The increase in global temperatures in the past decade has triggered environmental changes that pose an immediate and worsening threat to human health and survival globally.
The world has experienced the highest temperatures on records in the past eight years.
Extreme weather events are occurring frequently in every continent and studies indicate that climate change is making many of these events more severe or likely to occur.
These events have strained healthcare delivery systems, disrupted physical infrastructure and interrupted supply chains, thereby threatening the safety and quality of healthcare.
Healthcare-related pollution
While there is increasing concern about the impact of climate change on human health, there is less stated about the impact of healthcare-related pollution on climate change.
Healthcare delivery comprises a substantial portion of economic activity – an average of about 10% of GDP (gross domestic product) in OECD (Organization for Economic Cooperation and Development) countries.
The carbon footprint of healthcare varies across countries and across delivery systems, with a larger footprint per capita in high-income, compared to low- income, countries.
For example, the annual carbon emissions per 100 persons in the United States are estimated to be 25 times that of India.
A carbon footprint is a measure of the total amount of greenhouse gases caused directly and indirectly by an individual, event, organisation or product.
In the OECD, the healthcare delivery system contribution to the countries’ total carbon footprint is about 3% in Mexico; 4% in Greece, Turkey and the United Kingdom; 5% in Canada; 7% in Australia; 8% in Holland and France; and 8-10% in the US.
Studies suggest that healthcare delivery systems pollute more over time with the increases in health expenditure and as low- income countries increase their carbon dioxide emissions disproportionately.
Carbon dioxide emissions in the US increased by 6% between 2010 to 2018, while in China, the increase was 9% between 2000 to 2014.
The vast majority (70-80%) of healthcare carbon dioxide emissions are indirect, mainly from the supply chain or procurement of pharmaceuticals, medical products and devices.
Healthcare-related pollution also has an impact on patients.
Pollution associated with US healthcare delivery has been shown to account for the loss of 388,000 disability-adjusted life years in 2018 alone.
This number is similar to the harm associated with premature deaths due to medical errors, which was first reported in the US Institute of Medicine (now known as the National Academy of Medicine) report To Err is Human, a landmark report on patient safety published in 1999.
Unlike medical errors, which are directly linked to care provision and an individual patient, the harms from healthcare pollution have indirect effects that are difficult to attribute to any individual patient, but these harms cannot be ignored.
Governments and healthcare systems globally are becoming increasingly concerned not only with the impact of climate change on health, but also the impact of healthcare-related pollution on climate change.
There are global calls for decarbonisation targets, in alignment with the 2016 Paris Agreement timeline of 45% reduction in emissions by 2030 and net zero emissions by 2050.
There is increasing data on the contribution of different healthcare delivery sectors to climate change.
International comparisons are difficult because of different methods of measurement and categorisation.
However, there are similar conclusions on the healthcare sectors that are the main contributors to greenhouse gases.
In the hospital
Hospital care is one of the main sources of carbon dioxide emissions.
Activities related to diagnosis, treatment, radiology, physiotherapy, labour, construction, food and medical equipment have been estimated to account for 44% of all healthcare-related carbon dioxide emissions in Australia, and 36% in the US.
The carbon footprint of hospitalisation is estimated to be more than five times that of ambulatory care in Japan.
Surgical operations and related activities are the most resource-intensive activities in hospitals.
Greenhouse gas emissions from the operating theatre include anaesthetic gases, carbon dioxide canisters used for insufflation, and energy usage.
The latter has been found to be three to six times more than the usage of other hospital activities, mainly because of heating, ventilation and air conditioning requirements.
However, the carbon dioxide emissions from an operation vary widely depending on the type of surgery, as well as the amount of electricity and consumables used.
The intensive care unit (ICU) involves high resource utilisation for critically ill patients, compared to the general ward.
It has been found that ICUs generate three times more carbon dioxide emissions per bed a day, and 1.3 times more solid waste.
Drugs and devices
Medical and pharmaceutical products are among the top healthcare-related polluters.
It was estimated that pharmaceutical emissions in Japan exceeded the emissions from hospitals’ energy consumption.
Pharmaceuticals (both prescribed and over-the-counter) comprise 25% of healthcare-related greenhouse gas emissions in Canada, about 22% in Australia (with medical appliances), and 10% in the US (after omitting anaesthetic gases).
Indirect emissions from pharmaceutical procurement in France was estimated to account for about one-third of total healthcare-related emissions, followed by procurement of medical aids and appliances (21%).
Transportation
Transportation emissions, including freight and patient transportation, are among the top five sources of emissions for both direct and supply chain-related sources.
It was found in 10 primary care practices in Switzerland that 55.5% of the total carbon dioxide emissions in primary care were due to patient (33.2%), staff (12.5%) and courier transportation (9.8%).
Patient, visitor and staff transport to and from National Health Service (NHS) facilities in England accounted for 10% of all NHS emissions.
Ambulatory and nursing care
While there are fewer studies on carbon footprints outside the hospital, the research suggests that ambulatory primary and specialist care, as well as nursing and public health activities in community settings, are less resource-intensive than hospital care, and thereby less polluting.
Primary and specialist care were estimated to account for 4-6% of healthcare-related emissions in Australia, about 12% of healthcare-related emissions in the US, and 23% in the UK.
The carbon footprint from nursing services in Japan, with one of the world’s oldest populations, has been increasing, comprising 16% of total healthcare-related emissions.
Lack of stats
There is a paucity of Malaysian data.
With climate change being an existential threat to human life, perhaps readers can help start the conversation by asking the healthcare facility they next visit for its carbon footprint.
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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