As health professional students prepare for careers in medicine, they take a vow to “first, do no harm.” However, as a major global emitter of greenhouse gases, health care is contributing to one of the greatest threats to public health of the 21st century, climate change. To address the growing crisis, Jodi Sherman, MD, associate professor of anesthesiology at Yale School of Medicine and of epidemiology (environmental health sciences) in the School of Public Health, and founding director of the program on health care environmental sustainability of the Yale Center for Climate Change and Health, is calling for medical professionals to mobilize and strive for net zero emissions.
In order to avoid the severest effects of climate change, the Intergovernmental Panel on Climate Change (IPCC) has warned that global warming needs to be limited to 1.5°C. Experts estimate that achieving this goal will require cutting emissions to nearly half of 2010 levels by 2030 and reaching net zero emissions by 2050. Worldwide, health care contributes approximately 5% of greenhouse gas emissions. At the same time, much of the global population lacks access to quality care. Providing better care to more people is essential; however, it will increase harmful pollution, Sherman says, unless the medical community actively works to reduce emissions and achieve its own net zero.
“We more than any other industry should be leading the way to getting to net zero emissions,” says Sherman.
The COVID-19 pandemic has shed light on the vulnerability of even high income nations to disruptions in global supply chains. As the demand for care and supplies surged with the spread of the virus, health systems around the globe were left scrambling for resources. The medical community was able to act together, sharing information and changing models of care, to overcome many of those early difficulties with impressive speed.
Addressing the rate of health care emissions, on the other hand, has occurred much more sluggishly. In a paper published September 20 in The BMJ, Sherman and colleagues encourage clinicians to embrace planetary health care, a broadening of the concept of “first, do no harm” beyond caring for patients to also include preserving the natural world on which human health relies. Harm from health care pollution in the United States, says Sherman, is of a similar magnitude to the harm caused by preventable medical errors, and should be encompassed in patient safety efforts.
“Essentially, this planetary health lens acknowledges that there are crucial links between human health and ecological change and our ability to thrive,” she says.
Sherman lays out recommendations for clinician action at three levels—individual clinical practices, health care organizations, and professional societies and regulatory agencies. Larger scale initiatives include incorporating greener sources of energy into running hospitals and transportation systems. But even at the clinician level, providers have the capacity to make change.
“Everybody can do something no matter where they are or what position they’re in,” she says. “It is through collective action that we’re going to help transform the health care system.”
One way providers can reduce their ecological footprint is by maximizing the value of care they provide. Approximately a quarter of health care services provided globally, says Sherman, are considered “low value”—in other words, the costs outweigh the benefits. Examples include excessive supply consumption and unnecessary medical testing. It is the responsibility of clinicians to provide care that not only is wanted and clinically effective, but also minimizes harm to environmental health. Clinicians can work toward providing high value care by not just keeping up to date on the best practices, but also abandoning tests, procedures, and drugs that are outdated and acting as resource stewards.
“It’s one thing to adopt the latest and greatest type of care, but if we don’t de-adopt the older ways, we end up providing low value care,” she says.
Other key recommendations outlined in the paper include encouraging coordination among clinicians to avoid unnecessary travel and repetition of unnecessary tests, and being proactive to reduce the need for care in the first place. Over half of health care services in the United States are provided to only 5% of the population struggling with late-stage chronic disease. And in many cases, these diseases could have been reversible or preventable with less intensive measures had they been treated at an earlier stage.
Some of Sherman’s recommendations are quite similar to the solutions for challenges posed by the COVID-19 pandemic. Equipment shortages, for example, highlighted the importance of building resiliency in the worldwide supply chain. Sherman calls for moving toward a circular economy with reusable supplies manufactured and cleaned closer to home. Keeping materials in use as long as possible not only reduces vulnerability to disruption to consumable supplies, but also helps reduce emissions and other forms of waste.
Meeting the challenge of reaching net zero emissions in health care will need to be a global, united effort. And leaders at Yale are taking steps to improve their own environmental performance. Yale New Haven Health System, for instance, has introduced a series of sustainability initiatives and recently launched a new Center for Sustainable Healthcare to guide strategic measures and management.
“Health care is a significant contributor of environmental pollution, which goes against ‘first, do no harm,’” says Sherman. “We need to figure out how to make health care safe for planetary health as well as patient health.”