The health care footprint on the planet, one more reason for right care

Cristina Roure

According to the Health and Climate Change Commission of The Lancet, the greatest opportunity in 21st century health is an adequate response to climate change. I have to confess that, had I been asked, I would surely have answered that the next revolution in health would be technological, probably connected to personalized medicine, 3D printing or electronic health.

We think that way because we take for granted that achievements in health are permanent and that climate change is not a health problem. However, the truth is that anthropogenic climate change threatens the advances made in public health in the last fifty years. The World Health Organization already attributes a quarter of the burden of disease and death in today's world to environmental factors and, if it continues, can have a serious impact on health in any region of the planet in the next fifty years.

Human activity is transforming ecosystems quickly and deeply, and generates an increasing impact on all dimensions of people's health and well-being. This can be direct, as is the case of extreme weather events, or indirect, through the alteration of the ecosystem by contamination of water, air and food, or social changes. Consider, for example, the increased risk of infectious diseases transmitted by mosquitoes, in allergies or migrations forced by desertification and its consequences.

The Lancet Countdown is collaboration between twenty-four academic and intergovernmental institutions that monitors and provides an independent evaluation, using forty indicators of the effects of intervening or not doing so to reduce the risks that climate change has on health. The Lancet highlights the leadership role that health professionals must adopt to raise awareness that acting to alleviate and mitigate the threat of climate change is the greatest public health opportunity of the 21st century.

Despite this positioning and commitment, paradoxically the health sector ignores its own contribution to environmental problems. Hospitals, health organizations, the pharmaceutical and biomedical industry, either directly or indirectly through the products or energy they consume or the waste they generate, have a significant impact on the health of the planet and its inhabitants.

The environmental impact of an activity, organization or product on the planet is known as its "carbon footprint". This is quantified by calculating the totality of greenhouse gases emitted as a direct or indirect result of its activity (or its life cycle, if we refer to a product), and expressed in tons of CO2. The National Health Service has estimated its carbon footprint in more than eighteen tons of CO2 per year, accounting for 25% of emissions from the British public sector. This impact is not so strange if we think that the health sector consumes 8-10% of GDP in Europe and up to 18% in the United States. Health care facilities are some of the biggest fossil fuel consumers in the entire economy.

Health Care without Harm is an international alliance formed in the nineties whose mission is to renovate the health sector so that it’s ecologically sustainable and it does so with a global vision. Its president, Gary Cohen, explains in an interview that if the set of American hospitals were a country, it would emit more greenhouse gases than all of France. Apart from the evident consumption of energy and fossil fuels, the biggest source of contamination in hospitals is the supply chain, which accounts for 60% of its carbon footprint. These are, for example, medicines, health care materials, food, transport, toxic waste, packaging, etc.

If you have eight minutes and want to know more, listen to Cohen’s clarifications in this video on how hospitals contribute to the environmental threat to health and what they can do to reduce it and act more responsibly with the community. You will notice that yet again, Kaiser Permanente is involved and is ahead of the rest.

One of the Health without Damage projects is the Global Green and Healthy Hospitals Network (GGHH), formed by more than a thousand hospitals, organizations and health systems in fifty-one countries that share an agenda with ten objectives aimed at reducing your carbon footprint:

1. Leadership. Commitment to the prioritization of environmental health.
2. Chemical products. Replacement of toxic products with more safe ones to protect patients, professionals and the environment.
3.  Waste. Elimination of toxic incineration of sanitary waste and promotion of "zero waste" policies.
4. Energy. Implementation of clean and efficient renewable energy generation systems.
5. Water. Reduction of water consumption. Recycling and water treatment to minimize contamination and ensure access to water free of contaminants for the community.
6. Transportation. Promotion of local public transport for patients, family members and staff, to reduce pollution and respiratory diseases in the community.
7. Food. Purchase and consumption of healthy foods obtained by sustainable means.
8. Medications. Safe management of medicines and reduction of the environmental impact of their waste. Related to the Safer Pharma campaign of GGHH-Europe, which promotes the protection of the environment from pharmaceutical contamination in all stages of the life cycle of medicines, including their rational use.
9. Building and facilities. Responsible design and construction that minimizes damage to the community and the environment.
10. Shopping. Buying safer and more sustainable products and materials.

As the promoters of Health without Harm explain in the video Do No Harm, climate change is a health emergency. The Hippocratic Oath must evolve and pass from the primum non nocere referred to the patient to a more global vision of health, since it’s not possible to have a healthy population if you live on a sick planet.

In this context, the Right Care movement also acquires a new meaning and adds value. Because, beyond the immediacy of stopping activities to avoid the waste of resources and the eventual iatrogenic on people, it’s an exercise of responsibility with the community and avoids unnecessary damage also on the planet and consequently, on the health and well-being of its inhabitants.