Frederik: Hello and welcome to the Sustainable Healthcare Podcast. I’m your host. My name is Frederik van Deurs. I’m a medical anthropologist by training and day to day, I work as a management consultant advising primarily top 20 global pharma companies on implementing their sustainability strategies across the value chain.

I come across various different topics in my work, and together with Joachim, I have the great joy of exploring all of the intricacies of sustainability in healthcare. And one of the things that have come up quite often is the subject of biodiversity. When I came across Liz’s work on biodiversity and healthcare policy integration and indication, I was deeply intrigued. I reached out to Liz and asked her if she would come on the show and tell more about her work and the insights that she has found. And luckily she said yes. Without further ado, Liz, welcome to the show.

Liz: Thank you, Frederik, for having me.

Frederik: You are so welcome. I’m really excited about learning more. I’m going to be completely honest, I just skimmed the paper and I’ve also had a super busy day, so I have a very hard time remembering much. But I think that’s also life as a parent sometimes. Before we dive in, Liz, to your work, what do you like to do when you are not working with biodiversity and health?

Liz: I’m a big outdoors person, so I try to find activities to keep me outdoors. Walks, ocean sports, and generally try to keep a work-life balance, which is one of my challenges.

Frederik: Yeah, that’s a classic, isn’t it? What other water sports do you like to engage in?

Liz: Well, ocean based. Scuba diving, snorkelling, surfing when I can. One of those things I’m picking up in my later years.

Frederik: That’s a very obvious choice for sports to pick up, the ones that are fast, dangerous, and let you pick up injuries. I did some things similar, so that’s why I feel I can say it. Cool. Thanks a lot for sharing this, and I was looking through your resume and trying to sort of make sense of your past career. And you’ve done a lot of things. So yeah, when you present yourself, sort of, if you meet someone, maybe not in the supermarket as we discussed earlier, but if you met someone who was working in a hospital, how would you present yourself and your current situation and work?

Liz: Well, I have spent over 20 years working at this intersection between nature and health, and I think your question goes to the point that we haven’t had the ability to focus either as students or academics or professionals on this space very cohesively. As a result, my career path has woven particularly back and forth between kind of two domains at this nexus. One is working for environmental organisations as a health expert, working for health organisations as an environmental expert, and working at the local level and applying that in global fora or with global institutions and vice versa.

When I do describe my career path in a cohesive way, especially as you said to healthcare professionals, I use just a couple of terms: medicine and multilateral environmental agreements. That’s looking at that intersection of how environmental decisions are health-determining and really examining and digging into that space.

And to your point about the paper, I will say I consider myself a practitioner. I generally don’t describe myself as an academic because I haven’t marched up that path, though I’m in those circles. And so with the paper, it really is in my view a practitioner looking at this space and trying to translate it in a way that makes sense for people who are working in public health practice on the ground and trying to implement better decisions and policies and create a healthier environment for people.

Frederik: That’s amazing, and thanks a lot for the work that you’re doing and also for putting it in such humble terms. When I’m listening to the way you’re putting it out there, and I hear sort of that overlap about being someone working in healthcare focusing on environment, or working in environment focusing on healthcare, I think there’s a lot of overlap in there that’s meaningful. Where you’re kind of, in a way you can say you are at the outskirts in both arenas. But there’s just such an important overlay.

When you are looking at decisions being made and their health and climate implications, are there any concrete examples that you can share with us so we can associate more to a concrete geographical context or concrete clinical setting? A good illustrative example to bring up.

Liz: So if I understand correctly, you’re trying to translate the intersection of ecosystem and public health, what is an example of that in decision making?

Frederik: [nods]

Liz: Actually, many of our decisions that relate to the habitat around us, the air that we breathe, the quality of the food that we have and the quality and access to water are all environmental decisions. The essential building blocks for the core of public health are actually environmental decisions.

The argument, the space that I play in often professionally, is that we divorce those things. So if we’re looking at ensuring public health water access, we think about the number of households with running water, but we’ve managed to separate that from the environmental decision, which is: what are the water bodies around this population? What is the quality of water in those bodies? How is it impacted by things like temperature and natural hazards and other elements that can be related to climate change and other global environmental changes?

That data is separated, but you can easily see that when something starts happening to those water bodies, we are going to have to start considering the public health impacts and what that means for obtaining a glass of water. And in some regions of the world, that can be a pretty critical element. So, for example, if you need to desalinate your water, it’s a huge endeavour to get that glass of water. And so thinking about the local environment is something that’s pretty critical.

Frederik: So if we, I’m trying to force you to get super concrete here. Is there a concrete policy decision you can think of as an example that took place historically that you can reference? So we get some very concrete examples we can learn from.

Liz: So looking more granularly, you mean at country level or sub-national level? There are many tangents I can take down this road.

Frederik: Just take one and then we can unfold it.

Liz: I think you can think about air quality and how we measure that, and how we determine what we are allowed to put in the air and what is an acceptable level of air quality. That is a decision that governments make all the time and may invest in infrastructure or diagnostics or tracking and surveillance to maintain, or not. It has a fundamental impact, particularly in municipal areas or areas where there’s a tremendous amount of circulating particulates.

Frederik: Would that be something like the city of Copenhagen where I live having a low emission zone where certain vehicles are not allowed to park or drive? Would that be a kind of policy decision that has to be made?

Liz: Exactly. You found the more granular answer there. It’s finding measures that are going to contribute to an environmental integrity and quality standard that are inherently linked to the health maintenance of people and population and the limitations of human physiology. We cannot maintain health after certain levels of pollutants.

Some people say, well, air pollution, I thought you were talking about biodiversity. But actually this is part of the ecosystem that needs to be maintained. Understanding what nature is and what biodiversity is and what ecosystem integrity means is a big area for capacity building. We can’t parcel out air, we can’t parcel out water, we can’t pick and choose. It’s all part of a system, a natural system that needs better granular decisions to maintain it.

So for example, that policy measure you’re talking about with cars and Copenhagen having limits to emissions, that is directly related to air. It also likely has very nice benefits for water in terms of runoff, in terms of exhaust, in terms of anything leaking out into the roads and the waterways. Many of those types of policies were produced for air, but have benefits to the entire ecosystem.

Frederik: Okay, now I start to see where you’re going with this. So when your paper is showing that for over a decade, nearly 200 governments have asked for integrated biodiversity-health indicators, and the scientific community has not delivered on these, is that a fair paraphrase?

Liz: Yes.

Frederik: And then I’m just thinking, so basically we have governments that are requesting information. You can say they’re flagging, this is a metric that we need. Why is it that the scientific community is failing to deliver on it when there’s such a clear ask?

Liz: I think this is such an oversight that part of the motivation to write this paper was to get this on the radar of more institutions. The global community has an environmental agreement on biodiversity. Biodiversity, broadly scoped to think from gene to landscape level, thinking about ecosystems, the species within them, and the interrelationships between species and ecosystems. That’s what biodiversity is, what this global agreement is on. There are about 196 countries who come together and make decisions on biodiversity.

And what this paper is about is that governments under this agreement have been calling for metrics to understand the intersection of nature and health for decades. That has not emerged on the radar of integrated scientists, health scientists, clinicians. And one of the reasons is what I brought up in the beginning, which is we have completely divorced our responsibilities when it comes to these environmental determinants of health. There’s the monitoring of the ecosystems, and then there’s the monitoring of health, and we haven’t built the institutional structures or the knowledge capacity or the academic disciplines to fill that gap.

And so how does that translate? You march up the ladder and all of a sudden you have an agreement that convenes 196 countries that’s been convening for two decades on a variety of topics. One of them being health has called for these indicators, but nobody knows that. So how do we raise awareness of that?

I think I have an anecdote, but go ahead with your question.

Frederik: When I hear you express it like this, in healthcare sustainability, we have seen a tendency for a myopic focus on a product LCA and the carbon footprint from one specific product or one specific device. What we are trying to do in our work is to look across the entire care pathway and invite a more holistic approach. If you’re just looking product versus product and ignoring the rest of the care pathway, essentially we are never going to lower the carbon emissions from the healthcare sector at large.

So it just occurred to me: when we’ve had other biodiversity experts here on the Sustainable Healthcare Podcast, we’ve had two or three episodes with Sebastian Nielsen from Slow Forest Coffee, who does regenerative coffee in a super impressive project, the first to have been recognised as being carbon negative on coffee production. So every time you buy their coffee, you are actually binding carbon, approved and validated by the SBTi.

But also with Alexander Holm, who’s a biologist. And Alexander talks a lot about umbrella species. So the focus that can come from saving the panda, for instance, invites NGOs to invest in protecting the habitat because the panda lives there.

Now I’m hearing you saying something along the lines that we’re trying to protect the drinking water coming out of the faucet. In order to do that, it’s a similar umbrella problem. We have to look beyond the scope of the actual water faucet because it’s not enough to understand just the end of the tap to see what bodies of water we need to protect and conserve.

That parallel really shows it’s important that we take a step back and zoom out a bit to design holistic solutions. If we zoom too much in and get too granular and focus on low emission zones, we might be missing a significant chunk of the big picture.

That perspective just occurred to me, and I couldn’t help sharing it.

Liz: I think there are some perspectives on what you’re saying where you can actually be more efficient with your decisions. If you’re looking to make an air pollution and carbon emission reduction through a traffic policy, for example, could that be even more cost-effective and create more health benefits if you’re looking more broadly on how that could situate in an ecosystem, not just looking at the atmosphere? The answer is usually yes, but we just don’t have teams that are doing that.

I wanted to share an anecdote that I think will be really helpful to the listener, which is: how did we get here? You asked how we arrived at this measurement gap and nobody is aware of it.

I would also say that I think this paper is timed in a way that many ears in the health system are paying attention to climate. Just in the last five years have we been really looking at carbon in the health sector. If we have this broad audience who’s now attuned to sustainability in the health system, we have health professionals who are thinking about carbon and reducing the footprint in healthcare. From that dimension, we have an audience that’s primed to understand ecosystems and environment more broadly. This paper is also timed to speak to those ears.

Here’s where I think the starting point is. A few years ago I was asked to give a grand rounds in an internal medicine department of a leading hospital for a US state. I was invited to speak on ecosystems and public health. They saw I was doing this interesting work at the intersection and asked if I could come speak at a grand rounds.

Grand rounds are monthly roundtables held in clinical environments where you present a topic that’s deeply related to either a clinical topic or to public health. I was speaking specifically to clinicians working in a hospital, all levels of medical professionals, nurses, the admin team, and they asked me to speak about ecosystems and public health.

We got all the way to the prep stage like we did today. Just before I was about to go onto this talk, the person moderating said, “By the way…” This is someone who had at least ten years of experience working in internal medicine, one of the hardest specialities in medicine. They said, “By the way, what exactly is biodiversity?”

This was off air.

Frederik: [nods]

Liz: I said, oh my goodness, I’ve been invited to this talk, we’ve had prep rounds, and now right before, we still don’t have this word. Here’s the reality: health professionals, specifically clinicians, doctors, for example, take dozens of science courses. They need to take building block courses, biology courses, microbiology, genetics. How many years and courses of science do these professionals go through? Then they interact with high-level science throughout their careers, but don’t know what biodiversity is or how to define it. How have we missed that really fundamental building block in the education?

Frederik: I heard a term called plant blindness that has been introduced recently in academia. That is, the ability to recognise plants in our local environments has completely diminished from the human skillset. You can actually achieve a significant reconnection with your local natural environment by going out and drawing plants, because we just don’t see plants the way humans used to.

As an anthropologist, I have a very firm belief that there’s a very meaningful connection that has been lost there. I love that there’s apparently academic projects going on investigating that. I’ll see if I can find something and put in the show notes on plant blindness.

The way you phrased biodiversity as ranging from the genetic level all the way to the landscape level, I hadn’t heard that definition before. I’ve found that there’s been a bit of a discrepancy about what people are talking about when they’re talking about biodiversity. Is it the number of different species, or is it the mass of different species in a given area? There are so many ways of quantifying and figuring out what’s what.

When you’re linking it from the genetic level to the landscape level, and then connecting that to the best minds in the STEM society that are still not trained in looking scientifically at the world from just a slightly broader lens, it is quite extraordinary that we have reached that level of siloing. We’re not even looking at our own feet anymore due to specialisation.

Liz: I think these kinds of micro discoveries about the gaps in our social approaches, our professional approaches to nature, are what drive me and my work. How impactful would it be if even understanding the term biodiversity in nature was something that was built into these health curriculums from the beginning? It would be transformative in many ways in terms of conceptual thinking, in terms of being aware of the decisions that impact nature and biodiversity, the ecosystems around us. It would apply at any scale: local, town, municipal. It would allow a level of translation and dialogue that currently doesn’t exist.

Another anecdote on this that is really valuable is: once these concepts are shared, they’re generally not rejected. It’s not very hard for a clinical person to immediately understand that there are a lot of inputs and conditions in the ecosystems around a population that impact kidney disease. Kidney disease is one of the leading reasons that people are inpatient in hospitals.

What are all of the impacts to kidney disease that are from the natural environment in a degraded state, in a built environment, that we need to be thinking about or that maybe we could be tracking at a population level to then go back and inform the decisions on our environment? These connections simply don’t exist right now.

This conceptual idea, thinking about the terms as part of the building blocks for how we develop professionally, how we’re educated, can really have a big impact down the road. Currently the leaders of most institutions don’t have this foundation of knowledge and so won’t even think to ask for data sets or to be part of interdisciplinary committees, because the awareness isn’t there.

Frederik: So we just did a carbon calculation of the footprint of the entire care pathway for chronic kidney disease in Denmark and quantified across the different CKD stages. There are five stages, and when you reach stage five, you’re in dialysis and you need to attend a dialysis clinic three times a week, four or five hours at a time. It’s a pretty significant treatment with a tremendous carbon footprint associated to it, and a decrease in quality of life and opportunities in life that is very hard to fathom until you see the impact that this disease has on the patients that are living with it.

We didn’t take biodiversity into account at all. We are just looking at the clinical classifications of the different stages and the treatments and activities that you go through in each of the stages on an annual basis. Then we attached a carbon value to each. Of course, around 85% of the emissions come from stage five, which is quite preventable.

This talks into what you’re alluding to here: if only we would have better strategies and action plans on national and international levels, maybe we could prevent some of this public health burden increasing the way it’s generally increasing across the board.

When you’re talking about countries that are embedding biodiversity-health metrics into their biodiversity strategies and action plans, what does that look like in practice? If I was about to talk to the Ministry of Environment or the Ministry of Health in Denmark… they now have no government because we just had elections, so we don’t know what ministries will exist when they agree. But they’ll probably have responsibility areas for both. Maybe they’ll be in the same ministry even, they get funky ideas when we’ve had elections.

But let’s say that there’s going to be a Ministry of Health and Ministry of Environment. How would you go about advising them in practice if they reached out and said, Liz, we’re forming the policies now, what are we doing?

Liz: Well, a couple of things to think about here. The first is that the environment is a good thing for health. It’s good for physical health, mental health, spiritual health, identity formation of children, cognitive states for elderly people. It is a health-promoting element to our lives. In a degraded state, it can lead to negative health outcomes. Pollution, for example, of nature would cause exposure. We’ve got the positive and the negative.

And what these national strategies really need to contain is environmental determinants of health and an analysis at the country level of what are the environmental determinants of health. And that should really think about both the positive and the negative. And in terms of the negative, one way that calculations are moving forward in the epidemiology community is looking at environmental burden of disease.

So countries starting to think about environmental burden of disease. This is a known concept, particularly in the field of public health, the idea of environmental determinants of health, what is really impacting populations in the country, and making those real terms in national strategies.

That’s a way to make it a much more integrated strategy, but it’s also a way to ensure that there is a hook there to then put that document on the desk of the Ministry of Health. Without that, there’s very little hook and it’s going to be a back and forth between, is it the chicken or the egg? Who starts this off?

Getting some of these fundamental terms into those strategies is a way to hook over to the Ministry of Health and say, hey, please take a look at this. Let’s start analysing this space. Where is the research we need? Is there existing research that can support this? If not, can we look at some gaps? How do we start thinking about caring for our populations, ensuring our children have less environmental burden of disease, for example, and that we have things like food security and water security planned out. That would be absolutely a first step. Unfortunately, many countries haven’t gotten to that stage, and it goes back to the terminology problem that we’ve talked about a few times already on this episode. These building blocks need to get planted in.

Frederik: I think you’re really alluding to something quite interesting here. At least in Europe, we’re seeing more and more health systems that are subscribing to net zero targets for their carbon emissions. And the whole argument is that we need to lower global CO2 emissions, which everyone agrees. And I think anyone who doesn’t agree would probably not listen to the show anyway, so we can firmly state that.

And the next thing coming up is then, well, what are the health consequences of global warming and climate change? We have seen cases where, for instance, when we have severe forest fires, like the ones you’ve experienced in the North American continent recently in the US and Canada, those forest fires have been clearly linked to more exacerbations for patients suffering from COPD or living with COPD.

From that observation to claiming that we can decarbonise the COPD care pathway by changing the medicinal treatment at a patient level, what is your take on how we balance on that knife’s edge of not claiming that we are stopping forest fires by switching medicines to lower-emission medicines, but at the same time, recognising that one of the fundamental reasons for why we need to tackle climate change is that the health burden is going to be extreme in a way that’s very hard to fathom? And that will either lead to very difficult ethical and moral decisions on who we are going to treat and who we’re not going to treat, or to a systemic healthcare collapse, which is basically the perspective that we’re already short on hands and health systems are not able to treat the patients that are there.

So how do you balance those relative and absolute terms?

Liz: I see where you’re going. My mind wants to go in five different directions with an answer. Let me see if I can bring one piece in.

There’s this element that’s really interesting and less developed and explored, but is also difficult conceptually: local. Global environmental change, climate change plus other global environmental changes, have local impacts. Those local impacts are generally changes in an ecosystem. Whether it’s the air and the atmosphere, the water, a flood, they’re local changes that people are experiencing and there are health outcomes.

We want to jump from that local level experience to saying, okay, we need to address that local health outcome, but we also need to address that bigger global environmental change problem. We need to do both at the same time. What you’re asking is how do you do that? How do you look at the local measures and not be too grandiose about what you’re trying to do, but also contribute to solving the problem?

This is a huge collective action problem. How do you get people to work together to see this bigger goal, especially when it’s so hard to move the dial at that level?

The optimistic way of looking at this is we are at the beginning. Particularly, I think bringing the biodiversity side into it is going to make this more comprehensive, cohesive, and relatable. Right now we have carbon scientists, we have the carbon argument, we have the climate and health sector. I would say there’s a mini-silo of climate and health specialists. If we expand that to a much broader pool of knowledge holders, including the conservation community, including the community in planetary health and One Health and all of these communities that are thinking about this local-to-global thing, we are going to get better at tackling the problem.

I wanted to share an anecdote on this that may be useful. There was a case in the United States in Montana called Held v. State of Montana. 16 plaintiffs went to court stating that local ecological changes resulting from climate change and global environmental changes were causing devastation to them socially, economically, culturally, and in terms of health outcomes. Sixteen different plaintiffs with different complaints, and this resonated because those outcomes were tangible.

There was evidence that all of these relatively more local, smaller ecological changes were having individual and distinct health and social impacts that were measurable and demonstrable. The court could take this forward and say, yes, we agree that slapping down a measure on the entire state of Montana makes sense so that we limit the emissions that are causing that bigger problem. At the same time, building into this decision that there need to be some remedies for some of these local outcomes.

It was a two-part decision, and in the lower courts it passed. [Note: subsequently upheld by the Montana Supreme Court in December 2024.] Bringing to the fore that these local changes have local social and health outcomes that are having distinct impacts on people at the individual and community level can be the kind of evidence we need to make those two-part decisions.

We can’t do that if we’re not yet thinking about ecosystems and all of the little changes that are in there. Bringing in a bigger community to think about these problems, widening these mini-silos, is really impactful.

In terms of the healthcare supply and products, we haven’t even scratched the surface, and there’s quite a bit of interest on that among health professionals. How do you think about healthcare supply? How do you think about the implements and the tools that we use every day with a lens that’s more nature-based? How can we limit the contaminants that are coming out in plastics? All these sorts of things. We’re just scratching the surface on that.

Frederik: I had a lot of thoughts going in five different directions, as you also said. I couldn’t help imagining John Dutton showing up from Yellowstone in court in the state of Montana for that lawsuit.

But I think there’s something quite interesting there. Would you mind writing the name of that case in the chat so we can get it in the show notes?

When Joachim and I have the Sustainable Healthcare Podcast, we spend a lot of time on the carbon footprint of care pathways, the carbon footprint of clinical trials, and the carbon footprint of the pharmaceutical supply chains. Of course that has a leakage effect into the other planetary boundaries. It has a leakage effect into biodiversity.

None of it happens without healthcare policy, because then there’s no market for it basically. But when you’re talking about health systems, you’re also talking about how they themselves impact biodiversity. I think that’s an angle that we haven’t quite seen enough interest for anyone to fund a project where we could get our hands dirty working with this. I’ve mostly worked at it on an interest basis, because it’s a huge interest of mine, but it’s not something where we see a lot of commercial focus going there in the industry.

Yet there’s still a lot of window dressing and showcasing that you have nature-based targets and such, but it’s not really into the core of the business anywhere. I think the biggest case I’ve seen is one pharmaceutical company purchasing regeneratively produced glucoses for some of their API production, which is great. But there’s very little translation from those nature targets into something that actually hits the road in the business.

So I’m curious to hear, where do you see a future where the sustainability metrics that we’re using in healthcare, what we have in Scope 1, 2, and 3 emissions reporting, what we have in lifecycle assessments, where do you see that converge with the biodiversity-health indicators?

Liz: I think there are many possible answers to this because the spectrum of indicators could be quite broad, but there are two things that really come to mind that I think would be worth sharing.

The first is I’m thinking here of the bright-eyed, bushy-tailed fresh medical student right out of medical school, really interested in the environment, wants a sustainable environment for their future, for their patients. It’s an exciting topic. We’ve got a blank canvas when it comes to looking at the nature footprint of healthcare. It’s so blank that when we say that, we’re like, well, what do you mean? That’s because that’s the state we’re at.

We need all of these bright-eyed, bushy-tailed young professionals to start working on those canvases and say, what is the nature footprint for healthcare in my country, in my city, in my hospital? How do we even start to scope that? That is a fundamental building block that I think a lot of people can get behind intellectually, even with small amounts of funding or PhD projects or master’s projects, and provide that information so that we’ve got some foundation.

The second piece to it, I think, is we need to, especially in the sector you’re working in, pharma, close a big gap on the waste side. If you think about pharmacology, fundamental to clinical training, you have very hardcore training on pharmacology, thinking about not only the physiology and the unintended consequences to humans, but about interactions with other drugs, et cetera.

One huge area that’s not touched on is: what happens when that really powerful drug that we’ve spent all of this time thinking about exits into the environment? What kind of side effects is it having on other species? The interactions of other species, food chains, and how much of it is getting back into our water supply and interfering with our drug interactions.

We have zero training in clinical medicine to say, okay, when this drug leaves out of the pipes, out of the trash of the hospital, what happens to it? How is that impacting nature?

That also is a canvas. Think about all the drugs that go out of a hospital every day. We are actually drinking some of those.

Frederik: Yeah.

Liz: Do we want to be drinking those? Whose problem is it? Is it the water treatment plant’s problem? Is it the hospital’s problem? Is it the drug manufacturer’s problem? Is it the fact that people should be buying different filters as consumers?

We don’t have enough awareness of that circle, and that blank canvas is something that could really be tackled more effectively. Right now, the cocktail of pharmaceutical pollutants is relatively unknown but understood to exist. Levels of NSAIDs, anti-inflammatories, levels of contraceptive medications, levels of antibiotics, levels of bigger drugs. In some parts of the world, the waste from tuberculosis treatment cocktails is in the water.

We have to think about the whole circle, the lifecycle of these products. In lifecycle analysis logic, this would be the end of life of a drug product. We have zero on that.

The pharmaceutical industry has had a focus on emissions at a factory level, making sure that nothing escapes the factory gate that shouldn’t escape the factory gate or the factory pipes, which I think is great. In general it’s fair to say that there’s a lot of quality control and quality assurance on a production level where you’ve put a plug in the big emissions from factories. But there’s a very poor sense of scale of what that translates to when all of the products going out of the factories are going into patients and then going out of patients and into wastewater treatments or wherever they’re exiting post-consumption.

Frederik: We did do a very interesting episode. It was me recording with Kelly [Thornber] on Pharma Pollution Hub, a new NGO that she has formed in investigating this. I was part of a roundtable with a number of industry experts recently, two serious workshops where we’ve been discussing a way forward for this.

I think you’re right on the money that this hasn’t been a focus of interest traditionally or historically, but now we are seeing the consequences of not paying attention to it. Maybe it will be a case of too little too late, but it’s definitely something that’s commanding attention now, which is great.

I think that’s a good segue into us rounding off. When we are working in this space of sustainability in healthcare and biodiversity and the environment, there are so many reasons to despair and so many bad news we’re exposed to all of the time. But overcoming that, I think a great vehicle for it is to share reasons for optimism that we, as experts and semi-professional activists, are exposed to.

What makes you hopeful even though you’re working with these bleak perspectives?

Liz: I think this is a great question. I sometimes don’t feel hopeful, but I think I often do. It’s really about how big the gaps in knowledge are, and how many fundamental building blocks are missing, and how easy it is to get some of these building blocks in place.

Just a tangent from the last discussion on pharmaceutical pollution: we don’t have anybody really looking at, for example, worldwide and in most countries, there’s this significant amount of prescriptions for antidepressants. We quite literally have limited to no one thinking about what all those antidepressants do to fish.

If we have no one looking at that, we can remedy that very easily by inspiring that sort of research to start to crack that door open. If, going back to some other parts of our conversation, we don’t understand after 12 years of medical training and 10 years of clinical work what biodiversity is, then we simply go back to the beginning and get the term to be understood as a requirement to go to medical school, or something that’s so easy and would take 30 minutes of someone’s time.

Those little building blocks, the little actions that can lead to long-term change or wider system change, are what really keep me going. I spend a lot of my time identifying those gaps. I think one way to do that is just to always take that systems view. Think about planetary health, planetary boundaries, the system of healthcare. Does nature connect to the system of healthcare? Does nature connect to health? Start to see the gaps in that. There’s something for everyone when you do that, ways to find your areas of interest. There’s just so much tremendous opportunity to bring these silos together.

Frederik: Amen. That was very neatly put. Thank you so much for coming on the show, Liz. And thanks to you, dear listeners, for listening in. You’ve been listening to an episode of the Sustainable Healthcare Podcast. I’ve been your host. My name is Frederik van Deurs. Please remember to like and subscribe to the show. Give us a rating if you please, and feel very free to suggest other guests that we should invite for the show. We’re always quite happy to hear that. Give us feedback on the show, what you like, what could have been better. We really deeply appreciate all the feedback that you give us. Thank you so much for listening.

Thank you, Liz. Let’s help you with your offline recording because that is a little bit difficult.