Funded PhD: Decarbonising the patient pathway for diabetes and obesity: Investigation of the co-benefits for health and environment

• Principal investigator(s) Prof. Mary Lynch, Dr Tommy Kyaw-Tun, Dr Elizabeth Morrow
• Research theme Endocrinology, Population Health and Health Services

The healthcare sector’s contribution to climate change is gaining greater attention. In health systems such as the National Health Service (NHS) current estimates suggest that it contributes 5% towards the United Kingdom (UK) carbon footprint. The NHS is committed to attaining net zero carbon emissions by 2040. The production and provision of healthcare has an impact on the environment through Greenhouse Gas Emissions (GGE’s) and to attain a balance between greenhouse gases produced and removal in the environment sustainability actions are required to attain net zero.

To achieve a net zero healthcare system, it is crucial to consider the changing healthcare needs, advancements in medical technologies, and focus on patient pathways rather than facilities, prioritising primary care and avoiding unnecessary treatments.

Ireland is dedicated to reducing GHE’s by 51% by 2030 and achieving a climate neutral economy by 2050. However, Ireland is projected not to meet its climate targets by 2030 and potentially could face a bill of between €8 billion and €26bn to other EU member states if it doesn't act now to reduce emissions. The Health Service Executive (HSE) Climate Action Strategy (CAS) 2023 – 2050, outlines six priorities areas with strategic objectives to address the co-benefits of actions to mitigate climate change. 

Included in the CAS is the strategic objective of Greener Models of Healthcare (GMH) and this PhD proposal will investigate the patient pathway in focusing on areas with high potential for carbon reduction, such as community, primary care or secondary care setting for patients with type 2 diabetes (T2D) and obesity.

Diabetes and obesity are both highly prevalent chronic conditions that result in multiple co-morbidities. The prevalence of diabetes in Ireland is estimated to be at 6% across all age groups, meaning that over 300,000 people have diabetes, with approximately 275,000 estimated to have T2D. Obesity affects over 30% of adults in Ireland.

The current standard clinical care pathway for both T2D is as follows:

1. Routine screening, or symptoms related presentation to the general practitioner (GP) leading to the diagnosis of T2D.
2. Management in the GP practice for >80% of patients.
3. Approximately 20% referred to either the community hub or the local hospital. The department of endocrinology in Connolly Hospital have over 3,000 patients registered with T2D.
4. Complications are screened for through various care pathways according to the complexity e.g. the national retina screening programme is the first line screening offered for all patients, with those with complications referred to ophthalmology services in the hospitals. Similarly, podiatry care is offered at both community level and specialist centres.

Obesity care is currently only offered in two publicly funded networks, although a third network in Connolly is envisaged to come online imminently. For both diabetes and obesity, there is significant impact on both the direct cost of care monetary wise, as well as to the environment.

The cost for manufacturing and production of medicines is in the billions, and the impact on the environment is unknown although it is well recognised that even the use of plastic pens and needles already produces a very large amount of waste. The costs of the complications of both conditions is also likely to be very significant as wound care, surgery, impaired travel (blindness and amputations) are all extremely common. 

In this project, interdisciplinary health professionals will be invited to participate in a focus group to identify key carbon-intensive ‘hot spots’ within current care practices, drawing on their clinical expertise and practical experience. 

Aim

• To investigate the decarbonising the patient pathway in the prevention, treatment and management of patients with type2 Diabetes and obesity to reduce GHEs and moving towards net zero.

Objectives

1. Explore the evidence to detect potential improvements in human or population health and reducing health inequalities as a co-benefit of the health systems transition to net zero in chronic disease pathways.
2. Examine and develop an emissions reduction plan (ERP) to recommend changes to processes and inputs to the diabetes/obesity patient journey, including changes to the journey itself where appropriate.
3. Identify GHE hot spots by mapping the patient pathway through primary and secondary care settings.
4. Develop a multi-stakeholder framework with clear pathways for data collection, engagement and policy, practice and public impact.
5. SROI of a non-clinical intervention to demonstrate a return on investment as well as decreasing the carbonisation of the patient pathway.

Tenure: Three years (stipend + domestic fees) with stipend for €25,000 per annum

Start date: 1 October 2025

Specification

Minimum requirements

• Candidates for this project will require a background in nursing, public health, health systems, psychology, social sciences, economics, or other cognate discipline. All candidates should have a minimum of 2:1 honours degree (level 8) in the disciplinary area outlined or in a cognate discipline.
• Candidate should be highly motivated, enthusiastic individuals.

Application process

Please apply for the research project through the link below.

Applications must include:

• A completed application form
• English language requirements – find more information here