Paper Title
Sustainability in healthcare: where do we start?

Background: Climate change and the healthcare sector are inextricably linked. The available evidence highlights the relevance of the health care sector's contribution to climate change. In the UK, the healthcare sector is responsible for 4% of England’s carbon footprint. Emissions along the supply chain from procurement all the way to waste disposal in clinics across the healthcare sector reveal multiple opportunities to identify and investigate areas where we can make significant improvements. In October 2020, the NHS became the world’s first health service to commit to reaching carbon net zero1, in order to help meet the net zero targets set under the Climate Change Act 2008.2The ‘Sustainable Dentistry Guides’ published by the centre of sustainable healthcare outline 4 principles of sustainable dentistry; that aim to provide practitioners with a framework to provide high quality patient care which is economically and environmentally sustainable.3 There is a growing body of research about the role that dentistry plays within creating a more sustainable healthcare. A recent literature review posed the question;‘What is the current state of environmental sustainability in general dental practice?’4. One of the identified barriers to theimplementation of sustainability in dentistry is the attitude and behaviour that exists within the profession and a disconnect between the responsibility we have towards climate change as members of the general public, and as a healthcare professional in relation to the aims of our core professional development. Sofar,no systematic analysis has been undertaken to ascertain what healthcare professional’s attitudes are towards sustainability and what barriers are currently present towards practicing in a more sustainable manner.Undertaking research into this area will make it possible to conclude more fundamental insights on how we can practically implement more sustainable approaches in dentistry. Aims and Objectives: The primary aim of this study is to investigate the current knowledge and attitudes of health care professionals towards sustainable dentistry. Secondary aims include investigating clinicians’ perceived barriers to practicing sustainable dentistry as well as to investigate the applicability of this framework in practice from a clinician’sperspective. Design: This is a cross-sectional survey which was conducted as a pilot study, starting with orthodontic health care professionals with a view to being rolled out to include all UK dental professionals in a subsequent study. Data collection will be undertaken by the use of a questionnaire that will be distributed electronically toall orthodontic clinicians working within the United Kingdom that are registered with the British Orthodontic Society. Questions will be based on the current framework developed by the centre of sustainable healthcare. Methods: The data will be analysed to assess the applicability of the identified guidelines and to identify barriers, if any, to their implementation and to suggest appropriate recommendations for the way forward. Data will also for the first time report on UK heath care professionals knowledge and attitudes towards sustainability in practicing dentistry. Qualitative methods of analysis will be utilised to identify common themes within the survey responses and utilise these in exploring strategies to improve sustainable practice in the future. Keywords - Sustainability, Healthcare, Dentistry, Climate Change