Jeff Bezos recently adorned the cover of the magazine The Atlantic. The maga- zine had taken presumptive liberties and carved up the profile of his brain to summarize his “master plans.” A sizable portion of the cortex was assigned to the goal of “colonize outer space.” Other notables included “tax avoidance,” “more Jeff-bots,” and slogans such as “resistance is futile.” The article was a fasci- nating summary by the author of what the world’s richest human being wants for the future of the human race: limitless growth.
What was notably missing from the “master plan” was discussion of the un- intended consequence of boundless, unfettered, and irresponsible humanization: harm to our planet. There was no mention of the mounting evidence that anthro- pogenic influences are polluting the planet at an unsustainable rate or discussion about the far-reaching impact of pollution and climate change on highly inter- twined ecologic systems. Disrupted weather patterns, rising seawaters, altered mi- gration patterns, and extinction of millions of species are just some of the reasons pollution and climate change have been described as the greatest threat to human survival in the 21st century.1
Even more removed from consideration is the unintended impact of health care and all its components on the environment. In line with other major economic sectors, each step in the process of healthcare delivery leaves behind an environ- mental footprint; from use of large quantities of natural resources to generation of tons of waste each year to emission of substantial quantities of greenhouse gases. There are countless ways that the healthcare sector as a whole could be more eco-friendly, less wasteful, and more efficient without compromising innova- tion, growth, or quality of care. Opting to continue with business as usual without considering ways to reduce and optimize health care’s ecologic output threatens the viability of the system as a whole and forgoes an opportunity to impact health care’s contribution to climate change, pollution, and population health.
We, as members of the healthcare system, have several reasons beyond just moral responsibility to improve and address the ecologic footprint related to patient care. First, given the vast use within coupled with the size of the global healthcare sector, targeting systematic methods of decarbonization offers an im- mense opportunity to reduce the ecologic footprint related to healthcare delivery. Global healthcare spending is projected to increase from $7 trillion in 2015 to more than $8 trillion in 2020, and health care accounts for approximately 4% of global greenhouse emissions. In the United States, for example, health care–related greenhouse emissions represent 10% of national emissions, an increase of 30% over the last decade.
The Intergovernmental Panel on Climate Change launched the Healthcare Climate Challenge as a global initiative pledging to engage healthcare institutions in reducing their carbon footprint, preparing for the impact of climate change on public health, and being advocates in their communities for healthier people on a healthier planet. In the United States, 7 leading health systems together embarked on the Healthier Hospital Initiative to engage the health sector to address the environmental impact of deliver- ing care. For providers, actionable items include establishing a sustainability task force that conducts an au- dit of current clinical practice with the goal to mitigate waste, increase efficiency, and apply evidence-based resource utilization. There is a near emergent need not only to halt the escalating trends in consumption and carbon output, but also to define a vision for hospital systems that are carbon neutral, toxin free, water balanced, and striving for zero-waste.
Second, there is a direct relationship between pollution and a sicker human race; controlling health care– related pollution is a way to improve the health of our patients. Environmental pollution is a global public health emergency and the most common cause of non- communicable environmental disease and premature death worldwide.4 The commitment to our patients is tightly interconnected with a commitment to the health of our planet. Pollution comes in many forms, and healthcare systems make large contributions to air, water, and chemical pollution. Hospitals are intensive users of fossil fuels, and hospitals in the United States consume nearly 3 times more than the most efficient hospitals in northern Europe.
In addition, the U.S. healthcare sector leads the world in chemical consumption, using more than twice that of other sectors. Air pollution is directly associated with cardiovascular diseases such as hypertension, increased serum lipids, accelerated atherosclerosis, increased incidence of arrhythmia, acute stroke, and myocardial infarction.5 Chemical pollution is linked to increased risk of multiple cancers. As health- care providers, our pledge to do no harm obligates our understanding that pollution and climate change are directly affecting the health of our patients.
Lastly, a more sustainable, efficient, and carbon- neutral healthcare system is a more economically sound system with positive ripple effects. Analysis of wasteful practices and implementation of strategies to reduce over-testing, over-treatment, and over-prescribing will lead not only to better and less costly care, but also care with a smaller environmental footprint. By lowering levels of health care–related pollution, we have an opportunity to impact climate change and its indirect adverse economic impact. It is estimated that more than 700 global climate-related events resulted in more than $300 billion of economic losses in 2017,5 and in 2015, the cost of lost productivity associated with pollution-related diseases was $53 billion in high- income countries.5
Given the imminent global impact of climate change and pollution, and the healthcare sector’s escalating contribution, our response as healthcare providers is im- perative. We have to foster a conscience and a culture that delivers exceptional health care with the smallest footprint. We must look to create a circular healthcare economy that commits to increased use of renewable energy, prioritizes use of environmentally responsible products, and incentivizes ”reduce, reuse, and recycle” in all aspects of healthcare delivery. Our master plan must require us to do better for our patients and our planet. Through commitment, advocacy, and leadership we must effect change for a healthy human race thriving on a healthy planet.
1. Costello A, Abbas M, Allen A, Ball S, Bell S, Bellamy R, Friel S, Groce N, Johnson A, Kett M, et al. Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission. Lancet. 2009;373:1693–1733. doi: 10.1016/S0140- 6736(09)60935-1
2. Pichler P, Jaccard I, Weisz U, Weisz H. International comparison of health care carbon footprints. Environ Res Lett. 2019;14:064004.
3. Eckelman MJ, Sherman J. Environmental impacts of the U.S. health care system and effects on public health. PLoS One. 2016;11:e0157014. doi: 10.1371/journal.pone.0157014
4. Landrigan PJ, Fuller R, Acosta NJR, Adeyi O, Arnold R, Basu NN, Baldé AB, Bertollini R, Bose-O’Reilly S, Boufford JI, et al. The Lancet Commission on pollution and health. Lancet. 2018;391:462–512. doi: 10.1016/S0140-6736(17)32345-0
5. Watts N, Amann M, Arnell N, Ayeb-Karlsson S, Belesova K, Berry H, Bouley T, Boykoff M, Byass P, Cai W, et al. The 2018 report of the Lan- cet Countdown on health and climate change: shaping the health of nations for centuries to come. Lancet. 2018;392:2479–2514. doi: 10.1016/S0140-6736(18)32594-7
Dr Ahmed is an Interventional Cardiologist at Santa Barbara Cardiovascular Medical Group and was formerly Assistant Professor of Medicine at the Geisel School of Medicine. Dr. Ahmed completed Internal Medicine residency at the University of Massachusetts, a Women’s Health fellowship at Cedars-Sinai Medical Center, followed by general Cardiology and Interventional Cardiology fellowships from the University of Vermont. Read On