Was, is and will Medicine be sustainable? - Elizabeth Humberstone
After taking a history and examining the patient in Bed 2, I take off my gloves and plastic apron, and throw them into the clinical waste bin. From there, they’ll be incinerated. It’s a simple act, and one I repeat many times as a medical student on the wards.
Yet even the smallest medical interventions have a drastic environmental impact. A single full blood count, for example, has been estimated to produce the same mean CO2 as a car driving 770m (McAlister et al., 2020). Indeed, as the technology used in medical intervention become more complicated, their carbon footprint increase – a week of in-centre haemodialysis produces up to 3818kg of CO2 equivalent per year per patient – approximately 3 return trips from London to New York by plane (Connor, Lillywhite and Cooke, 2011).
Of course, it’s more complicated than the numbers imply; technological advances can also be used in the journey to produce more sustainable healthcare. Bioplastics For example, could reduce both environmental impact of surgical implants and promote better patient outcomes following surgical recovery, whilst simple interventions such as telemedicine could save more carbon in lost travel time than technology needs put out (Ungar et al., 2017; Purohit, Smith and Hibble, 2021).
Furthermore, as resource costs (both financial and environmental) come into public focus, reduction in investigations and interventions may become a significant priority for healthcare organisers. It is perhaps worth noting that following the Covid-19 Pandemic, concerns about sterility may impact our assessment on the need for high carbon equipment, like single-use plastic PPE. Interestingly, interventions such as the ‘Gloves are Off’ Campaign at Great Ormond Street Hospital, show that reduction in single-use plastic is an achievable goal, which does not negatively impact patient outcomes (NHS England, 2018).
It's not only that healthcare systems can (and must) become sustainable, but also that environmental justice supports more sustainable medicine. As pollution increases, so do health problems linked to them – respiratory problems, communicable disease, nutritional deficiencies – arguably more work for the healthcare systems contributing 4.4% of global net emissions (Health Care Without Harm, 2019).
To stop a cycle of harm causing treatment and treatment causing harm, we should try to consider healthcare as ingrained to our social values. Environmental justice supports fair and equitable healthcare, safe and sustainable communities.
Indeed, in a climate where concerns about the cost of living and quality of patient care dominates in the UK, it is pivotal to consider the role of social sustainability. The old adage goes ‘for planet, people and profit’, and healthcare systems are not exceptional to this triple bottom line (Elkington, 1997). If we are to support healthy communities, and therefore reduce reliance on healthcare systems, we should consider the social determinants of public health, education, housing, job security, food systems and sense of community. Whether these have been achieved, at one point in history or another, is perhaps a less important question than whether improvement of these can be upheld and protected during conflict, natural disasters and political upheaval.
Social sustainability is not merely dependent on the support of patients entering a service, however. It also depends on the sustainability of people working within such systems. Recent strikes of ambulance and nursing staff have brought economic concerns to the fore, with low pay ‘long recognised as a challenge in social care’ (The King’s Fund, 2022). Similarly, on an individual level we should consider the importance of a sustainable career in healthcare, particularly with reports of 47% of NHS staff unwell under work-related stress, and 34% describing their feelings as ‘burnout’ (NHS, 2022). If we can agree that we can benefit from more sustainable technology, approaches to patient populations and healthcare systems, surely, we must also see benefit in the sustainability of staff and training systems.
It is important to consider that this essay has been informed by the experiences of medicine within a high-income country. It has long been accepted that whilst high-income countries are most responsible for global carbon emissions, it is low-income countries that most gravely feel the impact of these systems. Disruptions in supply chains, staff and systems adapting to the impact of environmental instability all contribute to this. A global health perspective to sustainability is therefore incredibly significant, and publication of research within this area can support the progression to more sustainable systems, for both high-income and low-income communities. Medicine clearly struggles against models of sustainability but has potential to adapt and evolve towards sustained environmental, social and economic changes which would support its own systems, people and the planet.
Connor, A., Lillywhite, R. and Cooke, M.W. (2011). The carbon footprints of home and in-center maintenance hemodialysis in the United Kingdom. Hemodialysis International, 15(1), pp.39–51. doi:https://doi.org/10.1111/j.1542-4758.2010.00523.x.
Elkington, J. (1997). Cannibals with forks : the triple bottom line of 21st century business. Oxford: Capstone.
Health Care Without Harm. (2019). Health care climate footprint report. [online] Available at: https://noharm-global.org/documents/health-care-climate-footprint-report.
McAlister, S., Barratt, A.L., Bell, K.J. and McGain, F. (2020). The carbon footprint of pathology testing. Medical Journal of Australia. doi:https://doi.org/10.5694/mja2.50583.
NHS (2022). NHS Staff Survey 2021 National results briefing. [online] Available at: https://www.nhsstaffsurveys.com/static/1f3ea5c952df62a98b90afcf3daa29ac/ST21-National-briefing.pdf [Accessed 18 Feb 2023]
NHS England (2018). NHS England» ‘The gloves are off’ campaign. [online] England.nhs.uk. Available at: https://www.england.nhs.uk/atlas_case_study/the-gloves-are-off-campaign/.
Purohit, A., Smith, J. and Hibble, A. (2021). Does telemedicine reduce the carbon footprint of healthcare? A systematic review. Future Healthcare Journal, 8(1), pp.e85–e91. doi:https://doi.org/10.7861/fhj.2020-0080.
The King’s Fund. (2022). The health and care workforce. [online] Available at: https://www.kingsfund.org.uk/publications/health-and-care-workforce#training-and-recruitment [Accessed 18 Feb. 2023].
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Unger, S.R., Hottle, T.A., Hobbs, S.R., Thiel, C.L., Campion, N., Bilec, M.M. and Landis, A.E. (2017). Do single-use medical devices containing biopolymers reduce the environmental impacts of surgical procedures compared with their plastic equivalents? Journal of Health Services Research & Policy, 22(4), pp.218–225. doi:https://doi.org/10.1177/1355819617705683.