The Harm We Do: The Environmental Impact of Medicine

Healthcare is a “dirty” business with widespread effects on the environment. In the US, healthcare is estimated to generate 9.8% of our greenhouse gases and 9% of our particulate matter emissions.¹ Hazardous wastes must be incinerated, emitting carbon dioxide, nitrogen oxides, and volatile substances into the atmosphere.² Similarly, hospitals are responsible for 7% of commercial water use in the US.³ Conventional water treatment systems are not designed to remove heavy metals, pharmaceuticals, and disinfectants in hospital wastewaters; these compounds have been detected in rivers and streams throughout the US.^4,5 Furthermore, pharmaceutical compounds such as antibiotics, anti-epileptics, and narcotics have even been isolated in our drinking water.⁵

As hospitalists, we are the directors of inpatient care, yet we only witness brief moments in the lives of our patients and the products we use for their care. For example, we are unaware of particulate matter emissions needed to power an extra imaging study or the contribution of unused materials to a growing landfill. However, pollution, including that from our clinical practice, is detrimental to human health in many ways. Exposure to particulate matter and toxic wastes has been linked to increased rates of reproductive and developmental disorders, cancer, and respiratory disease. ⁶ Particles <2.5 µm in diameter can diffuse through alveoli into the bloodstream, contributing to heart disease, stroke, and lung disease.⁷ Climate change has been linked to a wide range of adverse cardiovascular, respiratory, infectious, and mental health outcomes.^8,9 These examples of the health impacts of pollution are illustrative but not exhaustive.

The environmental impact of US healthcare accounts for an estimated 470,000 disability-adjusted life years lost; this figure is on par with the burden of preventable medical errors.¹ Clearly, change is necessary at all levels in the healthcare system to address our impact on human health. Fortunately, healthcare systems and hospital administrators have begun to address this issue. This perspective describes sustainability efforts in hospitals and healthcare systems and seeks to motivate hospitalists to build upon these efforts.

With the ability to affect change from the top down, health systems are playing an important role in healthcare’s environmental sustainability. Ambitiously, Kaiser Permanente outlined eight environmental stewardship goals, which include becoming net carbon positive and recycling, reusing, or composting 100% of their non-hazardous waste by 2025.¹⁰ The Cleveland Clinic has pledged to become carbon neutral within the next 10 years.¹¹ Other healthcare systems may follow suite. Many “green” interventions aimed at reducing waste and pollution also protect population health and reduce hospital operating costs.

From 2011 to 2015, a group of Boston Hospitals decreased energy use by 9.4% compared with a historical growth of 1.5% per year and saved over 15 million dollars.¹² Similarly, Virginia Mason reduced landfill waste by reprocessing single-use medical devices, thereby decreasing purchasing costs by $3 million.¹³ As part of a regional campaign to protect the St. Croix River, Hudson Hospital and Clinic in Wisconsin saved over $20,000 with new recycling and waste reduction programs.¹³ Notably, these programs not only benefit hospitals but also patients and payers by reducing costs of care.

These examples illustrate that a greener healthcare industry is achievable. Despite the potential benefits, sustainability efforts in US hospitals are the exception, not the rule, and the diffusion of such innovations must be encouraged from within.

In addition to the moral case for environmentally sustainable healthcare,^14,15 such efforts can also improve our quality of care. The conversation around healthcare waste has focused on costs. Yet, examining our waste from a new perspective may reveal new ways to increase the value of patient care while protecting population health. Our communities and families are not immune to the health impacts of pollution, including that generated by our industry. However, predicted effects of climate change including altered patterns of vector-borne disease and frequent hurricanes and forest fires are upon us, affecting our communities, hospitals, and health delivery enterprise today. These challenges represent educational, academic, and economic opportunities that hospitalists should embrace.

Education and Awareness

The first step to engagement is to promote awareness of the effects of healthcare waste. Physicians remain one of the most trusted sources of information about the health impacts of climate change.¹⁶ By educating ourselves, we can spread accurate knowledge to our patients and communities. Furthermore, we have the ability to advocate for our hospitals to follow institutions such as Kaiser Permanente and the Cleveland Clinic.