A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.
Do no harm. We learn this throughout our medical education and training, and in practice it is a keystone for clinical decision making. This principle continues to inspire patient safety, quality improvement, and better patient care. Do no harm also applies to the environment. How we practice medicine directly impacts our carbon footprint, and as a consequence, climate change. It is now more important than ever that we use this doctrine to drive sustainable health care delivery.
In a recent 2023 survey of 2,000 C-suite executives of various industries across 24 countries, climate change has emerged as a top three priority. In its current state, U.S. health care is a disproportionately high contributor of greenhouse gas emissions. U.S. health care emissions have increased more than 30% over the past decade, now at 8.5% of the national total. Comparatively, the global health care sector contributes approximately 4.6% of greenhouse gas emissions. The U.S. health care contribution to greenhouse gas emissions is growing annually, despite increased political and social awareness for climate change.
Greenhouse gas mitigation is critical, because we know climate change impacts a wide range of health outcomes. Rising temperatures, extreme weather, megafires and resulting smoke, rising sea levels, and increasing carbon dioxide levels lead to heat-related disorders, respiratory problems, increased vectors causing infectious disease, physical injuries, and mental health consequences. If you live in the U.S., you have likely endured a heatwave, tornado warning, flood, or air quality alert this summer – or, like me, practically all in the same week.
Health care delivery grows challenging, as extreme weather impacts ease of access, physical structures, communities, and power outages. Although most U.S. hospitals have generator-backup, most American homes do not, placing those patients that rely on critical medical equipment at an increased risk for morbidity. In an already stressed medical system, disparity in access to care worsens. And according to a 2021 report, the impacts of climate change and fossil fuel air pollution is costing the U.S. $820 billion in health costs every year.
As an anesthesiologist, I am acutely aware that my choice of anesthetic impacts my daily carbon footprint. Volatile anesthetics, or “gas” anesthesia, and nitrous oxide, or “laughing gas,” are potent greenhouse gases. Inhalationals can account for 50% of the carbon emissions of a surgical procedure, and 5% of a health care facility’s carbon footprint. (Interested in determining and reducing your facility’s carbon footprint? Find out more here.) Desflurane and nitrous oxide are the most environmentally destructive of our anesthetic options, and they have become the focus of a multicenter, multinational movement to stop their use and remove them from operating rooms. With a global warming potential 2,540 times that of carbon dioxide, desflurane has been banned in Scotland and is projected to follow a similar fate across the European Union by 2026.
Health care’s carbon footprint, of course, extends beyond the operating room. As health care providers, we need to identify strategies in all dimensions of our roles. Perhaps you are part of a large mega-hospital system or own a primary care office. Every specialty and practice setting is a VIP – very important player – in healthcare sustainability. We need to be champions for change and lead by example. Does your practice have a green team or sustainability officer?
Waste, and especially pharmaceutical waste, creation and disposal significantly impacts sustainability. The current trajectory is considered to have grave implications for drinking water, wildlife, and ecosystems. The current U.S. trend towards disposable equipment over reusable is a major contributor to this waste, with limited, if any, advantage in clinical outcomes. Even small changes in clinical workflow can make a big impact. Is there a way to replace a disposable item with one that is resuable, or simply use less of something, and therefore, waste less?
Supply chain resilience has become an important goal for health care institutions, with supply and resources overwhelmed in part by climate change. We can guide important mitigation strategies and make meaningful environmental decisions, especially when considering the purchasing power of large health care systems and resulting long-term benefits. We can make equipment decisions with environmental considerations in mind, while preserving reliability and patient safety. Often, emission-conscientious changes also lead to financial savings. Perhaps you connect with your supply chain team or practice manager, implement LED lighting or reusable linens, or decommission a nitrous oxide pipeline.
By improving our ailing planet, we improve population health. Maybe you are reading this article because you are already a leader in carbon mitigation or want to learn more. Maybe your institution is already participating in the White House-HHS Health Sector Climate Pledge, volunteering to cut greenhouse gas emissions by 50% by 2030 and achieve net zero emissions by 2050. Do you face any obstacles in implementing change? Whether it is a need for sustainability education, lack of time, clinical demands, administration support, cultural barriers, or something else, please share your experience.
Shreya Aggarwal is an anesthesiologist.
