To fulfill the first duty of the Hippocratic Oath 鈥� 鈥渄o no harm鈥� 鈥� the health care sector must look to its role in reducing carbon emissions, according to a recent by Brown researchers.
The study, 鈥淪upporting Decarbonization of Health Systems,鈥� investigated 73 countries鈥� commitments and plans to decarbonize their health care sector. Researchers found that while many countries have committed to overall decarbonization, 鈥渇ew have published delivery plans for meeting national targets.鈥�
The authors sought to understand 鈥渨hat 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,鈥� said lead researcher Emily Hough, who was an affiliate senior research associate at Brown at the time of the study. 鈥淪o, 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?鈥�
Hough and co-author Arielle Cohen Tanugi-Carresse, a PhD candidate at Universit茅 Paris-Est Cr茅teil and former research assistant at Brown, examined 鈥� materials and research that are not published via traditional academic channels, such as government documents or news articles 鈥� using keywords such as 鈥渟ustainable healthcare鈥� and 鈥渃arbon reduction鈥� 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.
鈥淚f 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,鈥� Hough said.
In addition, the pharmaceutical industry also contributes largely to health care emissions. Hough highlighted some pushes for change, such as in anesthetics 鈥� switching from desflurane to sevoflurane due to its lesser emissions 鈥� 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 鈥�,鈥� a study examining health-care-related carbon output, authors found that emissions from the supply chain 鈥� including transport, testing and research, plastic and pharmaceuticals 鈥� were the biggest culprit in health care emissions, followed distantly by healthcare facilities鈥� direct emissions and emissions from direct purchases of energy.
Addressing health care emissions is 鈥渁n interesting challenge,鈥� Hough said, because of 鈥渄ifferent鈥� 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.
鈥淲hen 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,鈥� she added.
The effort to balance decarbonization with high quality care means 鈥渞ethinking a patient journey and providing the right amount of care and not excessive amounts of care,鈥� Cohen Tanugi-Carresse said. 鈥淚f you give out too much medicine, it鈥檚 also more plastic, more paper, more stuff that you鈥檙e producing and getting out.鈥�
Cohen Tanugi-Carresse said more research into emissions metrics is required to improve current roadmaps for healthcare decarbonization. 鈥淚f you don鈥檛 have the data, you don鈥檛 know what you鈥檙e specifically targeting,鈥� 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 鈥渘et-zero operations in health trusts by 2045.鈥� Additionally, Colombia started a project with to estimate their health system鈥檚 climate footprint at the facility level.
According to the study, the United States is 鈥渙ne of the world鈥檚 worst offenders鈥� when it comes to emissions from health care, with 8.5% of the nation鈥檚 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 鈥� 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.
鈥淲hen you look at resilience in our health systems, often a higher income country might have a more resilient health system to start with,鈥� Hough said. 鈥淏ut 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.鈥�
