Learning Module | SUSTAINABLE HEALTHCARE
Chapter One
1. Our Obligation
CONTEXT
Canada is the third largest emitter of healthcare life cycle greenhouse gas emissions per capita in the world, after Australia and the United States. Globally, healthcare emissions account for 4.6% of total greenhouse gas emissions. Although this may not seem like a large percentage, this equates to 33 million tonnes of greenhouse gas emissions in Canada per year. And that’s not all. Healthcare activities generate over 200,000 tonnes of other pollutants as well. The largest sectors contributing to health damages include public hospitals (22%), prescribed drugs (21%), and physician and clinical services (13%). [2,14]
Despite the alarming numbers, research specific to the environmental footprint for Canada and BC is lacking.
the environmental footprint of HEALTHCARE
Hospital building design
Sustainable building design aims to have a minimal impact on the environment during construction and operation. Using strategies that cater to the natural environment can help improve energy efficiency and can also promote wellbeing. [13]
Energy use
Hospitals require a lot of energy, from lighting, to heating and cooling, to numerous medical equipment. Therefore, monitoring and managing energy use is an important method of mitigation. [3]
Water use
Healthcare facilities tend to be the most water-intensive users in a community. Infection control and prevention policies often limit the conservation practices that can be implemented. Given that many communities are already experiencing water shortages, water monitoring and conservation methods are possible and should be enforced. [1]
Procurement
The production and distribution of medications and equipment accounts for a large portion of healthcare related emissions and also increases exposures to harmful pollutants. Sustainable procurement of medical goods would not only decrease the environmental impact, but also reduce the direct harms healthcare is imposing on health. [11]
Waste production
Healthcare is a notoriously wasteful practice. While maintaining infection control is important, there are various ways that waste could be reduced, from moving away from single-use plastics to re-evaluating how much equipment should be used in the first place. [15]
Transportation
Healthcare isn’t delivered equitably across the province, and therefore some patients have to travel far distances to necessary appointments. Telehealth appointments are an instrumental tool in reducing emissions from travel as well as decreasing time and costs for patients to attend these appointments. [6,7]
Image courtesy of Jared Pritchard, UBC medical student.
Land use
Our land is limited, and what we decide to do with our land has a critical impact on our overall environmental footprint. Although hospitals are necessary for our health, transforming more forests into urban cities releases greenhouse gases stored by trees. Plus asphalt holds in heat, increases the risk of heat waves and related illnesses. [4]
Food consumption
Although hospitals aren’t usually considered a dining centre, food is an important aspect of health. Since food distribution and consumption has a huge environmental impact for each individual, the distances food travels, and the emissions of the types of foods being offered in hospitals should be considered. [4]
Why Should We Care?
An estimated 23,000 life years are lost due to disability each year from direct exposures to pollutants from Canada’s healthcare system and indirect damages due to the consequences of malnutrition, infectious disease, and temperature extremes. [2]
These health impacts are expected to occur at every stage of life, from young children to older adults. However, despite the various ways that climate change will progressively impact health, this issue is vastly understated in the medical community. [14]
Healthcare workers are in a unique position to speak up about important policies and, therefore, have a responsibility to recognize and respond to that duty. Given the impacts of climate change on health, advocacy for climate action is an obligation that physicians should accept.
WHY SHOULD WE SPEAK UP?
Expertise
Healthcare workers in general have the medical knowledge and training to understand the health trends seen, and to attribute the growing prevalence of diseases, such as respiratory conditions, to the changing environment.
Effectiveness
Given their medical expertise, physicians are more likely to be effective at communicating the issues with climate change (and the fact that it exists) to both the general population and policymakers. They have the social influence to effect change.
Public Trust
In following the Hippocratic Oath, physicians have a responsibility to ‘do no harm.’ They have a duty to uphold the trust of their patients, which includes advocating for their health and the safety of the environment.
Low Risk/Cost
Given the position of power that physicians hold, advocating for climate change action is unlikely to come at any risk or cost to the individual. Other individuals within the climate movement do not have the same opportunities to speak up, and may not have the same freedom to express their opinions. Physicians should be conscientious of the power and the privilege they are given, and should use that power to affect positive change in the world.
Consequences
As a global community, failing to act will undoubtedly result in severe outcomes. As voices of power and expertise, physicians should respond to this crisis and they should do it now.
REFLECT
Watch this short video produced by Healthcare without Harm on the obligation of healthcare workers to advocate for environmental justice. [5]
For more information, click here.