Commonly used inhaled anaesthetics are potent greenhouse gases that contribute to global warming. — Wikimedia Commons
The effect of climate change on human health is increasingly severe and unpredictable.
The direct impacts include injuries and death from extreme events such as fires, storms, floods and heatwaves, while the indirect impacts are mediated by air pollution, waterborne and vector borne diseases, and food safety and insecurity.
On the other hand, the health sector is also a significant contributor to climate change.
Healthcare delivery contributes to climate change through greenhouse gas (GHG) emissions, water scarcity and air pollution.
The carbon footprint is the total amount of GHG, including carbon dioxide and methane, generated by an individual’s or organisation’s actions.
The exact size of the global health sector’s carbon footprint is unknown.
However, what is known is that it is substantial and is estimated to be equivalent to the annual GHG from 514 coal-fired power plants.
If the global health sector were a country, it would be the fifth-largest emitter on the planet.
Research into the carbon footprint associated with healthcare delivery in 36 countries, including all the Organisation for Economic Cooperation and Development (OECD) countries except Chile, China, India, Israel and New Zealand, has shown that it contributes an average of 5.5% of the total national carbon footprint.
The percentages range from 3.3% in Mexico to 7.9% in the United States.
By comparison, the aviation industry’s estimated carbon footprint is about 2.5%.
In all industrialised and many developing countries, the provision of healthcare services is a massive energy-intensive activity.
The health sector is also a major consumer of water, computers, medications, food and other resources.
Mitigating carbon footprints
The health sector, particularly in Europe and North America, are taking an increasingly active role in reducing their carbon footprints and moving towards climate neutrality.
Many others are addressing particular aspect(s) of the problem.
Some examples are discussed below.
The National Health Service (NHS) of United Kingdom embarked on its “Net Zero” NHS plan on Oct 1, 2020 with the aim to be the world’s first net zero national health service.
There were two targets i.e. “For the emissions we control directly (NHS Carbon Footprint), we will reach net zero by 2040, with an ambition to reach an 80% reduction by 2028 to 2032”; and “For the emissions we can influence (NHS Carbon Footprint Plus), we will reach net zero by 2045, with an ambition to reach an 80% reduction by 2036 to 2039.”
On July 1, 2022, Net Zero was embedded into legislation in the Health and Care Act 2022.
Recognising that surgical care has a significant environmental impact, the 2023 Green Surgery report sets the basis for reducing the carbon footprint of surgical care.
The Green Surgery report contains mitigation measures like reducing the need for surgical care, surgical care pathways, operating theatre energy and design, anaesthesia, products used in surgical care and addressing barriers and facilitators to implementation.
This report was endorsed by UK’s surgical Royal Colleges and a green operating theatre checklist is available.
The carbon footprint of healthcare delivery in Western Australia’s public health system has also been quantified.
According to the Global Green and Healthy hospitals network, seven South East Asian healthcare facilities i.e. Dr Arturo P. Pingoy Medical Centre (Philippines), Mary Johnston Hospital (Philippines), West Java Mental Hospital (Indonesia), St. Paul’s Hospital Iloilo (Philippines), Sunway Medical Centre Velocity (SMCV, Malaysia), Buddhist Tzu Chi Dialysis Centre (Malaysia), and Ibnu Sina Public Hospital (Indonesia) “have shown remarkable sustainability practices that deserve recognition, dissemination, and replication – from reducing carbon emissions and recycling used cooking oil to harnessing renewable energy sources and implementing cutting-edge waste management strategies.
“The case studies reveal a multifaceted approach to sustainability that addresses not only environmental concerns but also enhances the quality of healthcare delivery.”
IHH Malaysia is advancing green practices with its establishment of a building efficiency index.
The Green Surgery report contains mitigation measures such as surgical care pathways, operating theatre energy and design, and products used in surgical care. — Pexels
SMCV is the first Malaysian hospital to commit to Race to Zero by 2050. It is monitoring its carbon footprint with the climate impact checkup tool.
The common features in the above examples include:
> Awareness of healthcare’s carbon footprint.
> Identification of hotspots within the healthcare system.
> Quantification of the carbon footprints.
> Development of mitigation strategies which can be top down or bottom up. The latter include reducing GHG in anaesthesia and inhalers, and identifying where disposable materials can be replaced with recyclable or reusable ones.
> Assessment and monitoring of the mitigation strategies.
> Research.
Although the Health Ministry (MOH) provides about 75% of all hospital beds in the country, its silence about a green and sustainable health sector has been deafening.
Summary
The health sector in many countries has taken an increasingly active role in addressing climate change.
It is time for the everyone in the health sector to take a moral and tangible leadership role in mitigation efforts, beginning with its own policies and practices.
This was put succinctly by members of the World Health Organization’s Health Security and Environmental Cluster 16 years ago in the American Journal of Preventive Medicine: “The health sector is one of the most trusted and respected sections of society, and it is also one of the largest employers and consumers of energy.
“This presents both a responsibility and an opportunity to be an ‘early mover’ to achieve climate-neutrality in its own operations, and to demonstrate that this can go hand-in-hand with improved effectiveness and cost saving.”
Climate change poses an existential threat to humankind.
There is no health or healthcare on a dead planet.
The MOH and the Malaysian Medical Council must demonstrate ethical climate leadership that is urgently required.
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.
