My emergency medicine team had spent several tense hours working to ease the severe asthma attack that was making breathing difficult for our 8-year-old patient. Once she was stable, her mom asked, “Why do you think her breathing got so much worse than usual?”
I gave her the standard answer — maybe her daughter caught a virus or her medicine regimen needs to be changed — but I cringed a bit as I stripped off my gloves and tossed them into the overflowing waste bin, knowing that’s not the whole story. There is also air pollution from factories and power plants near her home, smog from cars and trucks, and pollution from the hospital she is being treated in.
To most people, the health care system is synonymous with healing. But it is also a major source of health-damaging pollution. Every day, U.S. hospitals create nearly 7,000 tons of solid waste, like my gloves and the plastic wrapping around the tools and medicines my team used for our asthma patient. As Matt Eckelman and Jodi Sherman wrote in PLOS One, health care accounts for 10 percent of greenhouse gas emissions in the U.S., 10 percent of smog formation, and 9 percent of other harmful air pollutants.
This pollution affects entire ecosystems by contributing to climate change. It also affects human health by contributing to cancer, heart attacks and strokes, asthma, and a host of other diseases. Eckelman and Sherman estimated that pollution from health care results in the loss of an estimated 614,000 disability-adjusted life years (DALYs) annually. That’s four times more than the 150,000 DALYs lost due to adverse effects of medical treatment reported by the Global Burden of Disease project in 2016, and on par with the harms caused by preventable medical errors, which the Institute of Medicine says cause between 44,000 and 98,000 deaths per year, an estimate that sparked the patient safety movement.
As the health care sector grows, its environmental impact will likely grow with it. Health care is now a huge and expanding sector of the U.S. economy, with nearly $1 out of every $5 spent on health care.
Why does so much pollution emanate from the health care sector?
Some of the problem is the facilities themselves. Hospitals are energy-intensive buildings, open and operational 24 hours a day, 365 days a year. That requires constant lighting, heating and cooling, and electricity for high-tech diagnostic and treatment equipment. Housekeeping and sterilization professionals use potentially harmful chemicals to keep patient-care areas and equipment clean and safe. Laundry services keep linens and towels clean but use huge amounts of water, detergent, and heat.
Everything a hospital uses must be shipped to it, leading to emissions from trucks, trains, ships, and planes. Staff members, patients, and family members drive to hospitals or take public transportation, further adding to air pollution.
Hospitals and health care facilities use large quantities of materials, much of which ends up as waste. The average U.S. hospital generates 29 pounds of waste per bed every day. For my hospital, that’s more than 50,000 pounds of solid waste, a combination of municipal, hazardous, biohazardous, pharmaceutical, and radioactive waste. For comparison, the average American generates 4.4 pounds of waste per day.
And don’t forget about the food. Every day, the hospital I work in uses more than 100,000 pounds of food to produce nearly 30,000 meals. That requires approximately 35 million Btu of energy to cook and generates around 29,000 pounds of food waste.
The single largest factor driving health care pollution is clinical care. Every diagnostic and therapeutic choice that physicians and patients make affects nearly every category of environmental impact — waste generation, chemical use, water consumption, energy use, and, indirectly, building construction.
Clinicians must always keep the best clinical care of their patients front and center. But that doesn’t mean more is always better. Every patient encounter has different energy and natural resource inputs and different environmental outputs. The sum total of clinical decisions drives health care’s environmental impact.
Here’s one example. Because hospitals, doctor’s offices, and other health care facilities deal with people who are sick, they must be vigilant about preventing the transmission of infections. But excessive prevention practices have both upstream and downstream effects on public health with diminishing returns for patient safety. The latest trend is a focus on equipment that is thrown away after a single use without regard for either whether it really is safer than reusable equipment or the harm to environmental and human health from discarding all that plastic.
Much as medical care ought to be holistic and account for the entirety of the patient rather than have a myopic focus on a single problem or condition, decisions about health care services should also be made holistically. It’s time for health care providers to look at the cradle-to-grave life cycle of the products we use and the processes we implement, considering all of the environmental inputs and outputs.
When researchers have taken this kind of complete view, they’ve learned that many choices may be equivalent clinically but create significantly different environmental impacts on human health via upstream and downstream pollution. Health care decisions ought to consider both patient safety and public health, neither in a vacuum.
What can we all do to help?
The first and biggest step may come as a surprise: eat more healthfully and exercise. Not only would that improve health and mood, but it would also reduce the need for resource-intensive health care.
Most Americans will likely need health care at one or more points in their lives. When that happens, work to right-size it — get the care you need, not more or less. This means frank conversations with doctors about your worries, values, and the risks and benefits of care. Sometimes patients and physicians need the added certainty of a diagnostic study, lab test, or imaging. But sometimes they don’t, and avoiding unneeded care can help limit health care related pollution.
Keep in mind that an unneeded test can not only harm patients, but it can also pose a risk to someone somewhere else from its impact on the environment.
Finally, we should all demand better environmental performance by health systems and health professionals.
Some hospitals and health care systems are already working to improve their environmental performance. More than two dozen health care organizations across the country, from California to New England, have committed to meet the Paris Agreement climate action goals. Many others, including Massachusetts General Hospital, where I work, have committed to 100 percent renewable electricity, in addition to existing efforts to reduce waste and polluting emissions. Practice Greenhealth, with 1,100 participating health care organizations, and its sister group, Health Care Without Harm, have been helping hospitals and health systems for two decades to share best practices and provide leadership to others.
As a major contributor to air, water, and other kinds of pollution, health care can damage health even as it heals. By working together to reduce the environmental impact of health care, doctors and patients can keep themselves, their communities, and the planet healthier for generations.
Jonathan E. Slutzman, M.D., is an attending physician in the Department of Emergency Medicine at the Massachusetts General Hospital and an instructor in emergency medicine at Harvard Medical School. He is also a trained environmental engineer and previously practiced environmental engineering for an international consulting firm.
