By Amy Collins, MD, and
Lucy Berrington, MS
Tracey Burg, RD, teaching kitchen chef at Boston Medical Center at the hospital’s rooftop farm. Photo: Boston Medical Center
Physicians take an oath to do no harm. Yet our health care facilities create an environmental and carbon footprint that damages the health of our patients, communities, and planet. If the US health care sector were a country, it would rank 13th in the world for greenhouse gas emissions, ahead of the UK. It generates 14,000 tons of waste a day, according to the Healthcare Plastics Recycling Council. Pollutants related to health care lead to an annual loss of 405,000–470,000 years of healthy life in the US, according to a 2016 study in PLoS One.
The financial costs are no less startling. The health care sector spends more than $8 billion on energy a year, enough to cover more than 100,000 nurses at an average salary, according to the US Department of Energy. Improved management can result in savings both direct and indirect, say advocates and researchers — in part, and crucially, by reducing the incidence of human disease.
“Climate-Smart Health Care”
As trusted leaders, physicians have many opportunities to advance sustainability within their organizations. A 2017 report by the World Bank Group and Health Care Without Harm, a campaign for environmentally responsible health care, argued for shifting the industry toward “climate-smart health care.” That emerging term covers low-carbon design, construction, and supply purchasing, energy efficiency, waste minimization, sustainable transport and water use, and resilience in the context of climate-related disruption.
Professional and advocacy organizations are stepping up. Many hospitals have reevaluated their operations, reducing energy use and transitioning to renewable energy sources. Specialty organizations including the American College of Physicians, the American Academy of Pediatrics, and the American Society of Anesthesiologists are encouraging physician leadership on environmental sustainability. “Physicians and health organizations have obligations to use their influence, expertise, and resources to protect health, which includes promoting sustainability,” the AMA Journal of Ethics concluded in a 2017 case.
Sustainability Cuts Costs
How financially viable are sustainability initiatives in health care facilities? The 2012 report by the Commonwealth Fund, “Can Sustainable Hospitals Help Bend the Cost Curve?,” looked at programs aimed at reducing energy use and waste and improving operating room efficiencies (OR consumption and waste is particularly high) in selected hospitals. It found that the savings associated with sustainability interventions far exceeded the costs of implementation, which were relatively low.
If applied nationally, the interventions studied could save $15 billion over 10 years, the researchers concluded. Many programs did not require additional costs but generated immediate savings; for example, reprocessing single-use devices, salvaging unused items from OR packs, and disposing of nonhazardous items separately from costly “red bag” waste.
The Commonwealth Fund report anticipated that sustainability efforts could yield even larger savings in nonacute settings, because of their lower fixed costs — citing, for example, “Kaiser Permanente’s annual savings of tens of millions of dollars through systemwide implementation of its environmentally preferable purchasing program.”
How to Get Started
The Health Care Without Harm Physician Network is the primary forum for physicians who are interested in promoting climate-smart health care and reducing the environmental impact of health care delivery. Health Care Without Harm and its sister organization, Practice Greenhealth, which works with health care facilities to achieve sustainability goals, offer extensive resources. Environmental organizations and initiatives emphasize that sustainability in health care settings requires committed leadership; leadership resources are available from Practice Greenhealth.
Dr. Amy Collins is the founder of Health Care Without Harm’s Physician Network, which helps physicians promote sustainability and climate-smart health care; acollins@hcwh.org.
Key Resources
Health Care Without Harm: The leading campaign for environmentally responsible health care and advocacy:
noharm-uscanada.org
Health Care Without Harm Physician Network:
noharm-uscanada.org/physiciannetwork
Practice Greenhealth: The leading membership association for hospitals and businesses engaged in sustainable health care:
practicegreenhealth.org
See
massmed.org/environment for additional details and resources.
