The environmental impact of healthcare

As the impact of human-induced pollution grows, the public health spotlight has been slowly, but steadily, swinging towards the importance of planetary health.

More frequent floods, bushfires, and droughts illuminate a core truth: we cannot lead healthy lives if we live in an ailing world.

But what is often overlooked is that our efforts to improve human health can feed into environmental degradation, which then ultimately compromises our health. The relationship between planetary health and human health is more cyclical than most of us might realise.

Waste in the healthcare sector

The healthcare sector, which includes the public health system, hospitals, primary health services and pharmaceutical companies, is a major contributor of harmful emissions and waste.

Globally, 4.4 per cent of greenhouse gases can be attributed to the sector, with hospitals the most energy-intensive and wasteful.

In the US, the healthcare sector contributes an estimated 8.5 per cent of the country’s total greenhouse gas emissions. The sectors of other developed countries, like Canada and Japan, leave a relatively smaller but still significant carbon footprint, at about 4.6 per cent of each nation’s total.

And Australia isn’t any better.

Our health system generates approximately seven per cent of the nation’s total carbon footprint – this is equivalent to emissions from the construction of half the number of homes, buildings, oil rigs, roads, pipelines dams, and rail lines across the country.

Hospitals are responsible for roughly half of this seven per cent.

Where do these emissions come from?

A large portion of carbon emissions can be traced to energy use across the healthcare sector. Power generation of healthcare facilities for heating, cooling, ventilation and hot water all require substantial energy use.

Globally, the energy used to cool hospitals each year is estimated to produce the same amount of emissions as 110 coal power plants. Energy consumption along the supply chain, however, constitutes the lion’s share of carbon emissions.

The manufacturing, delivery, consumption and disposal of products and services adds up to an estimated 60 to 70 per cent of the healthcare sector’s global footprint.

Each year, billions of dollars worth of drugs are discarded because they are packaged in vials larger than what’s needed for a single patient, leading to unnecessary wastage.

Manufacturing replacements for disposable items like surgical equipment, blood pressure cuffs and bed linen generates a large amount of emissions. The incineration of these disposed items – which is widely practised – can also release air pollutants if inadequately executed.

The consumption of single-use items has become an even bigger concern with the onset of the COVID-19 pandemic, as healthcare professionals don disposable personal protective equipment (PPE) to decrease the risk of infection.

The first 20 months of the global COVID-19 response generated an estimated 87,000 tonnes of PPE and 144,000 tonnes of additional waste from vaccines (including syringes and needles), highlighting the urgent need for the healthcare system to re-examine how medical waste is managed.

The importance of a green healthcare sector

Those who work in the healthcare sector can view climate change as lying outside the realm of their responsibility – greenhouse gas emissions are the least of their worries when they’re busy saving lives and administering treatments.

Climate change can feel like a ‘problem for the future’ due to the perceived gradual onset of its consequences when compared to other immediate health concerns like infectious diseases and complications presenting from chronic health conditions.

However, this short-sightedness can be detrimental to our health in the long run.

Greenhouse gas emissions and resultant global warming cause, and worsen, a range of health conditions. Higher concentrations of particulate matter in the air can increase the risk of respiratory diseases. Malnutrition can result from disruptions in crop yields and dietary diversity caused by rising temperatures.

An increased prevalence of disease can then lead to an increased need for healthcare, which produces more emissions and environmental damage.

And so the vicious cycle is reinforced.

The goal of the healthcare sector is the maintenance and improvement of individual and population health. So the sector needs to be on the frontline in the fight against climate change.

To take a backseat is to betray the health sector’s commitment to help and heal.

What can be done?

There are choices in healthcare that can be made now to help reduce the environmental impact of the sector, from small-scale changes at the facility level to large-scale changes at a multi-sectoral level.

For example, by opting to use propofol instead of desflurane as an anaesthetic, hospitals can eliminate the release of a harmful gas that has the greatest impact on climate change out of all commonly used anaesthetics.

Desflurane remains in the atmosphere for 10 years, and each hour of desflurane usage exerts a greenhouse gas impact that’s equivalent to driving 350 kilometres.

The sector must also create changes upstream in the supply chain for there to be a significant decrease in emissions. Health systems have immensely strong purchasing power, which could be leveraged to drive a shift to sustainability in other sectors.

By requiring suppliers to lower their carbon footprint and adopt more sustainable practices, the healthcare sector can influence their supplier’s bottom line to prompt a green transition.

Health co-benefits should also be a focus of sustainability efforts as they provide strong incentives for motivating change. Climate change mitigation policies can result in benefits for both the environment and population health.

For example, when a local hospital transitions its food system to one that is fresh and locally sourced, it not only helps the environment by reducing the carbon emissions involved in transport, but can also improve the health of its staff, patients and visitors at no extra cost.

The healthcare sector needs to act quickly to combat climate change, the biggest threat to human health.

Now is the time to implement policies and designs that lead to real improvements because climate change can’t be brushed away as a future consideration.

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