How US Healthcare is Killing the Planet
If US health care was its own country, it would be the 13th largest emitter of greenhouse gases.
By Peter Trinh
Image by Esther Moon and Jason Silverstein.
A few weeks ago, diplomats at the United Nation’s COP27 Climate Change Conference finally agreed to establish a “loss and damage” fund to compensate the poorest countries for damage from climate-related disasters. The fund represents an easy cause for celebration in the fight against climate change. However, such a deal comes at a time when Big Oil still reaps record profits, and no actual progress was made to address climate change’s root cause: greenhouse gas emissions. In the words of Manuel Pulgar-Vidal, who presided over the 2014 UN climate summit, “we cannot afford to have another climate summit like this one.”
To address climate change’s root cause, we must identify the primary culprits. Most Americans rightly blame oil and gas firms, but, as a resident physician who spends most of his time in the hospital, I want to highlight another guilty party: American health care. My fellow health care professionals and I work hard to care for our patients, but in doing so, we unwittingly contribute to a crisis that threatens the health of billions. American health care is responsible for roughly 8.5% of the nation’s greenhouse gas emissions; If health care was its own country, it would be the 13th largest emitter of greenhouse gases just behind Brazil.
American health care is responsible for roughly 8.5% of the nation’s greenhouse gas emissions; If health care was its own country, it would be the 13th largest emitter of greenhouse gases just behind Brazil.
This makes some sense: health care facilities are energy-intensive—hospitals run 24/7, requiring double the energy of commercial buildings—and that health care uses extremely potent greenhouse gases in both anesthesia and commonly used inhalers.
But American health care is also incredibly wasteful. We order around 14 billion laboratory tests each year, but up to one-third are unnecessary. That means millions of needles and test tubes go to waste. In the name of safety, health care workers (including doctors, nurses, technicians, janitors, and food services workers) also use unbelievable amounts of disposable products. Many of them, like protective gloves, are rightfully single-use, but others, like medical gowns, could be reused. Hundreds of thousands of disposable medical gowns are used every day—up to 85% of all gowns in US hospitals are disposable. Such high usage rates are nonsensical when recent studies have shown that reusable gowns are cost-effective, protect their users just as well as disposable gowns, and have much lower environmental footprints.
In some cases, health care professionals do not even use the disposable products before throwing them away. For instance, standardized single-use kits for various medical procedures, often contain unnecessary materials that doctors throw directly into the garbage.
All this waste is the byproduct of the siloed nature of health care and the lack of centralized leadership focused on sustainability. My colleagues care about sustainability and lament how wasteful we are in our day-to-day care of patients. However, many of the decisions that would influence the amount of waste we generate, such as what materials we use, are out of our control. Hospitals within the same health system and even medical departments within the same hospital largely function independently from each other, making organized grassroots action on sustainability very difficult to achieve. What American health care systems need are centralized leaders, or Chief Sustainability Officers (CSOs), dedicated to ensuring that health care practices are aligned with environmental sustainability. CSOs embody an institutional commitment to environmental sustainability and can bridge divisions between departments and drive sustainability initiatives across entire health systems. As of March 2021, 95 of US Fortune 500 companies employed a CSO, but zero hospitals or health systems had a CSO. They clearly need to catch up.
CSOs could both drive institutional change and help reduce Scope 3 emissions of hospitals and health systems. Scope 3 emissions are the indirect emissions generated by the supply chain of companies that manufacture and deliver medical supplies and medications, and they account for roughly 80% of the US health care system’s greenhouse gas emissions. Decreasing Scope 3 emissions is essential, and CSOs can help by exercising their institution’s purchasing power to create demand for greener products and more sustainable practices from suppliers and distributors.
Currently, sustainability is a blind spot in the health care supply chain. As part of a small pilot study at my hospital to reduce unnecessary laboratory tests, my team has been investigating the environmental footprint of basic lab tests, reaching out to our institution’s suppliers of lab reagents and materials to see what data they have on their products’ carbon footprints. We contacted major firms such as Roche Diagnostics, Stago Diagnostica, and Becton Dickinson. None had any product-level environmental data, and all were surprised by our inquiry. According to Manpreet Sandhu, the Sustainability Program Manager for the Health Industry Distributors Association (HIDA), manufacturers of medical products like McKesson and Cardinal might have facility-level data on their emissions but nothing at the product level. This dearth of data reflects how little sustainability has been valued within health care. CSOs can change that.
In June 2022, 61 of the nation’s largest hospital and health sector companies committed to cutting greenhouse gas emissions 50% by 2030 as part of the Biden administration’s Health Sector Climate Pledge. But seeing where the industry is now and what its leaders have vowed to accomplish, this Climate Pledge might only amount to lofty corporate greenwashing.
Peter Trinh is an internal medicine and primary care resident physician at Brigham & Women’s Hospital in Boston, MA, and a Blair and Georgia Sadler Fellow at Health Care Without Harm.