COVID-19 Has Outlined Healthcare Systems’ Dangerous Emissions Problem
Healthcare’s overreliance on single-use products and equipment contributes to its carbon footprint

Failure to align the global recovery from COVID-19 with an equally powerful climate response could threaten the worldwide effort to limit the average global temperature increase, public health experts have said.

In a convention in 2015 now known as the Paris Agreement, the United Nations Framework Convention on Climate Change (UNFCCC) established its aim to pause the increase in global average temperature by “well below 2 degrees Celsius above pre-industrial levels and to pursue efforts to limit the temperature increase even further to 1.5 degrees Celsius”.

To achieve that, a global effort is required to decrease greenhouse gas emissions by 7.6% each year across five years. This number falls further out of reach each year without action.

“The reality is that the next five years are going to be pivotal,” Dr Renee Salas, Harvard T.H. Chan School of Public Health, said during a webinar from the Lancet Countdown last week.

The 2020 Report of the Lancet Countdown on Health and Climate Change was published in December, and addressed the converging crises of the COVID-19 pandemic, healthcare systems and climate change.

“Healthcare has to show us how we can decarbonize and decarbonize our healthcare system,” she said, adding that it “is truly the embodiment that climate action is a prescription for health”.

COVID Has Outlined Healthcare Systems’ Flaws

The COVID-19 pandemic has highlighted healthcare’s overreliance on single-use products and equipment, the panel said. Additionally, as using personal protective equipment (PPE) has become a greater necessity, use of disposable products has been extended.

The health system in England is responsible for an estimated 4-5% of the country’s carbon footprint, for example.

NHS carbon footprint is mostly comprise of procured items from the health supply chain

The United Kingdom’s National Health Service listed crutches as accounting for nearly 70% of the carbon footprint for items it procured in 2020.

Additionally, the traditional model of outpatient care doesn’t strictly align with the nature of chronic illnesses, which requires patients return for unpredictable emergency treatment. 

Unpredictable treatment directly leads to increased road traffic and increased air pollution. NHS traffic accounts for 5% of road traffic in England alone.

Quantified in terms of environmental, financial, and health outcomes, this means that 753 deaths can be attributed to NHS traffic, and £650 million in NHS expenditure are lost a year.

“When [evaluating] the value offered in the delivery of a healthcare service, we need to start capturing data that looks at these consequences, thinking beyond the financial and individual patient outcomes,” said Jennifer Isherwood, a National Medical Director’s Clinical Fellow at the Royal College of Physicians, London.

“It’s becoming clear that COVID is not going to be the last pandemic that we see,” Isherwood added. “It may be … disruptive to start addressing challenges of different pathways to different care, but it’s the right tool to start future-proofing our healthcare systems.”

Hiten Patel, Senior Strategy Advisor for Greener NHS, said: “There’s always something else happening in healthcare systems that’s [considered] a priority. It’s about how we can try to make carbon emissions and climate change more of a priority within healthcare systems.” 

Concluded Dr Jodi Sherman, Yale University and Lancet Countdown author, said: “Everything we do in healthcare is through the lens of patient safety. Protecting public health is a matter of patient safety and needs to be integral to everything that we do.” 

Supply and Services Compose Four-Fifths of Overall Healthcare Carbon Footprint
The health supply chain comprises four-fifths of US healthcare carbon footprint
The health supply chain comprises four-fifths of US healthcare carbon footprint

While the COVID pandemic has flagged some key flaws in the world’s healthcare systems, what is still unclear are the direct and indirect carbon emissions of the healthcare sector, and the implications these emissions have on health.

Direct emissions are established and well understood products of the sector: gas exhausts from ambulance tailpipes to fumes emitted from waste incinerators.

But indirect emissions – offsite power generation, the provision of medical supplies and pharmaceuticals, and even research and testing – make up a larger percentage of emissions associated with the healthcare sector.

The United States alone spends more than US$3 trillion on healthcare a year. As healthcare expenditures increased, so too did the carbon footprint from goods and services. Around 7% is due to direct emissions from healthcare facilities, and another 10% from offsite energy.

But four-fifths of the footprint is the supply chain, composed of key sectors that include food, pharmaceuticals, and chemicals.

Dr Matthew Eckelman, Northeastern University, Boston and Lancet Countdown author, called on the health sector to take accountability for its immense carbon footprint.

“It’s very clear that buying renewable energy is not the only solution. You really have to work on reducing carbon emissions in the supply chain, as well.”

Lower the Infection Risk and Financial Losses by Reducing Health Waste

Speakers also addressed how vital it is not to risk patient safety in trying to reduce or cut expenses.

Healthcare-acquired infection – when a patient becomes infected while in care – affects hundreds of millions of patients globally each year. This leads to significant morbidity and mortality that incurs financial losses for health systems, in addition to excess pollution.

As a result, prevention is essential.

“While we do want to reduce waste and reduce costs, we certainly don’t want that to be at the expense of increasing infections,” said Dr Sherman.

Dr Sherman also acknowledged, however, that infection prevention methods often contribute to the excessive use of single-use disposable devices, like masks and gloves.

Using only disposable laryngoscopes would increase costs for hospitals
Using only disposable laryngoscopes would increase costs for hospitals

In a greenhouse gas emissions and cost analysis study comparing reusable and disposable laryngoscopes, Dr Sherman and Eckelman found that disposables – whether plastic or steel – outweigh the reusable in terms of greenhouse gas emissions. Using purely disposables would increase costs by up to US $700,000 a year, for one hospital department.

Recycling these disposables would only reduce a small portion of emissions, especially since the laryngoscope cannot be recycled entirely. “In other words, we can’t recycle a way out of this problem,” Dr Sherman said. 

“The answer isn’t that we should use disposables. It’s that we should clean up our supply.” There needs to be a balance between the “indirect disease burden from all the materials thrown away and lowering the infection risk curve.” 

The greatest causes of healthcare acquired infections, said Dr Sherman, have to do with staff discipline, such as hand washing, and patient health status, and exposure to infection. But simple hand washing and using more and more disposables is not the solution.

Image Credits: Flickr: Marc A. Hermann / MTA New York City Transit, The Lancet Countdown.

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