Healing the people, harming the planet?

The term ‘healthcare’ connotes healing, relieving or alleviating pain and the enhancement of human society’s overall well-being. However, there is a dark shadow associated with this noble sector. Recent reports tell us that in the process of delivering care, the healthcare sector is polluting the environment—if unintentionally. It has been found that healthcare practices contribute significantly to environmental pollution and eventually to climate change. Getting to the roots of the problem Digging deeper, it has been observed that human health and environmental health are intricately woven issues.1 Environmental pollution is compounding the health risks in human society, globally. Climate change, which pose challenges that affect many dimensions of human life, is widely acknowledged as the biggest threat that humans have ever faced. Approximately 141,000 deaths occur worldwide each year due to conditions like intense droughts, food and water scarcity, freeze-thaw cycles and extreme weather conditions, all resulting from climate change.2 The root cause of climate change is mainly the Greenhouse effect,* which is responsible for global warming and acts as a trigger for a chain reaction of environmental impacts. Greenhouse effect, in turn, is the result of high concentration of some gases that trap heat in the atmosphere. Major sources of greenhouse gases (GHG) include human activities such as the burning of fossil fuels, deforestation, cement production and other industrial processes such as the use of refrigerants. A recent study revealed a surprising fact: that the healthcare sector is a leading source of greenhouse gas emissions and is in fact 13% more polluting than the automotive industry.3 Globally, the healthcare sector accounts for 4.4% of total greenhouse emissions (which amounts to 2 gigatons of CO2 equivalents).4 The latest Lancet countdown report estimated that number has risen now to 4.9% of overall GHG emissions,5 equivalent to the annual GHG emissions from 514 coal-fired power plants. A majority of healthcare-related emissions (71%) are contributed by the health system supply chain through production, transport and distribution of supplies and services. Purchased electricity used for cooling, healing and other activities contributes 12% to healthcare’s GHG emissions. Healthcare facilities and healthcare-owned vehicles are responsible for 17% of total global healthcare emissions.6 (See Fig. 1.) The United States, China and all European Union countries collectively are accountable for more than half of the world's total healthcare carbon footprint (56%) as shown in Fig. 2. Of the 43 countries studied in detail for GHG emissions in the health care sector, India ranks the lowest in per capita health emissions.6 The Canadian healthcare system has been found to be a significant contributor to national greenhouse gas emissions, primarily due to emissions from hospitals, pharmaceuticals, and physician services. It was calculated that Canadian healthcare activities released 33 million tonnes of greenhouse gas emissions and over 200,000 tonnes of other pollutant emissions (4.6% of total GHG emissions), leading to an estimated of 373 to 581,000 disability-adjusted life years (DALYs) lost per year.7 A 2013 report found that the damaging health impact from US healthcare system pollution were of the same scale as deaths from preventable medical errors.8,9 In other words, in the process of treating health issues, the healthcare sector inadvertently endangers lives by polluting the environment. This is a grave paradoxical situation in which the institution that is supposed to “heal” and “to take care of” society is catalyzing the abruption and proliferation of various diseases (Fig. 3). Climate crises are challenging the health care sector in a dual way. Studies indicated a deep correlation between a country’s healthcare climate footprint and its healthcare spending. Generally, there is a direct proportionality between a country’s healthcare budget and its per capita healthcare emissions.6 Simply put, the more a country spends on healthcare, the more emissions it generates. Comprehensive gap analysis studies are required to handle this autocatalytic process. From climate change, the issue has swollen into a climate emergency where every sector must gear up to tackle this crisis. Sustainable practices need to be devised, adopted and popularized. Climate crises are health crises and vice-versa To curb the GHG emissions from health care, it is imperative to scrutinize all healthcare-related activities. Healthcare-related pollution results from direct activities such as hospital operations as well as from indirect upstream economic activities like procurement of hospital supplies and waste management. Exploring paths for a sustainable healthcare system Focusing on planet’s health will eventually benefit human health and healthcare systems as a whole. Aiming for a sustainable healthcare is the need of this hour. As per the World Health Organization (2017): “A sustainable health system improves, maintains, or restore 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.” Several steps must be taken to make the health sector sustainable: Making healthcare high tech by investing heavily in information technology (Health-Tech) Creating awareness about the importance of digital health Incorporating big data usage in healthcare management Designing eco-friendly circular products: creating and encouraging the usage of reusable textiles, reusable equipment and electronics Adopting sustainable packaging Switching to renewable electricity (“Green energy”) Encouraging purchasing from supply chains that are inherently sustainable As part of this ongoing series, our next articles will present more solutions and alternatives to address the concerns and challenges that the healthcare sector poses on climate change and environmental sustainability. References: Watts N, Adger WN, Agnolucci P, et al. Health and climate change : policy responses to protect public health : Lancet 2015;386:1861-914) Eckelman MJ, Sherman JD, MacNeill AJ (2018) Life cycle environmental emissions and health damages from the Canadian healthcare system: An economic-environmental-epidemiological analysis. PLoS Med 15(7):e1002623 Lotfi Belkhir, Big Pharma emits more greenhouse gases than the automotive industry, The Conversations, May 27, 2019; https://theconversation.com/big-pharma-emits-more-greenhouse-gases-than-the-automotive-industry-115285 Pichler P.P., Jaccard I.S., Weisz U., Weisz H.; International comparison of health care carbon footprints.;Environ Res Lett. 2019; 14064004 Romanello M., McGushin A., Napoli C.D. et al.; The 2021 report of the Lancet countdown on health and climate change: code red for a healthy future, Lancet. 2021; https://doi.org/10.1016/S0140-6736(21)01787-6] Health Care Without Harm Climate-smart health care series; Healthcare’s climate footprint; Green Paper Number One, Produced in collaboration with Arup; September 2019. Eckelman MJ, Sherman JD, MacNeill AJ (2018) Life cycle environmental emissions and health damages from the Canadian healthcare system: An economic-environmental- epidemiological analysis. PLoS Med 15(7): e1002623. Eckelman MJ, Sherman J. Environmental impacts of the U.S. health care system and effects on public health. PLoS One. 2016;11(6): e0157014. Eckelman MJ, Sherman JD. Estimated global disease burden from US health care sector greenhouse gas emissions. Am J Public Health. 2018;108(S2):S120–2. Aska Patel is a pharmacist, and an entrepreneur, with a passion for digital delivery of healthcare and environmental sustainability. She completed her Bachelors of Pharmacy and Doctor of Pharmacy degree from the University of Waterloo. Aska has worked as a pharmacist in community, hospital, government and home care settings. Aska recently launched her entrepreneurial venture, Acuvise Consultancy Inc., providing healthcare consulting while joining a digital health venture as a startup advisor, and launched a podcast, Diverse Conversations Podcast, where she discusses the future of pharmacy, healthcare, and healthtech with global industry leaders. Rajni Ratti, a sustainability consultant at Acuvise Consultancy Inc., holds a doctorate in Green Chemistry & Catalysis and worked on carbon dioxide utilization project during her post-doctoral research. With a strong background in Botany and Zoology she can efficiently amalgamate her expertise on various subject areas like toxicology, environmental sciences, biochemistry for creating sustainable systems. Having written several successful research proposals, she is an established grant writer. She has published her research results in various international journals of high repute and is often invited to review research papers from American Chemical Society, Wiley, Springer to mention a few.

Healing the people, harming the planet?

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