Healthcare industry emissions are a problem, but doctors can help

After her twins were born in 2008, obstetrician-gynecologist Jane van Dis grew more concerned about climate change. In Southern California, where she was living at the time, the increasingly scorching and prolonged heat waves made her worry for her children’s future. She began to look more closely at how her own industry contributes to the climate crisis. Too often, the public doesn’t hold healthcare to account, she says. But it contributes a significant chunk of planet-warming emissions. “It’s a huge sector that needs to stop being given a pass and to start reflecting on how it needs to be part of the solution, not only for the planet but for the communities that we serve as well,” she says.

Increasingly, healthcare providers are recognizing the role their industry plays in climate change and are taking action. Anand Bhopal, a public health researcher at the University of Bergen, says he is often asked why he focuses on healthcare rather than a more obvious target such as coal power. “That question is premised on the idea that we have time to do everything in the right order – but we don’t,” he says. “We need to show what is possible in healthcare, and we need to inspire and drive radical transformational action. ”

The healthcare industry is heating up the planet

Healthcare is estimated to be responsible for more than 4% of the globe’s greenhouse gas emissions. If the industry were a country, it would be the fifth-largest greenhouse gas emitter. The United States has the highest healthcare emissions of any country. While Americans comprise only 4% of the global population, their healthcare emissions make up 27% of global healthcare emissions.

Jodi Sherman, an anesthesiologist at Yale School of Medicine, says these excess emissions don’t correlate with better care. If the US had the best healthcare outcomes, perhaps those emissions would be justified, she adds, but that’s not the case. “We don’t have the best healthcare outcomes in the world, and there are many high-income nations that have healthier populations at a fraction of the cost and a fraction of the emissions,” she says.

Where healthcare emissions come from

These emissions come from a few broad categories, according to a report from Health Care Without Harm, an organization dedicated to reducing the environmental effects of the industry. Direct pollution from buildings and vehicles accounts for 17% of global healthcare emissions. One major source of these direct emissions is anesthetic gasses, which can be responsible for about 5% of a hospital’s climate footprint, says Sherman. Some inhaled gas anesthetics are powerful greenhouse gasses: one gas called desflurane is more than 2,000 times as effective at warming the planet as carbon dioxide. Another 12% of emissions comes from energy sourced by hospitals. Hospitals are heavy users of water and energy. If that energy is coming from fossil fuels, then it adds to the hospital’s climate footprint.

The hospital supply chain and the plastic problem

By far the greatest source of emissions is the healthcare supply chain. Globally, an average of 71% of healthcare emissions are associated with the production, transport, use and disposal of all the goods and services provided. That’s everything from medicines, chemicals and instruments to the food served in the cafeteria. Fossil fuels are used in many of these steps. They are turned into plastic, used in manufacturing, and fuel shipping – all of which contribute to the climate footprint of a product.

Disposal, in particular, is a problem. Prior to disposal at a landfill, trash placed in a medical waste bin must be sterilized using high-pressure steam or incinerated. These processes can release up to 10 times more emissions than regular waste management, says van Dis. While some waste needs to be sterilized for safety, most trash in red medical waste bins doesn’t meet the legal definition of medical waste, which involves being soaked in blood or tissue.

Single-use products are behind a large chunk of supply chain emissions. While some equipment needs to be thrown out after one use because sterilizing it is difficult or costly, in many cases reusable options can be just as safe and more sustainable. Even though reusable alternatives for items such as isolation gowns – which are worn by medical staff to protect them from microorganisms or bodily fluids – have energy and emissions costs associated with cleaning them, studies have shown that they have a lower overall environmental impact. “We just have not been diligent and thorough enough in questioning why it is that someone would want to sell us a product that we have to buy again, and again, and again, and again,” says van Dis, “versus the use of a device that we can wash.”

While preventing infection is sometimes used as a “trump card” for buying single-use products, Sherman says there’s little evidence to support the purported safety benefit of single-use in many products, such as bed linens, certain surgical instruments and blood pressure cuffs.

Curbing hotspots in healthcare emissions

While the whopping emissions of the healthcare system present a challenge, there are many hotspots that can be addressed. For example, improved management of anesthetics and the use of gasses with less climate warming potential could readily reduce a hospital’s carbon footprint. Sorting waste appropriately is another relatively straightforward step. Educating clinic staff on what is and what is not medical waste, and making sure there are regular waste bins available can make a big difference as it means avoiding adding to unnecessary emissions from the incinerator, says van Dis.

Building a more sustainable system

Beyond tackling hotspots, hospitals also need to change their business practices. Procurement departments will need to focus on purchasing lower-carbon products and reducing unnecessary consumption, says Sherman. But improving purchasing is complicated, she adds, because vendors can sometimes mislead buyers with greenwashing. Some companies claim their products are recyclable, for example, and they might even provide special bins to return used equipment. But not only is much of that material not fully recyclable, Sherman says, it’s an impractical system too. “We have thousands of supplies,” she says. “We can’t have thousands of bins.”

Sherman adds that the ethos of reducing unnecessary consumption must filter down to clinicians, who can reduce impacts by avoiding unneeded services. Even how a procedure is done can matter. Van Dis says that when a C-section patient requests a tubal ligation, she uses metal clamps to cut off the blood supply to the tissue that she then removes. “It’s ancient; It’s perfect,” she says of the method. While a single-use plastic clamping device could seal and cut the tissue at the same time, shaving a few minutes off the process, she goes with the old-school method to reduce waste.

There’s evidence that healthcare systems can improve. For example, following the UK’s 2008 Climate Change Act, the country’s national health system began assessing its emissions and taking steps to reduce them. The agency’s procurement policies require vendors of medical goods to disclose their emissions and climate plans and progress, making it possible to choose more sustainable options. The efforts have led to a decline in emissions of 26% compared to 1990 levels.

It’s hard to implement similar regulations in the US, where the system is more fragmented and largely privatized. But Sherman says regulating emissions through the Medicare and Medicaid federal programs may be possible through implementing carbon reporting standards. By making those government funds conditional on hospitals’ reporting their decarbonization performance and progress, it may be possible to impose standards broadly across the system.

What individuals in medicine can do

For an individual doctor, nurse or technician, it can be daunting to think of how to help. But Sherman says everyone can do something. Clinicians can learn about options for less greenhouse gas-intensive care or implement other sustainable practices in the clinic. If they want to go further, they can get involved in leadership roles, such as advocating for more sustainable procurement, or join professional societies to influence policies.

Forbes McGain, an intensive care physician in Australia, says that the principle of “First, do no harm” extends to helping people live well on the planet by addressing climate change. “It’s not just about the patient in front of you; It’s about all patients and all people,” he says. “I think that the more doctors and other clinicians become involved in these projects, the louder the voices become for change.”

Photo: Thomas Decamps for Welcome to the Jungle

Follow Welcome to the Jungle on Facebook, LinkedIn, and Instagram, and subscribe to our newsletter to get our latest articles every week!