To fulfill the first duty of the Hippocratic Oath — “do no harm” — the health care sector must look to its role in reducing carbon emissions, according to a recent study by Brown researchers.
The study, “Supporting Decarbonization of Health Systems,” investigated 73 countries’ commitments and plans to decarbonize their health care sector. Researchers found that while many countries have committed to overall decarbonization, “few have published delivery plans for meeting national targets.”
The authors sought to understand “what countries have said globally in terms of their policy and commitments around decarbonization, and whether or not those commitments (were) followed with specific policy actions,” said lead researcher Emily Hough, who was an affiliate senior research associate at Brown at the time of the study. “So, where (countries) have, for example, made a commitment to get to net zero, is there actually a plan for how they would decarbonize their health system?”
Hough and co-author Arielle Cohen Tanugi-Carresse, a PhD candidate at Université Paris-Est Créteil and former research assistant at Brown, examined gray literature — materials and research that are not published via traditional academic channels, such as government documents or news articles — using keywords such as “sustainable healthcare” and “carbon reduction” to seek out national policies, health- and hospital-level policies and individual case studies.
According to Hough, health care is a high carbon-emitting sector because of its massive size and complexity, contributing to high energy costs. For example, hospitals must not only run 24/7 but also maintain specific patient environments.
“If you think about, for example, an operating theater, you need to have the right air pressure and airflow, and there are safety issues associated with that, so that creates a very high carbon cost per square meter,” Hough said.
In addition, the pharmaceutical industry also contributes largely to health care emissions. Hough highlighted some pushes for change, such as in anesthetics — switching from desflurane to sevoflurane due to its lesser emissions — and inhalers, encouraging people to opt for dry powder inhalers which have a lower carbon footprint than their aerosol counterparts.
Even with environmentally conscious swaps, the energy cost of transporting these products across the globe and packaging them in mostly disposable sterile wrapping is still enormous, according to the study.
In “Health Care Pollution And Public Health Damage In The United States: An Update,” a study examining health-care-related carbon output, authors found that emissions from the supply chain — including transport, testing and research, plastic and pharmaceuticals — were the biggest culprit in health care emissions, followed distantly by healthcare facilities’ direct emissions and emissions from direct purchases of energy.
Addressing health care emissions is “an interesting challenge,” Hough said, because of “different” perspectives on health care when it comes to climate change. Some pollutants have gotten exemptions for healthcare uses, Hough said, pointing to the use of chlorofluorocarbons, chemicals formerly used in aerosol sprays that are now known to deplete the ozone layer.
“When you look at the correlation between some of the impacts of climate change and other emissions like air pollution on human health, it's actually really important that we consider sustainable ways to reduce our emissions alongside thinking about how we deliver high quality and affordable health care,” she added.
The effort to balance decarbonization with high quality care means “rethinking a patient journey and providing the right amount of care and not excessive amounts of care,” Cohen Tanugi-Carresse said. “If you give out too much medicine, it’s also more plastic, more paper, more stuff that you’re producing and getting out.”
Cohen Tanugi-Carresse said more research into emissions metrics is required to improve current roadmaps for healthcare decarbonization. “If you don’t have the data, you don’t know what you’re specifically targeting,” she said, noting the importance of understanding the composition of emissions and the strategies that apply to specific greenhouse gasses, rather than emissions at large.
For example, the study refers to Norway, which committed in 2021 to review their greenhouse gas emissions from their health sector to aim for “net-zero operations in health trusts by 2045.” Additionally, Colombia started a project with Health Care Without Harm to estimate their health system’s climate footprint at the facility level.
According to the study, the United States is “one of the world’s worst offenders” when it comes to emissions from health care, with 8.5% of the nation’s emissions coming from the sector.
The study addressed both mitigation and adaptation in addressing healthcare decarbonization. Since low-income countries tend to have lower emissions to begin with, they tend to use the adaptation approach — preparing for the future impacts of climate change on healthcare provisions. Mitigation, which means reducing current and future emissions, is more essential to decarbonization in high-income countries, such as the United States.
“When you look at resilience in our health systems, often a higher income country might have a more resilient health system to start with,” Hough said. “But also, when you look at the disproportionate impact climate change has on a global population, often you see the impacts of climate change falling on countries that are low-income.”
