The top three carbon emitters, the United States, China, and the European Union, contribute over half (56%) of the world’s total healthcare climate footprint [1]. Within the United States, the healthcare system is estimated to account for about 8.5% of the carbon dioxide emitted annually. The World Health Organization estimates that the costs of climate change’s direct damage to health will reach $2 to $4 billion annually by 2030: It is thus particularly important to minimize the compounding effects of heightened healthcare costs resulting from severe climate change effects on health by reducing the carbon footprint of healthcare in the first place. Ongoing operations in the healthcare setting in particular have a hefty carbon footprint, given their high demand for lighting, ventilation, heating, air conditioning, transport, and electronic equipment – representing a unique point of leverage to reduce environmental impact.
First, it is key to minimize the use of healthcare resources, both in terms of infrastructure and personnel: Empowering patients to make the right decisions and develop healthy habits to minimize their need for healthcare in the first place is a cornerstone to reducing the use of medical resources. In parallel, any system of healthcare provider payment based on a fee-for-service model will influence healthcare providers to run more tests and use more resources than might be absolutely necessary – therefore, it may be important to adopt a system which minimizes any use of resources linked to a financial incentive. Second, in as much as possible, telemedicine should be utilized to improve efficiency and reduce pollution from transportation to and from sites. Routine check-ups and similar care can occur via teleconsultation without a loss in quality in many situations [2]. Further, the separation of elective surgery and emergency care facilities may maximize the efficient use of operating resources and beds; multi-purpose facilities for extended primary care teams could allow for better, cheaper, more environmentally sustainable healthcare delivery.
As regards the ongoing operations of the healthcare system, indirect emissions from purchased energy sources such as electricity, steam, cooling, and heating account for 12% of the industry’s carbon footprint: It is therefore key to minimize their utilization, use them as efficiently as possible, and prioritize alternative energy generation. Hospitals can be built according to energy-efficient designs, and non-essential equipment can be switched off when not in use [3]. In addition, energy can be consumed and distributed more efficiently, with each unique medical specialty having its own opportunities and leverage points. Steps can also be taken to reduce, and recycle when possible, medical waste, food waste, and water use – all of which have a substantial impact at the institutional level.
Outside the hospital, healthcare-related transportation should aim to make use of clean energy, such as through the use of hybrid or electric vehicles, in addition to collective methods of transportation such as shuttle services. Hospitals can also encourage active transport by installing bike parking and shower facilities while collaborating with local authorities on suitable routes, as well as carpooling and public transportation initiatives.
Of course, optimal resource use will remain a difficult balance to strike. For example, the federal Occupational Health and Safety Administration is requiring hospitals to make hefty use of air purification systems to prevent the circulation COVID-19; however, this also increases energy use. “There are numerous other examples of where regulations compel hospitals to take actions that may not be aligned with efforts to decarbonize, but may be important to the care of patients or the safety of staff and others,” as explained by the chief operating officer of the American Hospital Association [4].
Having pledged to cut United States greenhouse gas emissions by at least half by 2030, engaging the hospital industry will represent a core hurdle to the new Biden administration. Health, as every sector of society, has the responsibility to align itself with the global carbon reduction agenda in order to ensure a low-carbon, equitable, and healthy future.
References
- Karliner, J., Slotterback, S., Boyd, R., Ashby, B. & Steele, K. Health care’s climate footprint: the health sector contribution and opportunities for action . Eur. J. Public Health. (2019). doi: 10.1093/eurpub/ckaa165.843
- Porter, M. E. What Is Value in Health Care? New Engl. J. Med. Perspect. Perspect. (2010). doi: 10.1056/NEJMp1011024
- Tomson, C. Reducing the carbon footprint of hospital-based care. Futur. Hosp. J. 2, 57 (2015). doi: 10.7861/futurehosp.2-1-57
- HHS will prod hospitals to cut carbon emissions | Modern Healthcare. Available at: https://www.modernhealthcare.com/politics-policy/hhs-will-prod-hospitals-cut-carbon-emissions.
