Sustainability...Every Other Sunday: The Healthcare System
by Hannah Paul
Hello again!
So, not being the most efficient and organized person, these posts have turned out to be a bit more time consuming than I originally expected. I’ll be delivering them every other week from now on to allow myself more time. I know that’s a disappointment for the two people that wait excitedly on the edge of their seats every Sunday to read my posts, so I’m truly sorry for the bad news, but I’m hoping you can forgive me!
This post will briefly cover what I’ve found on the healthcare sector’s environmental impacts. Our national emissions are often organized into the 5 categories shown in this figure. Like most systems, healthcare involves 4 of these 5 categories. Hospitals and other healthcare facilities are included in the “commercial and residential” sector, the supply chains they depend on fit into the “industry” sector, vehicles driven by employees as well as helicopters and ambulances contribute to the “transportation” sector, and electricity needed to run all heath facilities and operations account for a portion of the “electricity” sector. It’s easy to see how complicated achieving sustainability can become when you consider how multifaceted so many of our systems are. I am of the opinion that both top-down and bottom-up efforts are necessary to achieve sustainability and mitigate climate change, but I think the complex nature of our systems is is why the grassroots approach is so important. It is difficult to make effective generalized rules and regulations for such multifaceted issues. Therefore, changes initiated at the local and individual level are also essential in addressing the overarching problem. They may be small impacts on their own, but added together, they are significant. This obligation is especially relevant to us as future healthcare providers, where our entire profession is centered on maximizing the well-being of our communities.
Dentistry, on its own, is responsible for a small portion of the health burden of emissions and pollution. However, we are continually pushing for better integration of oral health and the dental sector into overall health and healthcare. If we want that recognition, we must also assume the corresponding responsibility to mitigate the negative impacts of the healthcare system as a whole, not limiting ourselves to our little dentistry bubble. General healthcare issues are now our issues, as much with sustainability, GHG emissions, and pollution, as with issues like nutrition, health equity, health literacy, or the increasing costs of healthcare.
Considering the public health benefits of sustainable development, I would also argue that we have a duty as healthcare providers to be educated on and advocate for policies and practices that promote sustainability in all levels and sectors of society. It might seem like a lot of extra responsibility, but with our positions in society, I think it’s fair to say we can be more influential than the average Joe. However, as with most things, determining a level of involvement that is sustainable for you personally is important in avoiding burnout and maximizing your contribution.
Below, I’ve picked out a few important points from two peer-reviewed articles to give you a general picture of the environmental impacts of our systems on public health.
1. Environmental Impacts of the U.S. Health Care System and Effects on Public Health: published in 2016 in the journal PLoS ONE
The US is second largest GHG emitter globally
If the US healthcare sector were a country, it would rank 13th in the world for GHG emissions.
The majority of carbon emissions is associated with suppliers of energy, goods, and services, and only 2.5% associated with direct operation of health care facilities (which is good, since we can change these things!)
Air pollution: US health care was responsible for the following fractions of national air pollution in 2013
12% of acidification
10% of smog formation
9% of respiratory disease from particulate matter
Environmental impact of U.S. healthcare accounted for 470,000 life years lost in 2013 (which they mentioned was comparable to the life years lost to preventable medical error)
2. The Harm We Do: The Environmental Impact of Medicine: published in 2017 in the Journal of Hospital Medicine
Healthcare is responsible for 9.8% of GHG emissions
Healthcare is responsible for 9% of particulate matter emissions
Including from incineration of hazardous wastes producing CO2, nitrogen oxides, and other volatile substances
Conventional water treatment systems cannot remove heavy metals, pharmaceuticals, and disinfectants in wastewaters, which have been detected in rivers and streams, and drinking water throughout the US
Exposure to toxic wastes and particulate matter is linked to increased rates of developmental and reproductive disorders, cancer, respiratory disease.
PM2.5 (particulate matter smaller than 2.5 micrometers) can diffuse through alveoli into the bloodstream – contributing to heart disease, stroke, and lung disease.
Climate change is linked to adverse cardiovascular, respiratory, infectious, and mental health outcomes (not to mention the ecological destruction that will imperil health in other ways)
Many of the solutions to these issues are centered around reducing use of fossil fuel derived energy, reducing water consumption, sustainable construction, waste management and reduction, supply chain revisions, and reduction of chemical use. Many hospitals and health care centers are already making an effort to reduce their impact (and are saving money doing so) through programs and organizations like the Healthier Hospitals Initiative , Health Care Without Harm and its Green Guide for Health Care, Practice Greenhealth, and the Sustainability Roadmap For Hospitals. All of these resources could also be useful for you if you hope to incorporate sustainability into your future practice. It looks to me that the concepts and strategies it outlines can be applied just as easily to dental offices, so I recommend you check it out!
In accordance with our goal to Do No Harm, we have a duty to implement, advocate for, and support sustainable practices in our healthcare systems and beyond to both save money and save lives. I hope these resources and information are helpful for you either now or in your future as dental professionals!