Greenhouse gas emissions associated with the American health care system continued to rise in the past decade - accounting for 8% of total U.S. emissions - and remains the largest emitter of any country.
A pair of new Yale-led studies described the increase, analyzed the outsized role of single-use medical devices in generating emissions, and advocate for mandatory reporting and reduction of emissions.
"Health care organizations have an obligation to their communities to protect public health," said Dr. Jodi Sherman, associate professor of anesthesiology and epidemiology at Yale and senior author of both studies. "We must lead by example. That includes setting ambitious, science-based carbon reduction targets to achieve net zero emissions before 2050. We must quantify current emissions and their sources, particularly throughout the health care supply chains."
The new studies, published in the journal Health Affairs, add to research Sherman and her colleagues have conducted over the past decade about sustainability in the health care industry.
In one of the new studies, Sherman and first author Matthew Eckelman, an associate professor at Northeastern University and adjunct associate professor at Yale, estimated that greenhouse gas emissions associated with U.S. health care rose 6% from 2010 to 2018, reaching 1,692 kilograms per capita. About 80% of U.S. health care sector emissions stem from the supply chain, including disposable medical equipment used a single time.
The researchers said health care pollution, especially greenhouse gas emissions and toxic air pollutants, resulted in the loss of 388,000 disability-adjusted life years - a measure of years lost due to ill health, disability, or early death.
"Disease burden from health care pollution is of the same order of magnitude as deaths from preventable medical errors, and should be taken just as seriously," Sherman said.
The researchers used a consumption-based economic model, based on federal data, to calculate life cycle emissions of pollutants produced by the U.S. health care sector. They analyzed direct emissions from hospitals and clinicians' offices, as well as indirect emissions generated throughout the health care supply chain.
The study also estimated emissions by the health sector in individual states and looked at associations between states' energy systems and access to and quality of health care.
The researchers found a wide variation in state-level greenhouse gas emissions per capita - but weak correlation between a state's emissions and the quality of its health care. This suggests the health care sector's environmental footprint can be reduced without compromising quality, according to Sherman and Eckelman.
"This work reveals that the health care sector is an important driver of greenhouse gas emissions in the U.S. and identifies where sustainability efforts have the most potential for reducing those emissions, especially improving building performance, sourcing low-carbon electricity, and working with suppliers," Eckelman said.
Co-authors of the study were Robert Lagasse and Robert Dubrow of Yale, Kaixin Huang of Northeastern, and Emily Senay of the Icahn School of Medicine at Mount Sinai in New York City.
In a second study, Sherman and first author Andrea MacNeill, a clinical associate professor of surgery at the University of British Columbia, examined the medical device supply chain and drivers of single-use disposable medical devices - such as stethoscopes, blood pressure cuffs, and complex surgical instruments.
The researchers said reliance on single-use devices is a large part of the reason that the vast majority of health sector emissions stem from the supply chain. This linear supply chain contributes to excessive pollution and public health damage, they said. Furthermore, it leaves the health sector more vulnerable to shortages due to interruptions and surges in demand as seen during the COVID-19 pandemic and climate-related weather events.
Multiple factors are driving this kind of "take-make-waste" economy, Sherman and MacNeill said: misconceptions about infection prevention, inconsistency in regulations and professional standards, and a lack of value placed on the protection of the environment as it pertains to materials management and public health.
"Addressing supply-chain emissions requires valuing public health and sustainability as highly as individual public safety at all levels of decision making," Sherman said.
The researchers suggested a range of ways the health care sector can promote sustainability and shift medical devices to a more systemic and regenerative "circular" economy: prioritizing durability and modular design to ease cleaning for re-use; setting procurement policies that favor reusables; re-evaluating infection control policies; establishing regulatory emissions targets; and mandating that device manufacturers report standardized environmental emissions information for all materials.
"Achieving a more sustainable, 'circular' economy in health care will require systemic transformation including new performance-based business models for manufacturers to incentivize quality and durability over the current practice of manufactured obsolescence," MacNeill said.
Lagasse and Eckelman were co-authors of the medical device study, as were Aman Khanuja and Saed Alizamir of Yale, Harriet Hopf of the University of Utah, Melissa Bilec of the University of Pittsburgh, Lyndon Hernandez of the Medical College of Wisconsin, Forbes McGain of the University of Melbourne, Kari Simonsen of the University of Nebraska, Cassandra Thiel of New York University, and Steven Young of the University of Waterloo.
