Greening Healthcare Systems
Author: Genevieve Silva is a first-year medical student at the Perelman School of Medicine. She is involved with the medical school’s Healthcare Sustainability Group and Climate Leaders at Penn, a university-wide organization. Genevieve is also on the leadership board of Medical Students for a Sustainable Future, a nation-wide network of medical students dedicated to action around climate change.
Climate change and human health are inextricably linked. The shifts due to climate change are projected to (and are already beginning to) impact nearly all dimensions of human health—chronic disease, infectious disease, respiratory health, mental health, physical trauma and injury, child development, nutrition, access to treatment, and more. Likewise, healthcare systems will bear a significant brunt of the burden of climate change due to these health impacts, compounded by supply chain shortages and influxes of survivors from natural disasters and populations of climate-displaced people.
However, the U.S. healthcare system, as it currently stands, is part of a dangerous feedback loop that escalates climate change even as it works to care for people who have fallen ill. From the standpoint of environmental responsibility, the U.S. healthcare system is not sustainable. A recent analysis concluded that the healthcare sector produces 10% of the greenhouse gas emissions in the U.S., outpacing the total emissions from all but 12 countries in the world. Greening the healthcare sector—at the levels of hospital systems and private practices—is, therefore, a high-yield target in moving toward climate solutions.
Hospital systems are major consumers of energy, ranking second in the U.S. in terms of energy usage by commercial buildings. Despite the fact that they must run 24/7 and power complex machinery, there are many modifications that can be made to reduce energy usage in hospital systems. Organizations like Practice Greenhealth consult with healthcare systems around the country to create efficacious plans for energy and emissions reductions. For existing structures, hospital systems can conduct an energy baseline analysis to identify underperforming buildings, verify the efficacy of existing efficiency efforts, and create energy reduction goal benchmarks. These benchmarks can be reached using demand- and supply-side management targets and hospitals can access and finance renewable energy through power purchase agreements and renewable energy certificates.
Hospitals are frequently expanding and renovating, and it is essential for new additions to utilize the latest innovations in building efficiency and take a low carbon approach to the building construction process. While the details are beyond the scope of this proposal, such a greening consultation could also target hospital transportation and food waste as part of its overall plan. At a more granular level, department-specific emissions and waste generation from operating rooms are key climate solution targets. Almost a third of the waste produced by hospitals comes from surgical procedures in the OR, presenting a significant opportunity for innovation around safe reusability. The imperative to maintain a sterile environment in the operating room has contributed to the development of large volumes of single-use paper and plastic during surgical procedures
Identifying points at which containers, devices, and products can be sterilized and reused, rather than discarded, is one strategy to cut down on waste. In addition, certain inhaled anesthetics (desflurane and nitrous oxide) are potent greenhouse gases, and excess waste gas is often vented off of facility rooftops in an uncontrolled manner. Hospitals should instate the recommendations of the American Society of Anesthesiologists in their “Anesthesiology Sustainability Checklist.” Following this checklist could reduce the carbon footprint attributable to anesthetic practices.
There are additional opportunities for improvement beyond the hospital-based specialties and hospitals themselves. Individual physicians and clinics can be proactive about reducing the impact of their practices by utilizing practice management tools like MyGreenDoctor. These tools provide clinicians with step-by-step instructions to make their practices more sustainable, incorporate tailored support team meetings and grant certification as further incentivization.
Examples of steps to consider include using energy-efficient machinery and accessing renewable energy, facilitating patient use of public transportation, reducing and recycling common medical office waste, cleanly disposing of drugs and chemicals, and conserving water. Specialist organizations may also partner with such practice management tools, providing the service to their members and publishing position statements and recommendations around climate and health.
For example, the American Academy of Dermatology recently released a position statement committing to supporting and facilitating member efforts to decrease their carbon footprints. The American College of Physicians, which represents internal medicine specialists, also released a toolkit around climate change, delineating steps to green a physician’s office. Although some medical specialty societies have climate change position statements, many still do not; this indicates an area in which action can be taken.
In this vein, a shift in culture and attitudes is just as critical a component of greening healthcare systems as the technical and logistical steps involved. In order to invest in and advance solutions around reducing the carbon footprint of the healthcare sector, momentum in the healthcare community must build around climate change. Organizations of medical professionals like the Medical Society Consortium on Climate & Health and Physicians for a Sustainable Future/Healthcare Without Harm, as well as statements by associations like the American Medical Association, are beginning to publicly bring the issue of climate change into the domain of medicine.
However, more remains to be done to promote policy and administrative change. Sustainability champions can be nominated within hospitals and practices who can themselves promote more systemic cultural change. Such a shift in perspective can be further promoted by efforts of medical schools to incorporate climate change into their curricula. Healthcare systems and practitioners must claim climate change as an issue within their purview, from which they should work toward protecting their patients.
In summary, an impactful climate solution could target hospital energy consumption and waste production, as well as reach to support greening efforts at the level of individual clinical practices. Given the significant contributions of the U.S. healthcare sector to global emissions and the known health impacts of climate change, activating the healthcare community around environmental sustainability is of paramount importance.
Originally published on April 22, 2020.