Patient safety is the core value in health care. We have made substantial progress through drug development, medical device innovation, and through physiologic monitoring. We have developed standards to prevent hospital acquired infections, as well as occupational exposure, through proper use of personal protective gear, cleaning and decontamination protocols, and waste disposal methods. This progress in individual patient safety has resulted in a culture of wasteful practices in health care, causing pollution and indirect harm to public health. It has become my life’s work to quantify waste and the environmental impacts of health care practice to strategically guide pollution prevention, and thereby increase the safety profile of clinical practice.
Pollution is a leading cause of morbidity and mortality, globally responsible for 16% of all deaths. Most of these environmentally-mediated deaths are linked to air pollution, whereas climate change has been identified as the greatest public health threat of the 21st century due to the myriad ways in which it undermines the social determinants of health and exacerbates other public health crises.
Healthcare is a major emitter of environmental pollutants that adversely affect health. My work has shown that healthcare is responsible for nearly 5% of global greenhouse gas (GHG) emissions and similar fractions of toxic air pollutants. These emissions arise directly from healthcare facilities as well as indirectly from the supply chains of healthcare goods and services. Healthcare pollution harms public health, yet remains underappreciated and largely unaddressed, despite the professional mandate to "first, do no harm." In the face of mounting evidence of the human health impacts of pollution, efforts to address patient safety and healthcare quality must now include mitigation of healthcare pollution and resource stewardship.
To avoid planetary tipping points, healthcare - like all sectors - must undergo a systemic transformation to a sustainable model of care. This includes mitigation of ongoing environmental impacts, as well as adaptation and resilience of healthcare infrastructure and delivery systems across the spectrum of public and privately funded care, in anticipation of increasing burden of climate- and pollution-related illness. Sustainable health system design requires reframing care through increased attention to health promotion and wellness, and appropriateness of care, to create systems that prioritize both optimal clinical outcomes and environmental performance.
My life’s work is centered around healthcare emissions research, their public health harms and opportunities, implementation science, and policy reform to help rapidly drive the transition to a sustainable healthcare system.
My research is at the forefront of the emerging field of sustainability in clinical care. My interest is in life cycle assessment (LCA) of environmental emissions, human health impacts, and economic impacts of alternative drugs, devices, clinical care pathways, and health systems. My work seeks to establish sustainability metrics, paired with health outcomes and costs, to help guide clinical decision-making, professional behaviors, and organizational management toward more ecologically sustainable practices to improve the quality, safety and value of clinical care and to protect public health. I routinely collaborate with environmental engineers, epidemiologists, toxicologists, health economists, health administrators, health professionals, and sustainability professionals.
Among many important collaborations, I am a member of the Lancet Countdown on Health and Climate Change, an international collaboration established to provide an independent, global monitoring system dedicated to tracking the emerging health profile of the changing climate. My team contributes metric 3.6, decarbonization of the healthcare system. I was a contributing analyst and strategist ofr the UK National Health Service Net Zero Programme. I serve on the National Academy of Medicine Action Collaborative for Decarbonization of the U.S. Health Sector. I am Co-Director of the Lancet Planetary Health Commission on Sustainable Healthcare.
Conservation of Natural Resources; Drug Contamination; Health Care Economics and Organizations; Environment and Public Health; Environment Design; Environment, Controlled; Environmental Pollution; Fresh Water; Health Services Administration; Public Health; Soil; Health Care Quality, Access, and Evaluation; Equipment Reuse; Greenhouse Effect; Ecosystem; Environmental Medicine; Carbon Footprint; Environmental Policy; Patient Harm; Chemicals and Drugs; Health Care
Community Health; Environmental Health; Ethics; Global Health; Climate Change; Health Care Quality, Efficiency; Health Care Management; Health Economics; Health Policy; Community Engagement; Health Systems Reform; Pollution