Someone, somewhere, is using a metered-dose inhaler right now. As they press down on its canister and take a deep breath, the inhaler is emitting a teeny bit of propellant into the air. That propellant, necessary to deliver the life-giving medicine inside, contains hydrofluoroalkane (HFA)—a potent greenhouse gas that contributes to climate change.
This is one small example of a larger issue: The tools we all rely on to stay healthy are making our planet sick. The health care industry is now responsible for around 5% of global greenhouse gas emissions—and that number is likely closer to 10% in the United States. If health care sectors in Australia, England, Canada, and the U.S. formed an independent nation, it would be the seventh most polluting in the world.
This won’t change simply by switching over to climate-neutral inhalers (though, some folks are on it). To move into a healthier future, we’ll have to renovate our health care system as a whole.
Why our current health care system is broken.
Climate change doesn’t just harm the planet; it harms human health. As Shweta Narayan, an India-based environmental health advocate with Healthcare Without Harm, said in her talk at the recent TED Countdown conference, “The climate crisis is a health crisis. It threatens our air, water, food, shelter, security—all of the basics on which human life depends.” This makes the high climate impact of health care all the more concerning.
As we treat one person for one disease, we might predispose someone else, worlds away, to another. The fossil fuels burned to create, transport, and administer medical care ultimately end up in our atmosphere as air pollution—which is responsible for 7 million premature deaths a year, mostly in low- and middle-income countries. They also contribute to a warmer planet and all the threats that come with it: longer and more intense allergy seasons, wider spreads of infectious vector-borne disease, heat stress, deadly storms, and the mental distress of a planet in flux.
Clearly, as we’re solving problems in the short term, we’re creating new ones in the long run. But a growing coalition of environmentalists and health care professionals are saying it doesn’t have to be this way.
“There is a lot that hospitals and health care industries can do to reduce pollution and greenhouse gas emissions at the same time,” Jane Burston, the executive director of the Clean Air Fund, tells mindbodygreen. Once we recognize how connected climate and health truly are, we see that we can advance both at the same time.
Here are some of the key pillars of a system that balances the needs of patients with the needs of the planet and does not only less harm but a lot more good.
One huge reason we haven’t taken more action to clean up the health care industry yet? We’ve had no idea how dirty it was. However, new papers like Healthcare Without Harm’s Climate Footprint Report, released in 2019, are giving us a sense of the scope of the problem and the type of solutions needed. Reports like these are essential for building momentum behind zero-emissions health care—which a growing number of hospitals, clinics, and state government health departments are now pledging to support.
Engaged health care professionals—and policymakers who listen to them.
Doctors are, rightfully so, some of the most trusted and respected professionals in the world. They also have a unique view on climate change, as they’re seeing how it affects patients firsthand. This expertise makes them valuable voices to invite to the climate policy table.
“We as health care providers have the ability to transform our system, transform our society, and transform the minds of our patients and public administrators,” Jodi Sherman, M.D., an anesthesiologist and the founding director of the Program on Healthcare Environmental Sustainability of the Yale Center for Climate Change and Health, tells mbg. In a new paper in the British Medical Journal, Sherman and her team reiterate that “achieving net-zero emissions in health care will be possible only with radical and immediate engagement of the clinical community.”
Incentives to clean up the health care supply chain.
If you’re wondering why the health care industry is such a heavy emitter in the first place, consider your last visit to the doctor: You probably sat on disposable exam paper, had your temperature taken using an individually wrapped thermometer, and walked away with a prescription to a plastic tube filled mostly with air and some medication.
These are just the parts of the system we can see: Behind the scenes, there is a massive industry making these medical supplies and distributing them around the world, only to be quickly thrown away to prevent the spread of infection.
Sherman explains that 70 to 80% of the health care industry’s emissions come from the supply chain, with the top offenders being pharmaceuticals, medical devices, food, inhaled anesthetics, and metered dose inhalers. None of these heavy hitters are incentivized to make their products more sustainable or reusable because, like any other industry, they operate off a consumption-based model: The more products they sell, the more money they make.
Sherman gives single-use medical equipment and arbitrary best-by dates on pharmaceuticals as examples. “A lot of attention is paid to drive disposability,” she says. “Obviously, we need to prevent infection; that’s fundamental to what we do. But a lot of the disability is not evidence-based, and industries are making it harder and harder to reuse things. Our regulatory policies are supporting that.”
In most of the world (the U.K. is an exception), there is no national policy mandating that the health sector measure or reduce its carbon footprint. As long as emissions reductions remain voluntary, Sherman predicts that they won’t happen—certainly not at the speed we need them to.
A new dialogue between clinicians and patients.
The WHO now considers air pollution one of the biggest threats to human life—so why do we seldom hear about it in the doctor’s office? It’s largely a matter of causality. It’s often impossible to directly attribute a medical condition to pollution or climate change.
Even so, encouraging conversations about climate and health in the checkup room is essential. For starters, Narayan says, they can make people feel more supported by their health professionals. They can also help validate patients’ concerns about how their environment is affecting their health.
Burston adds that when things like fossil fuel emissions are discussed as health concerns—in and out of a clinical setting—they tend to be less politically divisive. While people may argue about climate change and climate policy, they can probably agree that having clean air to breathe is important—a rare common ground that can inspire positive action from all sides.
Another problem happens when health care services are doled out unnecessarily. Sherman notes that “globally, a quarter of care is deemed low-value or inappropriate—meaning it’s not needed, it’s not wanted, or it’s even potentially excessive.”
This, she says, is why self-care can support a more sustainable industry. When those of us who have the means to eat healthily, prioritize sleep, stay active, and practice other forms of preventive medicine, we take some of the load off of an overtaxed system and free up medical resources (and their emissions) for those who really need them.
As scary as it is to think about, most experts are predicting that life-threatening weather events will only become more common in the years ahead. This means we’ll be relying on doctors, nurses, first responders, and other caregivers even more. To set them up for success, we need to ensure that their infrastructure is resilient.
“We want hospitals to be the last buildings standing,” Narayan says, and thankfully, “a lot of the measures that make the health care sector resilient also make it low-carbon… these are two sides of the same coin.” For example, moving a clinic off the grid and fueling it with renewables will give it a clean power source and make it less likely to lose power in a flood or hurricane, meaning more beds for communities in crisis.
Moving toward a healthier future for all.
These pillars can help us keep our current system intact—but we shouldn’t stop there. To help the 2 billion people around the world living without high-quality health care, we’ll have to find ways to apply this model of collaboration, honesty, and accountability far and wide. As we do, we’d be wise to stick to a promise that health care professionals live by day in and day out: Do no harm. To people, to the planet, or to the generations to come.
