title: Health, climate change and energy vulnerability: a retrospective assessment of strategic health authority policy and practice in England.
abstract: A number of policy documents suggest that health services should be taking climate change and sustainability seriously and recommendations have been made to mitigate and adapt to the challenges health care providers will face. Actions include, for example, moving towards locally sourced food supplies, reducing waste, energy consumption and travel, and including sustainability in policies and strategies. A Strategic Health Authority (SHA) is part of the National Health Service (NHS) in England. They are responsible for developing strategies for the local health services and ensuring high-quality performance. They manage the NHS locally and are a key link between the U.K. Department of Health and the NHS. They also ensure that national priorities are integrated into local plans. Thus they are in a key position to influence policies and practices to mitigate and adapt to the impact of climate change and promote sustainability.
  
  
  
  The aim of this study was to review publicly available documents produced by Strategic Health Authorities (SHA) to assess the extent to which current activity and planning locally takes into consideration climate change and energy vulnerability.
  
  
  
  A retrospective thematic content analysis of publicly available materials was undertaken by two researchers over a six month period in 2008. These materials were obtained from the websites of the 10 SHAs in England. Materials included annual reports, plans, policies and strategy documents.
  
  
  
  Of the 10 SHAs searched, 4 were found to have an absence of content related to climate change and sustainability. Of the remaining 6 SHAs that did include content related to climate change and energy vulnerability on their websites consistent themes were seen to emerge. These included commitment to a regional sustainability framework in collaboration with other agencies in the pursuit and promotion of sustainable development. Results indicate that many SHAs in England have yet to embrace sustainability, or to integrate preparations for climate change and energy vulnerability within their organisational strategies. Evidence also suggests that SHAs that have recognised the importance of sustainability within their documentation and policies have yet to fully demonstrate this in practice through the implementation of these policies.
  
  
  
  Further research is required to investigate means by which SHAs (U.K.) and agencies responsible for health service policy in other countries may be enabled to include a greater consideration of sustainability and climate change within their policies, and to find effective ways of implementing these policies within daily working practice.
authors.affiliation: Professor of Health Services Research, Faculty of Health and Social Work, University of Plymouth, 3 Portland Villas, Drake Circus, Plymouth, Devon PL4 8AA, U.K.
authors.forename: J
authors.initials: J
authors.lastname: Richardson
authors.forename: F
authors.initials: F
authors.lastname: Kagawa
authors.forename: A
authors.initials: A
authors.lastname: Nichols