Cleaning up our act in healthcare
By Vamini Selvanandan
The healthcare system is tasked with saving lives and improving the health of populations and individuals. But what if it is contributing to environmental degradation and global warming, and making us sicker in the process?
The healthcare system is the fifth largest producer of greenhouse gas emissions globally and contributes 4.6% to all greenhouse gas emissions in Canada. Comprised of hospitals, community clinics, pharmaceutical manufacturers and public health, the healthcare system is also a major contributor to waste production.
Greenhouse gases are emitted all along the supply chain of pharmaceuticals and medical equipment from manufacturing and transportation to consumption and disposal. Heating, cooling, ventilation and hot water systems of healthcare facilities further contribute to the carbon footprint of the industry.
Anesthetic gases such as desflurane emitted into the atmosphere from hospital rooftops have 20 times the climate warming effects of other greenhouse gases - using one bottle of desflurane is the equivalent of burning 440kg of coal.
With respect to solid waste, a study of 110 hospitals done in 2019 in Canada found they generated 87,000 tons annually. Plastic syringes, single-use surgical equipment, containers and packaging are sent to landfills or end up scattered on the land or in rivers and oceans.
Fifteen percent of healthcare waste is biohazardous - either toxic or infectious – and must be incinerated. In addition to greenhouse gases, incineration releases dioxins and furans which are carcinogenic to humans. Heavy metals emitted into the environment during incineration contribute to air pollution and increase the risk of heart attacks, strokes and death from cardiorespiratory causes.
Healthcare systems exist to prevent unnecessary deaths and treat illnesses, yet the way they operate can damage the health of our planet and our population. With direction from leaders and decision-makers and encouragement from consumers, healthcare systems can pivot to operating in ways that maintain the health of the planet and the people they serve.
Representing approximately 12% of Canada’s gross domestic product (GDP), the healthcare industry has immense purchasing power and can put pressure on suppliers to use sustainable practices in the manufacture of their products including reducing packaging, eliminating environmentally unfriendly chemicals in the manufacturing process and reducing the weight of items while maintaining quality.
The federal government can establish minimum environmental standards and practices for provinces and territories in healthcare provision as a condition of the Canada Health Transfer and hold provinces accountable for reducing healthcare-related waste and carbon emissions.
Provinces have set up health authorities to operate healthcare facilities, with Alberta Health Services being the single health authority in our province. The provincial government can stipulate that, in fulfilling its mandate, Alberta Health Services must follow environmental standards and practices that enhance the health of Albertans; that they must act to reduce greenhouse gas emissions, reduce waste and reduce the release of toxic and carcinogenic materials into the air we breathe.
Operating rooms produce more than 30% of waste in healthcare facilities and use five times more energy per square foot than other parts of the hospital. Hospitals providing surgical services can reduce their environmental impact by reducing use of anesthetic gases (particularly desflurane), sterilizing and reusing all surgical instruments and using washable bed linen and gowns. Furthermore, sterilizing biohazardous waste prior to disposal in the landfill will have less environmental impact than incineration.
Ten to fifteen percent of hospital waste is food waste and buying policies that minimize waste, as well as composting and donation of excess food to rescue programs, can work to reduce the amount of food wasted.
Health clinics in the community, whether they provide primary or specialist care, dental care or physiotherapy, can do their part by reducing, reusing and recycling wherever possible including encouraging patients to return reusable products such as crutches and orthopedic boots, buying items in bulk to reduce packaging waste and sourcing products from ecofriendly manufacturers.
As clients of the healthcare system, we too have a part in reducing medical waste and we can make our concerns for personal and planetary health known to our healthcare providers and encourage the hospitals and clinics we visit to implement greener measures.
We can change our own behaviour to reduce medical waste and decrease stresses on our overburdened healthcare system. We can take care of minor self-limiting illnesses like colds at home and reduce waste by not asking for unnecessary medications such as antibiotics for viral illnesses.
We are all consumers of healthcare, starting most often with birth in a hospital setting and ending with needing health resources to deal with sudden disease, injury or prolonged illness at the end of life. Dedicated to improving the health of individuals and populations, the healthcare industry is also a contributor to negative environmental and human health effects. We need to acknowledge that human and planetary health are inextricably linked and work together to protect both. It is time to clean up our act.
Vamini Selvanandan is a rural family physician and public health practitioner in Alberta.