtreatment, uh We see it overdiagnosis and overtreatment and that's uh roughly it would be uh a third of all the pollution So this is highly important. Now, we'll try to talk about this a little bit further when we talk about uh environmental pollution uh and uh the health of people, it's interesting to have a, a framework to think or a lens. So in the, in the middle here, you see interconnection within nature. That's the first thing we need to realize that we are nature and everything we do to nature we're actually doing to ourselves. So we need to in, in blue. Now, we need to think of our health, of our health, sorry uh in ecosystems collapsing because we need to build movements for systems change. And for that, we need systems and complexity thinking. So we get better health equity and social justice. This is a uh an outpatient community clinic where I take my students for the family health strategy. We see a lot of cases, clinical cases and I'm gonna highlight two cases. So this is uh a girl and her mom and she had Dengue. Uh And the other case is uh um a delivery motorcycle uh boy, that's how we call it in Portuguese. I don't know how to call it in English. So sorry. So we don't, we, we didn't have Dengue until recently. And uh Dengue is, is a very important model for understanding climate change in Brazil and understanding uh environmental determinants because the mosquito is getting more and more uh capable of transmitting dengue because it likes heat it likes humidity, rain and it likes trash and uh plastic recipients. So it has a lot to do with the postal code. And, uh, we offered the girl, uh, evidence based medicine. So we avoided overdiagnosis and overtreatment, uh, useless, uh, uh, exams and medicines that could even cause harm. And, um, we also, uh, talked about this motorcycle, uh, uh, working man and he had asthma exacerbated by long COVID and also by the air pollution of the roads. So we gave him the best treatment available which is uh is not, is no longer the spray which also has the propellants, which is a pot uh potent greenhouse gas. Uh So we, we gave him the powder inhaler which is evidence based and has a better medicine, not only the bronchodilator, it also has corticosteroids which uh reduces the lung inflammation. So we had uh this one minute for our planet which is a framework that we're uh promoting through the world organization of family doctors. Mhm. So when we talk to these patients, the the girl and the, and the working man, we try to address one minute for the planet uh within the framework of co benefits as incentives for lifestyle changes. So the girl, we told her that uh Dengue will get worse if we continue polluting uh the the air because of uh greenhouse gas emissions. But also because these emissions come from burning uh fossil fuel, which also contributes to air pollution and to and to death. So if she avoids fossil fuel, uh and avoids eating red meat, for instance, uh she will reduce air pollution uh and will better for her health. And red meat is very important in Brazil because most of the air pollution and most of the greenhouse gas emissions comes from the burning of the Amazon because cattle are pushing the frontiers. So if we produce red meat, we will reduce uh uh Brazilian uh greenhouse gas emissions. And here, if you switch from the spray to the powder, you will have better health and uh much, much less pollution. So this is also an incentive if the patient understands this, this is an incentive to change lifestyle. So we need to uh to think of the traditional models of medicine, including uh uh organs and genetics and anatomy. And we need to include a more dynamic, complex, systemic way of thinking about uh uh the health status which would include uh climate migration, land use, air pollution, economy, politics and so forth. We can't avoid these topics anymore. Now, I like to talk about this disease cascade and the healing journey. So we start with the upstream problems, which is the hyper population of the world, a techno a technology which is uncoupled and really uh sort of hates nature uh and doesn't care for nature, which is the pre uh considering health care systems. It's really uh overdiagnosis over pollution and ignoring uh nature. Based solutions and hyper consumption, which is also driven by commercial determinants of health. Uh uh For instance, in private uh private uh health healthcare plans which uh stimulate you to consume more and more. It all produces hyper pollution, hyper exploitation of nature which affects the postal code. And it's also modulated by the postal code as I explained earlier, determinants uh of health, social and environmental and uh it will get my patients and myself sick. Now we have the journey of healing and I say you're a family doctor be because it's really what I do and I what I, what I study. So we treat the patient, we treat the uh heat events, we treat the air pollution, we treat the flooding lactosus dengue. But we can also uh do evidence based medicine within primary care which uh enhances health equity uh and within the healthcare systems, it uh increases, increases efficiency, reduces overdiagnosis and uh overtreatment. So it reduces over pollution, over uh exploitation of nature and it improves improves wellbeing well wellbeing, we know that stabilizes population growth and many times it can reduce even uh make it negative. As we see. We see in richer, richer places, richer countries. And we hope that wellbeing will also reduce the need to, to consume, to over consume. We say in Brazil that the people like to have instead of being so uh we hope that wellbeing and if the healthcare professionals help people to uh be more uh wellbeing and less looking for having, right? And uh to look for more uh uh nature Based Solutions, which is very strong in primary care. I won't get any details now. So uh here I am in the Lancet Commission for Sustainable Health Care and we have a very uh strong vision underlying that, that climate change is the greatest threat to health in the 21st century. But that it can be the greatest opportunity for global health in the 21st century. Why? Because we, if we get collective action from all uh involved from the healthcare professionals, we can do mitigation adaptation, resilience, educate and lead uh for a critical mass to uh change the whole uh uh geopolitical systems and it's been done before. So a few examples and I'll finish. Uh we, this is Bernard Law uh geologist from Harvard, he passed away, Andov a Russian cardiologist. And during the Cold War, they started the movement, of course, it was a lot of people but they led against the nuclear arms proliferation and they, they got the Nobel Prize for this. Another example is uh uh fighting against the smoking industry. And Brazil is a very good example of succeeding in this. And, and the last example here is uh the lockdowns that the healthcare professionals managed to, to uh convince people to stay home in order to protect their lives. So we can do it as long as we communicate. And lead society. And if we did uh the lockdowns, we, we most certainly can improve the uh um the climate change, mitigation, adaptation and resilience. So we have uh a dilemma here. Do we continue going to the left with uh uh business as usual producing a lot of trash? Or we take the the greener the more sustainable climate smart uh pathway which, which really means a a smart healthcare system. So key messages, think healthy planet, healthy people then uh focus on evidence-based health care and all the co benefits. Think one minute for the planet in consultations or on your daily lives. And for healthcare professionals, remember you are a leader. People, look at you to know what is best for the person, family community and now the world, the planet. So thank you very much. Thank you very much for your really interesting talk. And um certainly the um points that you are making have been themes throughout today's session. So it's a very nice way to have this key note to summarize some of the key planetary health issues that have been um um part of this ongoing discussion that we've had today around building resilient and environmentally sustainable health systems and the urgency. I think, you know, the urgency of the need to address this, that we don't have time to be just talking about it, which is why we put fast tracking as the first word of um today's theme. I'm just wondering in your role as a primary care doctor. If you have any suggestions on some practical top tips or ways that you bring in, uh you know, addressing the planetary health while you're addressing people's health, that you do, how you do that as a doctor in your professional role. Yeah. Yeah. The, well, uh to introduce uh planetary health or climate change discussions has really been my phd uh theme. Uh And uh I would go around and talk to people and people would feel uncomfortable and they actually asked me many times for lists of when you talk and how you talk and what are the topics? And I always try to think a lot about this. But since, since climate change is hitting us so bad, it's become really easy to talk about this in my office. So, uh, the climate is really crazier. Everyone realizes this. And I tell everyone, well, today it got cold but yesterday it was really hot. So we talk about the climate and people know, and I just say, uh, we have to stop pollution and uh other things. But many times people come up for a checkup and I tell them, well, you don't really have to do all these exams if you will really wanna do, uh, do well and be healthy. Uh, you have to start avoiding the car, uh, walk more to your service, bike, more to your service and avoid bad food, highly industrialized food. Avoid red meat because it's connected excessive red meat because uh it's linked to cardiovascular disease, diabetes and especially colon cancer. Uh So I always try to use it as an incentive for better health. We need to be very careful not to push people and just do it when it's appropriate. So it's really, uh it's really uh a, a gray line, right? And my focus is really an evidence based health or medicine because if you really do that, you're already doing a, a good healthcare system in Brazil tries to copy uh the US which is very fragmented and hospital centric and uh commercially determined. So I teach people to be evidence based and it, that's, that's very good for uh the health of people and healthcare systems. I think there's time to, we're nearly to time. But if we sneak in one more question from Jasmine Abbott, who says, thank you so much for your talk. Do you think that health care professionals need to do more to raise awareness of the imbalance between where contributions to and effects of climate change are mostly seen? And if so, what do you think is the best way to do this? Uh This is a very good question, the postal code matters. So um it's, it's very important to see uh how, how your community understands it and how prepared it is to uh hear healthcare professionals uh about climate change. So, where I live, we have a lot of uh far. Right. Uh people and lots of fake news and if I just go out and tell them about anthropogenic uh pollution causing climate change, I could be seen as someone lying. So I have to be very careful. People that come into my office. I, they, they look for me and so I talked to them in an appropriate way and in a healthy way. So it, it's more reliable instead of going out and telling people what they have to know instead of people asking me what they need to do. So I think it's, it, it will depend, right? So if you're in a very progressive community, I'm sure you could just go up there and talk about this and people will enjoy. So postal code matters. Now, what I'm doing as a science activist is I'm working with uh uh with high-level people in the healthcare systems. I talk to journalists, I teach at the medical school and II do the lancet countdown policy briefs for Brazilian stakeholders. And now I joined the this commission for, for healthcare sustainable Services. And I'm sure that all healthcare professionals can find ways, ways of doing scientific activism, but always thinking of the postal code. OK. All right. Thank you so much and um especially thank you that, you know, you're obviously busy working today and you've made time to come and speak to us and um with the time zone difference as well. But um luckily we put you at the end of the day. So it wasn't quite, uh, in a, a terrible time zone for you. And uh at least it's in your mid time, um, lunchtime, um, period. So, thank you so much for that and, um, we hope to continue the conversation and, um, and hear more from you and stay in touch. All right. So we've just come to the end of the program and what a brilliant share conference this has been. And um for those of us who have been involved in planning, we've been doing this for a number of years now and it's just grown year on year and with one of the people who came to the very first one, his name is Ben Whitaker and many of you will know Ben and we were chatting earlier today and reminiscing about how we remembered how the first one very much wasn't a conference. It was just some like-minded folk in Brighton that were concerned about the planetary health and wanting to do something. He didn't quite know what to do. So we all brought a lunch and started talking and all these years later, it's grown into an international gathering um as an annual event. So, so do keep in mind to come back for sure. 2025 next year, we've not set a date yet. So keep it, look for that on um the websites of the three organizations and the contact details that you have for today and social media um et cetera as well as the healthcare blog page. It will be listed as an event on that blog um for when it happens next year and um I'll just do some final housekeeping um before we close. So just to have an announcement, um I'm wondering if Phillip and um Alex are still with us. Uh Phillip, she and Alex Ha from the University of California Burke, the USA. Um I don't know whether they're still with us. It was very early in the morning for them. They presented at the last breakout session and they just to announce were the um selected winners for the Planet or Health Report Card Student Prize. And uh for that, they were offered an oral presentation slot in the program. And um there's been students presenting throughout today, actually undergraduate, postgraduate doctoral level and how fantastic to um see um students um using university assignments at all sorts of levels to um to explore planetary health and to be doing these planet Health report cards to be feeding back to their host institutions on um suggestions for improvements. So, congratulations to Phillip and Alex for your um poster, a winner. And just to announce the oral presentation, abstract winner, I've looked in the list and I was anticipating they wouldn't be here today. I was in their session and they were clearly in a, a clinic or a hospital working today. So they're off um doing things with patients right now, but just announces um Emma Baker and Lucy Wimmer from Northampton General Hospital, NHS Trust and their abstract title was Preoperative Hand Therapy Appointment for Plastic Hand Trauma Patients. This was a qi project addressing environmental, financial and social sustainability. And they provided both quantitative and qualitative information in their abstract including patient and staff feedback. Um So congratulations to that Northampton team and we'll make sure that we follow up with them and their prize will be a, a free course from this at health care. And uh so if anybody knows them, you can uh send them a message of congratulations and I will follow up with them to make sure they receive the prize and certificate. And speaking of certificates, a few people have asked about that they're automatically generated from the middle site. And I'm just gonna put in the chart, the feedback that uh will be AAA form that you fill out and once you complete the form, it's not long um that uh your attendance um certificate will be generated for um coming today. And the um if there's any problems with that, um just let us know one of the questions we've asked is what will you be doing um in your practice as a student, as a healthcare professional, as a interrelated professional that maybe from social care or elsewhere, that's not necessarily in health care, but um design material science we've had today So in your feedback would be fantastic to hear about your plans or ideas that you have, that you can implement knowledge that you've learned today into your practice. Whether that's clinical practice, education, research policy. Um If you could share that with us, we'd love to hear how this uh share conference is having impact. And what I'll ask for is the um, anybody from the planning committee, I know it's a school run at the moment and some people are off sorting out Children for. But uh anybody, um Matt Gemma Alison Joey, um uh Mood inga um anybody else from the planning committee? I haven't um said if they're able to turn their cameras on just as a final thing. Anybody here matches here. Anybody else, maybe people are all unable. So it was just as a planning group. Um and, and they all the chairs and the co-chair that have contributed today. There's been, you know, a huge amount of time and effort that, you know, many people from the University of Brighton School of Sport and Health Sciences, Brighton and Sussex Medical School and health Care have um uh contributed today. So a big thank you to, to all who have been involved and um hopefully everybody's really enjoyed the day. So we're exactly to time and I believe Angela Glenn, um Doctor Glenn is our Dean at the School of Sport and Health Sciences and I checked that she was in the speaker list and she's there hurra until the camera comes on. You never quite know. But I knew we had emailed and things and she's very kindly offered to do our closing address today. Thank you, Angela. Thank you. But II haven't cleared my background. So there are a collection of random objects but we won't, we won't focus on those. Um Thank you everybody and thank you for asking me to do this Heather and I have been dipping in and out of sessions um today for, for this um conference, it's always such an exciting event. So I'm delighted to have the opportunity to just make a few comments. It's not gonna be long uh to draw it to a close. Um And first of all, I'm very proud that the University of Brighton is part of this wonderful collaboration with the Brighton and Sussex Medical School and the Center for sustainable Health Research in putting on this event um uh annually and the interest as Heather said in this conference grows year on year. So today we've had 542 participants registered from 100 and 70 cities in 41 countries around the world. And for me, the really exciting thing about this conference is that it's an opportunity for academics and colleagues in practice to share research and innovative practice and sustainability. And we can see this by the fact that we've got colleagues joining us from 82 universities and 100 and 78 different health care organizations. So the work done through these networks and collaborations that can be fostered by these kinds of activity can be applied directly into real world practice resulting in meaningful and impactful change. Um On a personal note, as a dean, I'm always eager to hear from students undertaking the Planetary health report card in our school. And it was really interesting and thought provoking to have a chance to peruse the posters done by students in other universities and see what their recommendations are. This tool can really help us to embed sustainability in the health curricula and prepare our students to be professionals who consider global challenges in their daily lives and go on to be leaders and change makers. We like to encourage our students to challenge the accepted ways of working and find creative solutions to sustainability issues in the health and care sector. And it's important that our colleagues in practice role model, good practice in this area too. And I think that's all evident for the con from the conversations that I've heard going on in this session today, this conference today. So looking at the amount of activity that is happening in the area with three excellent keynote keynote speakers and a big thank you to them for their contributions today, as well as 45 abstracts presented in the breakout sessions and discussed by colleagues and the 41 posters that we've all had a chance to look at as well. So I think the interest and passion that colleagues in the health and social care sector have for the global sustainability agenda is clear and I hope that today's given you some inspiration for making changes in your practice and for moving forward the wider global agenda that will help us to make real impact again. On a personal note, I'm gonna make sure I add sustainability into my leadership meeting agenda to ensure we do follow up the excellent findings from the planetary health report cards in our nursing and physiotherapy courses um that I've already heard from the students, but also heard in their presentations today and also to include sustainability as one of our threads across our school for interdisciplinary learning development across the university. So, um I need to let you go as uh Heather said in the UK, it's um school run time um across the world. Goodness knows it could be bedtime. Um But again, I want to thank particularly thank the organizers for this fantastic event. So thank you very much everybody and thank you for everyone for your participation today. It's been a real privilege to join you for some of the sessions. Thank you. Excellent. Thank you so much. And we're a minute early, but that's OK. We're uh by the time we actually shut our things off, we'll be bang on time. So, uh just a final, thank you to everybody and really looking forward to um next year's event and um to hear continuation of projects or new projects. And certainly as academic sisters help us to um as Angela said, uh put new ideas into our, our curriculum and hopefully for researchers, clinicians, policymakers, whoever you are out there, that there's something for you here today. So I hope you enjoy the rest of your day, evening, morning, wherever it is across the world. And um we wish you all well and fast tracking, resilient and environmentally sustainable healthcare systems. Goodbye, everybody.