In March and April of 2020, we Houstonians held our breath as COVID-19 cases continued to spike in New York City. We sympathized with health care providers working on the front lines and showed our support, all the while priding ourselves for only being at 10% ICU capacity in Houston. We’re fine, we all thought. Then came Memorial Day weekend, and the number of cases rose sharply, likely in accordance with our state’s premature reopening. More and more Houstonians tested positive, and shortly thereafter Houston became the new hot spot.
As a medical student seeing patients in the Texas Medical Center, full PPE became my everyday attire. I quickly lost track of the number of N95 masks, plastic gowns, and latex gloves I went through each week. Now, with a PPE shortage, it breaks my heart every time I exit a patient’s room with my team of residents, nurses, and attending physicians and watch as the whole group puts their gowns and gloves straight into the trash. In a world with less waste, maybe we wouldn’t find ourselves in a shortage of products made from plastic.
Why do we choose not to focus on environmental sustainability in health care? It’s a question I’ve asked myself repeatedly throughout medical school. There are a few main reasons. First, there is the issue of good hygiene. We want our surgeons to maintain a sterile field during an operation to reduce the risk of infection. Proper hand-washing technique has saved millions of lives. Airborne and contact precautions promote effective infection control. Second, there is the issue of patient confidentiality. I was shocked to learn that paper never gets recycled in our hospitals here in Houston due to Protected Health Information concerns. That’s right, the world’s largest medical center does not recycle. And trust me, 21 hospitals go through a lot of paper.
In order to keep private information secure, documents undergo shredding, and since most recycling facilities don’t accept shredded paper, these documents end up in landfills. And although black-and-white printer paper shreds are safe for composting, the sheer volume of shredded paper generated by the Texas Medical Center would produce an unfavorable carbon-to-nitrogen ratio at any composting site nearby. Because paper is so naturally high in carbon, the relative deficiency in nitrogen from plants would disrupt the composting process, making high-volume composting at the local level impractical.
The result is that health systems are among the highest waste-generating sectors in the world. While more and more companies and organizations in private and public sectors alike are addressing the significance of climate change and implementing new sustainability strategies, the health care sector has remained stubbornly stagnant. The excuses for not prioritizing environmental sustainability in health care are good, but not good enough. We need to reduce the exorbitant amount of waste produced by our hospitals.
In Houston and in high-income countries, the increasing use of disposable instruments and prepackaged materials generates a tremendous amount of waste. Just last week I helped perform a minor procedure on a patient with several metal instruments, all of which were promptly thrown in the trash upon completion despite their ability to be recycled because recycling “just isn’t done here.” And one might assume that this waste goes straight to landfills, but incineration is common practice due to the presumed biohazard risk. In reality, an estimated 85% of health care waste is non-hazardous. Nevertheless, many materials are burned out of precaution and release greenhouse gases. Here in the U.S., our health care system contributes to a staggering 10% of our nation’s carbon emissions, though it is rarely mentioned as a carbon-intensive industry the way transportation, agriculture, and energy production are. And trash generation is not the only component of health care’s environmental impact. From wastewater to energy consumption to toxic chemicals, our hospitals have a colossal carbon footprint. For example, desflurane, sevoflurane, and isoflurane, three commonly used inhaled anesthetic agents, also happen to be greenhouse gases with a non-negligible ecological footprint — a good reminder that what may not be toxic to us can still be harmful for the earth. Finally, negative staff attitudes about sustainability, inadequate recycling facilities, and lack of awareness regarding recycling options only further compound the issue and create barriers to meaningful change.
We as health care professionals need to demand evolution in our workplace. We need to urge lawmakers and hospital boards to pass bills and implement policies that improve efficiency and decrease waste in the hospital setting. In 2019–2020, Congress introduced 333 bills related to environmental protection, and yet none of these bills directly addressed hospitals or the health care sector in particular.
There are countless advantages to taking action: increased financial savings, improved efficiency, and reduced environmental risk. Simply put, environmental sustainability is good business. Not only does it help lower operational costs, but it also allows more resources to go directly to patient care. Those who have committed to increasing efficiency have already enjoyed its tremendous financial benefits, as illustrated by Memorial Hermann Health System here in Houston, who saved $47 million over five years by implementing energy efficiency strategies and Kaiser Permanente, who saved $4 million a year by purchasing energy-efficient, environmentally responsible computers.
The opportunities for sustainability are numerous, and range in aspect from energy, to water, to supply chain, to waste, to commissioning. The American Society for Healthcare Engineering has proposed feasible sustainability efforts for hospital systems, some of which include scheduling preventative maintenance, insulating hot water systems, installing on-site renewable energy, installing energy-efficient lighting, reducing water flow by upgrading lavatory faucets to low-flow fixtures and minimizing water used for laundry, and programming heating and cooling to ramp up only when spaces are occupied. Though certain investments in renewable energy — like solar panel installation on the rooftops of sunny Texas hospitals — may have a lower return in the short term, the potential for long-term return is enormous.
In a time where we are facing a pandemic, a hurting economy, and a suffering planet, environmental sustainability is certainly worth fighting for. I am calling on our legislators to focus specifically on waste and emission reduction in the health care sector. I am calling on hospital administration to implement strategies to increase energy efficiency and improve recycling efforts. And finally, I am calling on all of you to spread the word and turn one voice into many. Health care saves lives, but if we continue to absolve the industry of its role in climate change, we might not have lives left to save.
Illustration by Jennifer Bogartz