The patient-care principle ‘first do no harm’ seems to fly in the face of many essentials in running the health system: intensive cleaning with harsh chemicals, one-time use of personal protective equipment and other procedures that can leave a heavy ecological footprint.
Hospitals with clinical-grade disinfecting practices use energy around the clock. Personal protective equipment (PPEs), medical devices and pharmaceutical drugs are among waste-producing staples in a system that’s been working towards sustainability by using environmentally and economically sound practices without compromising human health or aspects of the system.
The COVID-19 pandemic that began in early 2020 has placed extreme strains on the system but it’s also fostered opportunities for change and innovation, industry members say.
“The pandemic has taught us that we [the health care system] can really focus our attention on addressing a major public health issue,” says Neil Ritchie, Halifax-based executive director of the Canadian Coalition for Green Health Care, which was founded in 2010.
“If we can put that focus on climate change and resilience, then there certainly are possibilities, but it’ll take a massive level of co-operation between the public and private sectors.”
Worldwide, the health care sector is responsible for about five per cent of global greenhouse gas emissions that contribute to climate change and global warming, according to research, including a British paper published in February, 2021, in The Lancet Planetary Health.
At the recent United Nations climate summit (COP26) in Glasgow, Canada was among the countries that committed to developing “climate-resilient and low-carbon, sustainable health systems” — a move hailed by both health-system veterans and up-and-comers.
Canadian Coalition for Green Health Care initiatives include a Green Hospital Scorecard tool, which helps measure an institution’s energy and water conservation, waste management and recycling, pollution prevention and corporate leadership. Hospitals then report on their environmental and sustainability efforts and get a scorecard summarizing their performance relative to their peers.
“The bottom line is that climate change is a health-care issue and a health equity issue, and a health care sustainability issue, and the time to act is now,” says Edward Rubinstein, director of environmental compliance, energy and sustainability with Toronto’s University Health Network (UHN).
Although the pandemic resulted in increased energy needs for extra ventilation and a surge in PPE waste, UHN says, it completed 47 environmental projects and made strides in green initiatives across the organization in 2020. Its sustainability practices include Operation Green, collecting expired or unused medical supplies and sending them to countries in need — most recently earthquake-devastated Haiti last summer.
At UHN’s Toronto Western Hospital, work is underway to install the world’s largest raw wastewater energy transfer (WET) system using thermal energy from municipal sewer water to supply most heating and cooling needs. It’s expected the system will reduce electricity and natural gas consumption and cut carbon emissions. It’s set for completion in late 2022.
To reduce its emissions, Vancouver Coastal Health (VCH), with its network of hospitals and other care facilities across British Columbia, is upgrading operating rooms with better infrastructure (including heating, ventilation, air conditioning, electrical systems and plumbing) and new technology to capture anesthetic gases. It’s helped reduce emissions from the equivalent of 290 cars to fewer than 10, according to its 2020-2021 IMPACT Report.
Sixty per cent of emissions from the health system are linked to supply-chain items like pharmaceuticals, single-use PPEs, and medical devices, says Linda Varangu, the Canadian Coalition for Green Health Care’s senior adviser on climate change.
The coalition believes the key to health-care sustainability, which also would save money over the long term, is transforming supply chains to the circular economy — sharing, leasing, reusing, repairing, refurbishing, and recycling materials and products. It’s a departure from the traditional, linear economic model that focuses on maximizing profits from the mass production of short-life products using easy-to-get materials.
Since 2017, Grand River Hospital in Kitchener, Ont., has been collecting single-use devices such as compression sleeves and laparoscopic sealers (an instrument used to divide and seal tissues) for recycling, instead of sending them to landfills or biomedical waste.
“We need a full-level commitment in health care to fulfil the mandate of doing no harm,” says Owen Luo, a third-year medical student at McGill University and co-chair of the Canadian Federation of Medical Students’ Health and Environment Adaptive Response Task Force (HEART).
“In my hospital-based learning experiences, I really got to see first-hand the waste that health care produces,” says Mr. Luo, 22, from Montreal.
“A lot of times, bags [of medical items] would go to biohazardous waste, which would be incinerated and have an even greater impact on the environmental waste stream,” he says. “All this got me thinking about how we can not only adapt to climate change as physicians and take care of patients affected by it, but also mitigate climate change and reflect on our ongoing contributions to the climate crisis.”
Mr. Luo says family physicians can play a big role in helping consumers learn about greener alternatives to consumer products such as menstrual pads and tampons with plastic casings, and inhalers to treat asthma and other respiratory problems. For instance, pressurized metered-dose inhalers (containing hydrofluorocarbon propellants, powerful greenhouse gases that escape into the air) can often be swapped for dry-powder inhalers, which work by breathing into them to deliver medicine directly into the lungs.
However, researcher Fiona Miller cautions against fixating on “things that are visible.”
“We see an overflowing waste bin and think that’s where the problem resides. Yes, there’s a need for reusables and recyclables, but remember infection prevention is an incredibly important environmental effort,” says Ms. Miller, a professor of health policy and director of the Centre for Sustainable Health Systems at the Institute of Health Policy, Management and Evaluation at the University of Toronto.
As an example, she says, anesthetic gases (largely invisible greenhouse gases) could be replaced with intravenous anesthesia administered through an injection or a catheter tube (which creates visible plastic waste).
“The obvious answer is to switch [to intravenous anesthesia], but by doing that, you see the visual of plastic waste,” she says.
“Reducing waste gets people started and it’s important, but it’s also where it came from and what it represents in terms of our practices, and whether we have that right – if it forces you to think upstream — and that’s a critical part of it.”
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