by Urvashi Bhatnagar and Dr. Jeff Thompson, MD
When early published studies pointed to tobacco use as the most important preventable cause of premature mortality in the world, physicians and healthcare providers not only stopped smoking themselves, but became important voices of public trust to guide smoking cessation-related initiatives. Studies show that among the medical population, compared with smokers, physicians who do not smoke are far more likely to engage in smoking cessation activities. In fact, greater tobacco control progress has been shown in countries with lower smoking rates among physicians than in countries where physicians have higher smoking rates.
Today, fossil fuel-related air pollution causes over 350,000 deaths in the United States and over 9 million deaths globally. That is, 16% of deaths globally are caused by climate change. For perspective that is three times more deaths than AIDS, tuberculosis and malaria combined.
The pollution generated by our healthcare practices—specifically hospital system-generated pollution—is literally killing Americans. Greenhouse gas emissions associated with healthcare are an alarmingly large slice of the pie—4.6% of total emissions worldwide, and a whopping 8.5% of all greenhouse gas emissions in the U.S are emitted by healthcare systems. The effects of these emissions and other pollutants on community health and more broadly in planetary health are well documented. Researchers estimate that annual healthcare sector greenhouse gas emissions in the United States would cause 123,00 to 381,000 disability-adjusted life-years in future health damages, with malnutrition being the largest damage category.
A common refrain among health system leadership is related to costs associated with decarbonization and entrenched processes—it will simply cost too much to redesign care delivery pathways and supply chains.
This is a misconception. In fact, firms do not use toxic materials just because they are cheaper than harmless ones, and green products don’t need to cost more for a poorer experience. These are simply assumptions or myths—that have been disproven time again—when the triple-bottom line benefits and success stories of sustainability transformation are presented to healthcare leadership.
For laboratories and other organizations in the med-tech space with infrastructural and chemical manufacturing-related supply chain considerations, sustainability is a strategic pillar for:
- Cost-avoidance: particularly in the handling of biohazardous waste and worker safety
- Cost reduction: particularly as it relates to waste prevention strategies
- Reimbursement and value-based contracting opportunities: particularly if population health benefits can be tied to reduction or elimination of hazardous substances from the community
- Compliance considerations: as The Joint Commission and CMS are committed to requiring sustainability metrics in the future
Healthcare organizations will need to embed sustainability into their strategic plans going forward and should begin the early work of crafting a vision for the future and understanding their current state gaps.
For laboratories and others in the med-tech space, supply chain innovations and sourcing strategies will be important to address some commonly acknowledged sustainability concerns.
From a lab waste standpoint, consider the effect of formaldehyde-waste handling alone—a chemical that meets its end of life in landfills. Formaldehyde emissions from landfills decrease the air quality in the surrounding area and leach into groundwater. Formaldehyde is also, not surprisingly, the most common pollutant in outdoor air. It is also a complex chemical to safely dispose of since dilution and other strategies for waste disposal do not work.
Another area of focus for the lab community is the hydrofluorocarbon (HFC) propellants used today in pressurized metered-dose inhalers (pMDIs) prescribed for patients with asthma. These HFC propellants have many times the global warming potential than that of carbon dioxide and their use, together with all other emissive uses of HFCs, is being phased down under the Montreal protocol. This is an opportunity to switch patients to dry powder inhalers (DPIs). Other innovations related to green anesthetics and inhalants are already in use and must be scaled to maximize environmental impact.
Providers and physician leaders are driven by an inherent desire to serve, furthering community health goals in times of prosperity and particularly in times of crisis, such as the most recent COVID-19 pandemic. The “First Virtue'' to do no harm extends provider incentives to transform health system operations to adopt a population-level view of the impacts of the externalities of their organizational operations.
Take, for example, Gundersen Health System in Wisconsin, which started on its sustainability transformation journey back in 2006. Since then, the health system has been recognized as Health Grades 50 Best Hospitals in America, with CEO Emeritus Dr. Jeff Thompson, MD, recognized as the White House Champion for Change.
In October 2014, Gundersen celebrated its first day of being completely heat-powered and cooled by renewables it owned. As the largest employer in the area, the public health benefit of the energy expense reduction was visible in air quality improvements in the local hospital service, including a 93% reduction in CO2 ppm, an 80% drop in nitrous gasses and a 91% decline in particulate matter between 2008 and 2015.
The health system went further to utilize savings from this first initiative to invest in sustainability programs that address biomedical and food waste.It has even utilized the byproducts of the biogas digester plant to create its own line of organic potting mix in Middleton, Wisconsin.
The negative consequences of the healthcare delivery system are best innovated by the providers that understand the complex regulatory and technological advances that exist in their environment.
Albert Einstein once said, “Problems cannot be solved at the same level of thinking that they were created.” Providers—not regulators or industry “outsiders”—are best placed to drive healthcare and planetary wellness ahead of the curve by employing sustainability-levers.
As Thompson states in his book, “Lead True,” the community health benefits of the impact of cleaner water and air on the long-term health, strength and opportunities of the surrounding populace has been immeasurable.
About the authors: Dr. Jeff Thompson, MD, is the former CEO of Gundersen Health System, pediatrician, and author of “Lead True: Live Your Values, Build Your People, Inspire Your Community.” Gundersen was nationally recognized for higher quality, lower costs and dropping its greenhouse gases by 95%. Thompson spoke at the Paris climate talks and was honored by the Whitehouse as a champion for change. He has served as the board chair of Healthcare Without Harm. Dr. Urvashi Bhatnagar is a healthcare executive, physical therapist and author of “The Sustainability Scorecard: How Firms can Implement and Profit from Unexpected Solutions.”