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Do No Harm, To Patients Or The Planet

Op-Med is a collection of original articles contributed by Doximity members.

It is a virtual certainty that humans have played and continue to play a vital role in global climate change. We have now reached a point where climate change is considered the greatest threat to human health and survival in the 21st century (1). Continuing with business as usual and taking a head in the sand approach jeopardizes the health of the human race across the globe and more importantly, places the planet at perilous risk.

My constant need for environmental stewardship has become a good source of humorous fodder for those subjected to my militant requests to reduce wastefulness and consumption in my workspace, a hospital. I find myself relentlessly searching for ways to reduce my carbon footprint and though this is easier to accomplish at home, it is a daunting task at work.

Health care systems such as hospitals are important sources of environmental pollution and contribute significantly to greenhouse emissions, generation of chemical waste and consumption of natural resources and products. The United States spends a fifth of its GDP on health care related costs- an estimate three trillion dollars in 2013. With this comes the sobering fact that US health care related greenhouse gas emissions have increased by more than 30 percent over the past decade and represent 10 percent of national emissions. Even more sobering is that if U.S. health-related emissions were ranked globally, it would rank 13th in the world, more than all of the United Kingdom.

Hospitals are large, energy-consuming buildings that are always open and utilize an extraordinary amount of resources in the form of fuel and electricity. They also drive the use of products such as pharmaceutical and medical devices that use significant resources for production. Every step of health care delivery has an environmental impact including both the upstream and downstream delivery of services, through utilization of natural resources and through generation of millions of tons of waste each year. Wasteful and inefficient practices within a hospital system are rapidly contributing to adverse climate change and climate change at its current trajectory will have far-reaching effects on the health of the global population. It is no wonder that improving hospital practices can have enormous impact on the rapidly enlarging health care related carbon footprint.

There is growing interest in estimating the health care sectors direct impact on environmental pollution and indirect impact of the pollution on public health. In a study evaluating trends in health care sector emissions and its potential harmful effects on public health in the United States, the authors concluded that the health care sector was responsible for 10 percent of national air pollution emissions with hospital systems providing the largest contribution. In addition, the indirect adverse impact on public health from environmental pollution related to healthcare systems was similar to annual death rates related to preventable medical errors.

For all of us in the health care system, our primary calling is to prevent and treat disease. What we are failing to recognize is that we as providers and those who deliver health care are inadvertently contributing to a public health crisis. Fortunately, there are initiatives that are raising awareness and are a call to action to prioritize decarbonization of health care systematically. At the Paris Climate Accord in 2015, in partnership with Health care without Harm and Global Green and Healthy Hospitals, the global community put forth the Health Care Climate Challenge. This as an opportunity for hospital systems to pledge to mitigate and curtail their current environmental impact, be prepared for the impact of climate change on public health and lead the way in educating their communities to be responsible and better informed citizens.

We as providers and protectors of our patients and our planet have to acknowledge that it is time for action. We must lead the charge in bringing necessary change to how we think about not only delivering the best care but also one that leads to the smallest footprint. We must urge our institutional leadership to prioritize an assessment of current wasteful and inefficient practices, perform a "green check," to bolster efforts to promote patient care with the smallest footprint possible and to invest in the long-term promotion of a stronger, smarter and a sustainable health care system.

The Gaia theory is a reminder that we have a symbiotic and synergistic relationship with all our surroundings on this majestic and vast planet we call home. How we respect and treat that which we inhabit will perhaps be the most important determinant of the future of the human race. We cannot expect to live healthy lives on an ailing planet.


1. Nick Watts, Markus Amann, Anthony Costello et al. The 2018 report of the Lancet Countdown on health and climate change: shaping the health of nations for centuries to come. The Lancet 2018. 392 (10163) 2479-2514

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