Almost everyone is a patient at some time. And even if the interaction with a doctor or nurse or other clinician is brief, it’s an opportunity to do something to fight climate change.
The health care sector is responsible for 8.5% of all greenhouse gas emissions in the United States. To be sure, some of that comes from the amount of energy hospitals consume 24/7. But some also comes from choices that health care workers make.
As an anesthesiologist who has dedicated the past few years to alerting as many clinicians and health care executives as I can to the importance of making health care more sustainable, I continue to be surprised that sustainability and decarbonization have yet to enter into most clinicians’ care decisions.
Clinicians receive very little formal education about health care pollution or how it may harm their patients’ health. Most medical students are lucky to get a single lecture connecting climate change to health and consequently know very little about what has been deemed the “greatest threat to global public health” by the New England Journal of Medicine (and 200 other health journals).
Clinicians need to become more aware about the effect of health care on climate and climate on health. I believe that patients can help catalyze this education.
Ask your clinician about health care’s impact on climate change
In the U.S., there are more than 860 million outpatient clinic visits and 100 million inpatient and outpatient surgical procedures each year. Around two-thirds of Americans say they are worried about climate change. If every one of them asked their clinician about how climate change might be affecting their health — or how this visit might be affecting climate change — that would mean more than 600 million climate-focused learning opportunities a year.
When a patient asks me a question I can’t answer, I start looking for an answer. I know it’s the same for many other clinicians. In other words, patients can inspire their health care providers to learn about health care’s climate impact by capitalizing on their nature to do right by their patients.
Small changes can make big differences. I offer two examples: the choice of anesthesia for surgery and the choice of an inhaler for asthma.
Anesthesia gases used during surgery and metered-dose inhalers are outsized contributors to climate change. Both have alternatives that are far less polluting. And both are under the direct control of physicians.
Once anesthesia gases and inhaler propellants are used, they enter the Earth’s atmosphere and trap hundreds to thousands of times more heat per molecule than carbon dioxide released by burning fossil fuels. In the United Kingdom, whose National Health System is a leader in the sustainable health care effort, these two types of chemicals account for 5% of health-related greenhouse gas emissions.
One anesthetic gas, desflurane, harms the environment more than others. Each hour of desflurane used during surgery creates emissions equivalent to driving 230 miles in a gasoline-burning car. If an anesthesiologist uses sevoflurane instead, the emissions are 10 to 20 times less.
The propellants in metered-dose inhalers also trap thousands of times more heat in the Earth’s atmosphere per molecule than carbon dioxide. Going through a 200-dose inhaler is the equivalent of driving more than 350 miles in a car. Some metered-dose inhalers can be replaced with a “dry-powder” inhaler, which can result in a greater than 90% reduction in emissions. There are even new chemicals that may be used as propellants in metered-dose inhalers that reduce their greenhouse gas emissions to almost nothing.
Physicians and other clinicians are trained to ask “Do you have any questions?” before ending a patient visit. This is the moment for climate change interaction. For the millions of people who need surgery each year, the question could be, “Is the anesthetic agent with the fewest greenhouse gas emissions appropriate for my surgery?” For the 24 million Americans with asthma and the 16 million with COPD, it’s, “Is a less emission-intensive inhaler available and appropriate for me?”
Those fortunate enough to have neither an upcoming surgery nor a lung condition, climate change influences a variety of diseases that afflict almost every single organ system. For the teen trying out for high school soccer in mid-summer, dehydration and heat stroke. For pregnant people, eclampsia and preterm birth. For the outdoor enthusiast, vector-borne diseases like Lyme and West Nile virus. Each potential incident is an opportunity for a climate-focused question to a clinician.
I can only imagine the positive impact on health care sustainability and decarbonization if patients motivated their health care providers to learn more about health care’s impact on climate change. Here’s hoping the next time I attend a preoperative visit, my patient will ask me about the emissions from the anesthetic gas I plan to use. My smile will shine right through my surgical mask.
Matthew J. Meyer is a critical care anesthesiologist 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, a steering committee member of Virginia Clinicians for Climate Action, and cofounder of PeriOp Green, Inc., an organization dedicated to reducing operating room waste to the least amount possible.