Medical researchers and administrators are debating how to make US health care more sustainable

If you’re being treated in a hospital, your immediate concerns probably won’t include plastic waste, but maybe they should. Growing awareness of the links between the environment and human health has some in the US health care system wondering whether their promise to do no harm extends to the natural world.

This sector accounts for nearly 10% of US emissions and is one of the nation’s largest producers of waste, about a quarter of which – disposable plastic in the form of syringes, test kits, gloves and other equipment. Some health care organizations, however, have made strides in sustainability by using automated machines that dispense insulin in syringes instead of using individual vials, collecting unused supplies for donation rather than disposing of them after a patient is discharged, and installing solar panels, among other initiatives. .

Below, Stanford University infectious disease physician Desiree LaBeau and undergraduate student Navami Jain join Helen Wilmot and Christine Foster, chief sustainability officers at Stanford Health Care and Stanford Medicine Children’s Health, respectively, to discuss alternatives to single-use medical devices, the need for regulatory change, and more .

Jain and LaBeau recently co-authored a commentary at AMA Journal of Ethics, “How Should US Health Care Manage Global Changes in Plastic Waste Disposal?” Last June, Wilmot attended a White House roundtable on reducing health-related emissions that cause climate change. Foster has spoken at various national conferences on the topic of decarbonizing healthcare.

What are the most promising solutions for making healthcare more sustainable?

Wilmot: Each health care system should establish policies that define sustainability criteria—such as emissions of greenhouse gases and chemicals of concern—for goods and services, and include contract wording so that providers communicate such criteria. In addition, the industry needs a regulatory environment that favors reusable materials over disposables. At the federal level, the FDA should require suppliers to use reusable items by default and require justification for single-use items.

Jain: One solution that has attracted a lot of attention is reusable dresses. 2020 led by Stanford research provides evidence of their safety, sustainability and cost savings. Many institutions, notably UCLA and UCSF, successfully use these gowns on a regular basis.

What are the biggest obstacles to making US health care more sustainable?

Jain: There is a lack of accountability within both institutional operations and the procurement chain. In hospitals and other healthcare facilities, sustainability is not a priority, so no one is liable for failure to comply with this clause.

Foster: The lack of sustainability data at the product level creates a barrier to making decisions based on the overall carbon impact. Approximately 77% of carbon footprint for Lucille Packard Children’s Hospital at Stanford is attributed to the supply chain. Our percentage is higher than the industry average because we have already reduced or eliminated many other sources of greenhouse gases in our operations.

Wilmot: The health care system has a number of important priorities that compete with sustainability, such as quality initiatives, cost containment, and patient satisfaction. It is difficult to make changes or adjust work processes or change medical products when there are always other pressing matters in focus.

To what extent is staff or public perception a problem in switching from disposal items that are marketed as more sanitary to reusable items that may be perceived as less sanitary or safe? How can healthcare organizations overcome these challenges?

Jain: Many caveats stem from uncertainty about quality control strategies for reusable products. I think we owe it to staff and patients to be transparent about sterilization procedures and the research-backed evidence of product safety.

LaBeaud: Again, I think awareness is a huge part of it. Sustainability and the impact of climate on health must be incorporated into medical curricula from the outset. Grants and prizes to stimulate innovative ideas in the field of sustainable development can be used to encourage health professionals to work together to fight this crisis.

Foster: As we began sharing information about climate impacts on health and health care’s contribution to climate impacts with professionals in our community, it was amazing to see how quickly they got involved and wanted to contribute to the solutions.

What are the other benefits of more sustainable healthcare?

Jain: In our work we will discuss case examples health care systems recover millions in savings through waste reduction and recovery efforts. For example, one US hospital system implemented reusable gowns, resulting in savings of more than $3.5 million over four years. It was estimated that health care organizations in Nova Scotia, Canada could save more than $12 million thanks to policies that make producers and importers responsible by internalizing the environmental costs associated with waste streams.

Foster: Switching to cleaner fuels and eliminating chemicals of concern from the products and equipment we use in the hospital creates a healthier environment for our patients, families and staff, and for the communities in which we serve.