According to the World Health Organization (2017), “Ideally, an environmentally sustainable health system improves, maintains or restores health, while minimizing negative impacts on the environment and leveraging opportunities to restore and improve it, to the benefit of the health and well-being of current and future generations.”
Sustainable healthcare. Image Credit: Black Salmon/Shutterstock.com
As well as the environmental and social impacts, sustainability also affects the economic impacts of a healthcare system. Here we focus on the social and environmental impacts.
There is mounting evidence to suggest that the environmental impact of health systems has been steadily increasing. These emanate from:
- Consumption of energy and resources
- Use and disposal of toxic chemicals
- Production of greenhouse gas emissions
- Production of waste and wastewater
Focus on toxic chemicals
All the above categories are problematic, but particularly pertinent to healthcare is the use and disposal of toxic chemicals. Some of these function as endocrine-disrupting chemicals (EDCs). Also of concern are heavy metals. Several toxic chemicals have implications for grave effects on both health and on the environment. These include the following:
- Mercury
- Polyvinyl chloride
- Phthalates
- Volatile organic compounds
- Flame retardants
Patients and healthcare workers who are routinely exposed thereby constitute a vulnerable population. Also at risk are manufacturing workers involved in the production of these chemicals and those involved in their disposal. The problems extend beyond the bounds of persons involved in making, utilizing or disposing of the toxins to those who happen to simply live within proximity of manufacturing or disposal sites.
Substitutes have been found for some chemicals, but this is not always possible. Mercury is of particular concern. International environmental agreements have been instrumental in helping countries reduce these toxins and meet their obligations.
The NHS: Leading the way on sustainability
The World Health Organization (WHO) states that health systems represent a large sector of the economy in most countries. The UK National Health Service (NHS) is one of the largest healthcare systems in the world. In part due to its large size but also because of its specific processes and operations, the health sector in its entirety is a major consumer of energy and resources. It is also a massive producer of emissions and waste, both of which impact the environment. In fact, health systems in general are amongst the highest waste-generating sectors.
Healthcare generates between 1 and 5 % of the total global problem to be found situated in the following categories:
- Greenhouse gas emissions
- Nitrogen oxides
- Particulate matter
- Sulfur dioxide
- Increased malaria risk
- Nitrogen runoff
- Use of scarce water
Historically, concern has been directed toward minimizing harm to the environment via adherence to regulations. More recently there has been an increasing trend toward assigning accountability of companies and organizations for the societal and environmental impacts their activities might have.
In 2020 a plan was announced to achieve net-zero greenhouse gas emissions by 2050. Sources vary and according to some data the quote is set to be achieved by 2040. Nevertheless, the plan put the NHS at the forefront of environmental sustainability and clearly demonstrated the leading role of this organization in the maintenance of planetary health.
The example set by the NHS will hopefully entice other health systems to follow suit. Several countries are now seeking to mitigate emissions associated with their healthcare systems according to the commitments made under the Paris Agreement regarding climate change.
Carbon emissions. Image Credit: NicoElNino/Shutterstock.com
How to tackle the problem?
The race to net-zero would entail the re-imagining of a society that privileges health and well-being. MacNeill et al., (2021) present a framework for the construction of an environmentally sustainable health system based on three key principles:
- To reduce demand for health services. Factors such as aging, and population growth have created an enormous demand, and this has slowed progress toward mitigating the carbon footprint emanating from healthcare.
- Match supply and demand. Ensure care is appropriate and avoid any unnecessary investigations or treatments.
- Reduce emissions from the supply of healthcare services.
Measuring the impact of health care
We now have the technical ability to measure the environmental impact of healthcare. Researchers are exploring the carbon footprint of different areas of service ranging in scope from the global to the national level and incorporating hospitals and hospital services, anesthetic gases, individual devices and consumables. At present, a heavy bias toward greenhouse gas emissions exists in the scholarly literature.
According to Henscher et al., (2020) healthcare leaders should now look to focus on the following:
- Clear strategic goals for healthcare sustainability ––perhaps by following the NHS Net Zero approach
- Devise, adopt and implement internationally standardized metrics
- Aim for quality improvement, performance and accountability
The response of healthcare systems to the COVID-19 pandemic has demonstrated that rapid transformational change is achievable if the intent is there.
References
- Henscher, et al. (2020) Health Care Sustainability Metrics: Building A Safer, Low-Carbon Health System. Environmental Health. Doi: 10.1377/hlthaff.2020.01103
- MacNeill, A. J. et al. (2021) Planetary health care: a framework for sustainable health systems. The Lancet Planetary Health. Doi: 10.1016/S2542-5196(21)00005-X
- World Health Organisation (2017) Environmentally sustainable health systems: a strategic document. Online: https://www.euro.who.int/__data/assets/pdf_file/0004/341239/ESHS_Revised_WHO_web.pdf
Further Reading