The alarming new report, “Climate Change 2021,” from the U.N. Intergovernmental Panel on Climate Change emphatically and unequivocally reports that “human influence has warmed the atmosphere, ocean and land.” The next few years will determine how hot the Earth gets and how much that will stress all life on it.
The health sector, with its mission to help and heal, should be front and center in the fight against climate change, one of the greatest threats to global health in the 21st century. Inexplicably, it isn’t.
Evidence of climate change is everywhere. The drought in California is affecting the U.S. food supply. The heat wave in the Pacific Northwest has contributed to the deaths of nearly 200 people in Oregon and Washington state and the scorching of almost 1 million acres of land in California and Oregon. Flooding in Germany in July killed more than 175 people.
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Climate change affects almost every aspect of health: from burns and malnutrition to seasonal allergies, mental health, and even snakebites. The world could prevent an estimated 74 million deaths over the next 80 years by optimizing climate policy.
Globally, the health care sector emits 4.4% of global greenhouse gas emissions. In the U.S., this sector — hospitals, health systems, doctors’ offices, pharmaceutical companies, medical device companies, and others — is responsible for 8.5% of U.S. greenhouse gas emissions.
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The health care industry needs to do more to address climate change than just treating its victims. As a physician, I have pledged to do no harm and I want the rest of the health care sector to do the same.
Health care utilization creates greenhouse gas emissions, these emissions exacerbate acute and chronic health conditions, and exacerbations of acute and chronic health conditions lead to health care utilization. This vicious cycle increases the harmful impact of health care utilization. National policies are needed that focus on stopping it.
By thoughtfully applying policy to stimulate research, the health care sector can achieve medicine’s triple aim — improve the patient experience, improve value for patients, and improve public health — while also reducing health care’s impact on climate without any major technological advancements.
Oversight institutions like The Joint Commission, a national accrediting body for health care organizations, along with state and local health departments should champion minimizing emissions and pollution. Foremost, they can set emission and pollution standards for health systems. Through these standards, they can highlight the connection between environmental health and patient health and safety. Such changes in policy would prime the health care ecosystem to fight climate change by investigating and mitigating sources of health care-related pollution.
There are always choices in medicine: Clinicians and patients choose between brands, reusable or disposable items, and medical intervention versus surgical procedures. Comprehensive life cycle assessments calculate the global warming potential for the creation, use, and disposal of items or behaviors. With life cycle assessments, clinicians and administrators can consider the impact of their decisions on the environment and public health. This is especially helpful when clinical choices appear to be equally beneficial for patients.
My profession of anesthesiology offers an excellent example of the power of life cycle assessments with two anesthetic medications: propofol and desflurane. Propofol is a liquid that induces anesthesia by being infused into the patient. Desflurane is a hydrofluorocarbon gas that induces anesthesia by being inhaled by patient — once it is exhaled it is vented directly to the atmosphere. Desflurane’s impact upon climate change is hundreds of times worse than propofol’s impact. Desflurane lasts in the atmosphere for 10 years. Each hour of desflurane anesthesia can create a greenhouse effect greater than driving 220 miles. Each hour of propofol anesthesia generates the greenhouse effect of driving less than 1 mile.
This information has galvanized an international effort to limit the use of desflurane to situations when the benefit to patients is clear.
Thoughtful national policy focused on minimizing pollution from the health care sector will encourage health care companies to perform and publish life cycle assessments of their goods and services prior to marketing. This would motivate the creation of a more sustainable health care supply chain. Fewer products will be designed as disposables with a return to reusable instruments designed specifically for ease of sterilization, storage, and durability. Unavoidable disposables will incorporate materials that can be composted or upcycled en route to a health care economy in which no item is landfilled or incinerated.
Kaiser Permanente, a health system leading the field of sustainable health care, operates in Pacific Northwestern states plagued by heat waves, drought, and forest fires. In 2020, it declared itself to be a carbon-neutral health system. While this is an important step, the ultimate and challenging goal for fighting climate change is to achieve carbon neutrality without using accounting maneuvers like carbon offsets and renewable energy certificates that permit institutions to claim carbon-neutrality while still generating greenhouse emissions.
Sustainability is the future of health care. The changing climate and its impact on public health creates a moral imperative for the health care sector to take the lead on reducing emissions, waste, and pollution. The health care companies that make this pivot first will capture the 21st-century health care market as efficiency and sustainability are qualities that are attractive to employees and appealing to consumers.
As clinicians trained in a post-Katrina and post-Maria world enter the health care sector’s leadership ranks, we will make choices based upon climate impact. We plan to hold our organizations accountable to the same standard as we ourselves have sworn: do no harm.
Matthew J. Meyer is an intensivist and sustainable health care researcher at UVA Health, co-chair of the UVA Health Sustainability Committee, assistant professor of anesthesiology at the University of Virginia, steering committee member of Virginia Clinicians for Climate Action, and cofounder of PeriOp Green, an organization dedicated to reducing operating room waste to the least amount possible.
