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Incorporating ‘Green Podiatry’ into your clinic, and into your life

Abstract

Background

This commentary outlines practical ways of positively incorporating green podiatry, foot health, physical activity benefits, and relevance to climate change into the clinical setting as Conference of Parties (COP27) approaches. Recent reports from the Intergovernmental Panel on Climate Change, the World Economic Forum, and undergraduate curricula concerns, are presented.

Main body

Climate change is irrefutable, and as health professionals, podiatrists can discuss the benefits and principles of green podiatry with patients of all ages in their clinics, appreciating that people are increasingly worried about the climate crisis.

Feet as fundamental for independent, healthy, and carbon–neutral active transport, needs to become a key message. The three pillars for green podiatry are exercise, evidence, and the everyday changes that all podiatrists can make. Likewise, podiatrists can encourage their patients, and in doing so, join with community leadership, alongside other allied health and medical peers.

Conclusion

Podiatrists have a shared responsibility to work and live as ‘green’ as possible, and to share this message with patients. Reducing waste, physically and in the form of unnecessary treatment, and supporting a review of supply chains, are important aspects of reducing health care emissions.

Promoting feet as carbon–neutral transport, and physical activity as evidence based and health enhancing, are a sound contribution to twenty-first century public health. Podiatry has a great opportunity for positive legacy.

Peer Review reports

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),Footnote 1 The World Economic Forum,Footnote 2 and academics [3, 4], to outline practical ways of positively incorporating CC into the clinical setting, as COP27 approaches.Footnote 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. 1.

    Climate change is already harming people’s health

  2. 2.

    More action is needed to protect health

  3. 3.

    Climate solutions benefit both health and the economy [5].

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.Footnote 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

  1. a

    Students and young people

The ‘Foundations for Tomorrow’ survey (World Economic Forum [2]), had 10,000 responses from Australians aged under 30 years. Results were:

  • 93% saying the government was not doing enough to address CC

  • 75% said they would vote for political leaders taking bold action on CC

  • 11% felt their vote mattered

In 2021, Australian teenagers successfully sued the Minister for EnvironmentFootnote 5 regarding the government’s duty of care to future generations on CC.Footnote 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.Footnote 7 CC was a decisive election issueFootnote 8.

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/ [8,9,10]). 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:

  • 93.3% thought sustainability within Podiatry was important

  • 73% thought the topic was important for business

  • Respondents identified both barriers and opportunities enhance sustainability.Footnote 9

  1. b

    Indigenous people

Comprising less than 5% of the world's population, indigenous people protect 80% of global biodiversity.Footnote 10 Emerging in 2017, and pending referendum, the ‘Uluru Statement from the Heart’ represents a historic consensus of indigenous leaders in seeking constitutional change to recognise First Australians, and is an invitation from the Aboriginal and Torres Strait Islander people to,

“Walk with us in a movement of the Australian people for a better future”.Footnote 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].

Climate action needs promotion in public health to include the large emission areas, eg transport, energy, food, agriculture, housing; to reduce air pollution, increase physical activity, improve diets [14, 15].

A fresh focus on ‘big picture health’,Footnote 12 must balance/lessen the management of illness. Medical ‘prescribing’ can prioritise ‘green health’, to encourage time in the natural world as therapeutic, as occurs in Canada [16], Scotland [17], and China [18].

Green Podiatry – Pillars for Practice

Green Podiatry is founded on: 1) exercise, 2) evidence, and 3) everyday actionsFootnote 13 (Table 1). Calculation of your carbon footprint, at work and at home, is illuminating, and provides a baseline for targeting change eg,

  • walk to the shops rather than drive

  • use public transport

  • 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

Such simple changes are good for health, good for our planet, and raise awareness of both [19].

  1. 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 sedentaryFootnote 14 [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 gainFootnote 15. Aware manufacturers increasingly use natural materials, including raffia palm and banana skin fibres [21]. Footwear can be repaired and recycled (access local footwear recyclingFootnote 16), and dedicated companies offer ‘take back’ programmes,Footnote 17 and even shoes for leaseFootnote 18.

The Green Foot Orthoses Project (GFOP) is a new initiative,Footnote 19 and foot orthoses use must be supported by diagnosis, and evidence. Repairing orthoses further extends product life.

  1. 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.Footnote 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].

  1. 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.Footnote 21 HC is a large user, especially hospitals,Footnote 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.Footnote 23 Supply chains cause most emissions (approximately 70%), and RCPod, APodA could partner with suppliers, footwear manufacturers, waste hubs (eg TreadlightlyFootnote 24), 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.

Availability of data and materials

N/A.

Notes

  1. IPCC Report 2021: https://www.ipcc.ch/report/ar6/wg2/ Accessed 20 October 2022.

  2. Foundations for Tomorrow Report: https://www.foundationsfortomorrow.org/the-report Accessed 20 October 2022.

  3. UN Climate Change Conference 2022 (COP 27): https://sdg.iisd.org/events/2021-un-climate-change-conference-unfccc-cop-27/ Accessed 20 October 2022.

  4. The Conversation, Fri 6 Aug 2021, https://www.abc.net.au/news/2021-08-06/australians-three-times-more-worried-about-climate-change-covid/100354008 Accessed 20 October 2022.

  5. Federal Court of Australia: https://www.judgments.fedcourt.gov.au/judgments/Judgments/fca/single/2021/2021fca0560 Accessed 20 October 2022.

  6. The Guardian, 21 September, 2021: https://www.theguardian.com/environment/2021/sep/01/young-australians-screaming-for-climate-action-but-dont-trust-leaders-to-make-change-survey-suggests Accessed 20 October 2022.

  7. Green and teal candidates – independent of either major (Labour/Liberal) parties with strong policy for CC.

  8. The Guardian, 23 May, 2022: https://www.theguardian.com/australia-news/2022/may/23/teal-independents-who-are-they-how-did-they-upend-australia-election Accessed 20 October 2022.

  9. RCPod Abstract, 2022.

  10. National Geographic Society: https://www.nationalgeographic.com/environment/article/can-indigenous-land-stewardship-protect-biodiversity- Accessed 20 October 2022.

  11. The Uluru statement from the Heart: https://fromtheheart.com.au/ Accessed 20 October 2022.

  12. https://www.podiatry.org.au/documents/item/2272. Accessed 31 May 2022.

  13. President’s webinar, Royal College of Physicians and Surgeons of Glasgow, 7 June, 2022 (members: https://learning.rcpsg.ac.uk/mod/scorm/player.php?a=1273&currentorg=articulate_rise&scoid=2624&sesskey=CaIQ1gTvVz&display=popup&mode=normal).

  14. WHO physical activity fact sheets https://www.who.int/news-room/fact-sheets/detail/physical-activity Accessed 20 October 2022.

  15. Australian Institute of Company Directors (AICD) greenwashing https://www.aicd.com.au/risk-management/framework/climate/whats-on-the-watchlist.html

    Accessed 20 October 2022.

  16. Treadlightly footwear recycling https://treadlightly.asga.com.au/ Accessed 20 October 2022.

  17. Etiko fair trade footwear and clothing https://etiko.com.au/ Accessed 20 October 2022.

  18. On footwear https://www.on-running.com/en-au/cyclon Accessed 20 October 2022.

  19. University of New South Wales – Sustainable Materials Research and Technology (SMaRT) rehttps://www.smart.unsw.edu.au/search?keywords=podiatry Accessed 20 October 2022.

  20. Choose wisely https://www.wiserhealthcare.org.au/questions-to-ask-a-health-professional/ Accessed 20 October 2022.

  21. World Wildlife Fund (WWF) https://www.wwf.org.au/news/blogs/10-worst-single-use-plastics-and-eco-friendly-alternatives#gs.u5l02t Accessed 20 October 2022.

  22. Climate and Health Alliance (CAHA) https://www.caha.org.au/reducing_sup_in_health Accessed 20 October 2022.

  23. Global Green and Healthy Hospitals (GGHH) https://greenhospitals.org/ Accessed 20 October 2022.

  24. Treadlightly footwear recycling https://treadlightly.asga.com.au/ Accessed 20 October 2022.

Abbreviations

CC:

Climate change

HC:

Healthcare

COP26:

Conference of Parties, Glasgow, November 2021

COP27:

Conference of Parties, Egypt, November 2022

IPPC:

Intergovernmental Panel on Climate Change

GHG:

Green-house gases

LMIC:

Low-and-middle-income countries

UK:

United Kingdom

RCPS (Glasg):

Royal College of Physicians and Surgeons (Glasgow)

GFOP:

Green Foot Orthoses Project

PPE:

Personal protective equipment

RCPod:

Royal College of Podiatry

APodA:

Australian Podiatry Association

ESG:

Environment Social and Governance (policy)

CO2 :

Carbon dioxide

NH4 :

Methane

WHO:

World Health Organisation

UN:

United Nations

DEA:

Doctors for the Environment Australia

CAHA:

Climate and Health Alliance

NHS:

National Health Service

References

  1. Evans AM. Sustainable healthcare – Time for ‘Green Podiatry.’ J Foot Ankle Res. 2021;14:45.

    Article  Google Scholar 

  2. Evans AM. ‘Green podiatry’ - reducing our carbon footprints Lessons from a sustainability panel. J Foot Ankle Res. 2021;14:59.

    Article  Google Scholar 

  3. Dobson J, Cook S, Frumkin H, Haines A, Abbasi K. Accelerating climate action: the role of health professionals. BMJ. 2021;375:n2425.

    Article  Google Scholar 

  4. Brand G, Collins J, Bedi G, Bonnamy J, Barbour L, Ilangakoon C, et al. “I teach it because it is the biggest threat to health”: Integrating sustainable healthcare into health professions education. Med Teach. 2020:1–9.

  5. Dhage L, Widlansky MJ. Assessment of 21st Century Changing Sea Surface Temperature, Rainfall, and Sea Surface Height Patterns in the Tropical Pacific Islands Using CMIP6 Greenhouse Warming Projections. Earth’s Futur 2022;10. https://doi.org/10.1029/2021ef002524.

  6. Foong LH, Huntley R. Communicating about climate change – Who is listening, who isn’t and why: Implications for medical professionals. J Paediatr Child H. 2021;57:1826–9.

    Article  Google Scholar 

  7. Sorce G. The “Greta Effect”: Networked Mobilization and Leader Identification Among Fridays for Future Protesters. Media Commun. 2022;10. https://doi.org/10.17645/mac.v10i2.5060.

  8. Pihkala P. Commentary: Three tasks for eco‐anxiety research – a commentary on Thompson et al. (2021). Child Adol Ment H-uk. 2022;27:92–3.

    Article  Google Scholar 

  9. Gunasiri H, Wang Y, Watkins E-M, Capetola T, Henderson-Wilson C, Patrick R. Hope, Coping and Eco-Anxiety: Young People’s Mental Health in a Climate-Impacted Australia. Int J Environ Res Pu. 2022;19:5528.

    Article  Google Scholar 

  10. Bradley B, Hirose R, Fitchett H, Ranuzzi E, MacKenzie G. How eco-anxiety influences climate activism and everyday life in Britain. 2021. https://doi.org/10.15664/10023.24207.

    Book  Google Scholar 

  11. Clemens V, von Hirschhausen E, Fegert JM. Report of the intergovernmental panel on climate change: implications for the mental health policy of children and adolescents in Europe—a scoping review. Eur Child Adoles Psy. 2022;31:701–13.

    Article  Google Scholar 

  12. Tennison I, Roschnik S, Ashby B, Boyd R, Hamilton I, Oreszczyn T, et al. Health care’s response to climate change: a carbon footprint assessment of the NHS in England. Lancet Planet Heal. 2021;5:e84–92.

    Article  Google Scholar 

  13. Watts N, Amann M, Arnell N, Ayeb-Karlsson S, Beagley J, Belesova K, et al. The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises. Lancet. 2020;397:129–70.

    Article  Google Scholar 

  14. Brand C, Götschi T, Dons E, Gerike R, Anaya-Boig E, Avila-Palencia I, et al. The climate change mitigation impacts of active travel: Evidence from a longitudinal panel study in seven European cities. Global Environ Change. 2021;67:102224.

    Article  Google Scholar 

  15. Marshman J, Blay-Palmer A, Landman K. Anthropocene Crisis: Climate Change, Pollinators, and Food Security. Environ. 2019;6:22.

    Google Scholar 

  16. Pitt TM, Aucoin J, HubkaRao T, Goopy S, Cabaj J, Hagel B, et al. The Relationship of Urban Form on Children and Adolescent Health Outcomes: A Scoping Review of Canadian Evidence. Int J Environ Res Pu. 2021;18:4180.

    Article  Google Scholar 

  17. McDougall CW, Hanley N, Quilliam RS, Bartie PJ, Robertson T, Griffiths M, et al. Neighbourhood blue space and mental health: A nationwide ecological study of antidepressant medication prescribed to older adults. Landscape Urban Plan. 2021;214:104132.

    Article  Google Scholar 

  18. Zhang J, Cui J, Astell-Burt T, Shi W, Peng J, Lei L, et al. Weekly green space visit duration is positively associated with favorable health outcomes in people with hypertension: Evidence from Shenzhen, China. Environ Res. 2022;212:113228.

    Article  CAS  Google Scholar 

  19. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Brit J Sport Med. 2020;54:1451–62.

    Article  Google Scholar 

  20. Wild K, Woodward A. The bicycle as ‘constructive hope’: Children, climate and active transport. J Paediatr Child H. 2021;57:1785–8.

    Article  Google Scholar 

  21. Unal F, Avinc O, Yavas A. Sustainable approaches in textiles and fashion, fibres, raw materials and product development. 2022. p. 157–93.

    Book  Google Scholar 

  22. Siemieniuk RAC, Harris IA, Agoritsas T, Poolman RW, Brignardello-Petersen R, de Velde SV, et al. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ. 2017;357:j1982.

    Article  Google Scholar 

  23. Evans AM, Rome K, Carroll M, Hawke F. Foot orthoses for treating paediatric flat feet. Cochrane Db Syst Rev. 2022;2022:CD006311.

    Google Scholar 

  24. Fleck LM. Choosing Wisely. Camb Q Healthc Ethics Cq Int J Healthc Ethics Committees. 2016;25:366–76.

    Article  Google Scholar 

  25. Levinson W, Kallewaard M, Bhatia RS, Wolfson D, Shortt S, Kerr EA, et al. “Choosing Wisely”: a growing international campaign. Bmj Qual Saf. 2014;24:167–74.

    Article  Google Scholar 

  26. Barratt A, McGain F. Overdiagnosis is increasing the carbon footprint of healthcare. BMJ. 2021;375:n2407.

    Article  Google Scholar 

  27. Grunseit A, Richards J, Merom D. Running on a high: parkrun and personal well-being. BMC Public Health. 2017;18:59.

    Article  Google Scholar 

  28. Pegna V, McNally SA. Are single use items the biggest scam of the century? Bulletin Royal Coll Surg Engl. 2021;103:233–5.

    Article  Google Scholar 

Download references

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.

Funding

Nil.

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Authors and Affiliations

Authors

Contributions

AE drafted the manuscript. AE conceived the commentary, and structured its design. AE as solo author read and approved the final manuscript.

Corresponding author

Correspondence to Angela Margaret Evans AM.

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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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Supplementary Information

Additional file 1.

 Intergovernmental Panel on Climate Change, summary of 6th report, 2021.

Additional file 2.

 Impact summary of climate change from review of thousands of scientific papers – IPCC, 2021.

Additional file 3.

Green podiatry health education conversation outline.

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Evans AM, A.M. Incorporating ‘Green Podiatry’ into your clinic, and into your life. J Foot Ankle Res 15, 87 (2022). https://doi.org/10.1186/s13047-022-00591-y

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Keywords

  • Climate change
  • Footprint
  • Healthcare
  • Carbon
  • Podiatry
  • Emissions
  • Health
  • Green