Sustainable healthcare

The World Health Organization (WHO) has described climate change as the biggest health threat facing humanity, highlighting that those in low-income and disadvantaged communities, who historically contributed least to the causes of climate change, are being affected first and hit the hardest. Threats to human health vary from direct injury following extreme weather events, exacerbation of respiratory disease due to air pollution, change in the distribution of vector borne disease, increase likelihood of zoonotic diseases, malnutrition following crop failures, negative impact on mental health, heat related illness and many more. this means if the worlds healthcare systems were one country, it would be the fifth-largest emitter on the planet. due to a combination of patient, visitor and staff travel and delivery of supplies. The waste generated by healthcare, such as pharmaceuticals and plastic pollution, also has a negative impact on planetary health. In the United States, it is estimated that pollution caused by healthcare results in a loss of 388,000 disability-adjusted life years (DALYs) annually. Reducing the environmental impact of healthcare has a positive impact on both climate change and human health. == Medical waste ==

Medical waste is defined as any type of waste that originates from healthcare, its facilities, and its practices, and is considered a significant component of unsustainable healthcare, with financial, social, and environmental implications It can be non-hazardous, such as packaging material, or hazardous, including gloves, vials, sharps, single-use plastics, and medication. These hazardous wastes can contain some form of bodily fluids, chemical substances, or radioactive materials that are harmful to public health and the environment., or through autoclaving. However, both methods lead to landfill disposal, which can lead to water and soil pollution. In addition to adverse environmental impacts, medical disposal methods can lead to financial consequences. Often, medical waste is improperly sorted in healthcare facilities, causing nonhazardous waste to be unnecessarily classified as infectious. This ultimately can lead to higher disposal costs within the United States. == Health risks of unsustainable practices ==

As part of unsustainable healthcare practices, medical waste management can present severe health risks to healthcare employees and the general population Waste generated by healthcare can therefore enable the transmission of diseases and infection, as well as sharp needles and objects can physically hurt people. == Financial and Economic Impacts ==

Unsustainable healthcare can increase financial costs, in addition to posing threats to the environment and the public population. In the U.S. alone, medical waste costs account for 25% of total U.S. healthcare spending, ranging from $760 billion to $935 billion. A lot of this medical waste can be attributed to inefficient medical practices and waste disposal. These can include misclassification of medical waste as hazardous as well as the overuse of single-use disposables and pre-packaged medical equipment kits. Together, these practices lead to more expensive disposal methods. In fact, the United States spends around $790 dollars per tonne annually of medical waste generated to dispose of it. In a cross-sectional study across 49 U.S. hospitals, results from a survey declared that 24.3% of the staff were unaware of the hospital's local costs for medical equipment, and hospitals that reported the highest cost-consciousness actually were the least accurate in estimating costs of medical equipment, laboratory supplies, and medications. While proper protective gear is essential for infection control and prevention, it can exacerbate medical waste generation and thus, healthcare spending. == Environmental Justice and Ethical Concerns ==

Unsustainable health practices related to medical waste have been associated with disproportionate impacts on minorities and lower socioeconomic status communities through medical waste disposal. Medical waste is disposed of through two methods: incineration and autoclaving. However, both methods lead to waste eventually being stored in landfills, asthma, low birth weight, birth defects, heart issues, etc. Cancers such as leukemia, bladder cancer, brain cancer, and hepatobiliary cancer are among the concerns of greater risks for residents near these sites. Also, exposure to pollution can lead to respiratory issues, where coughing, wheezing, and persistent colds are common and persistent within populations surrounding incinerators. According to a study done on it, the incinerator is related to $36.9 million a year in health damages. Residents who live near it have greater rates of asthma and respiratory irritation as well as increased rates of mortality and illness compared to those living farther from these sites. Additionally, not only does the incinerator compromise the health of these communities, but it also further burdens them with economic and environmental challenges that they are already navigating. ==Approaches==

In 2017 the World Health Organization (WHO) published a strategic document outlining 10 actions points to improve environmental sustainability in healthcare systems. It also called on healthcare professionals to ‘join in the work of achieve environmentally sustainable health systems before 2030’. To achieve this target the ‘Greener NHS programme’ was created. In 2020 Greener NHS published a report ‘Delivering a Net Zero National Health Service’, which outlines how the NHS can achieve net zero. In this report the sources of carbon emissions across the NHS are summarised, this highlights various ‘hotspots’ where a high proportion of emissions can be targeted. Estates and facilities (including building energy) is highlighted as one hotspot, but there are also opportunities for change in supply chain, pharmaceuticals, medical devices and travel; all of which are directly influenced by the choices of clinicians, recognising that a change in clinical practice will be required. Oral Medication Waste Reduction Medication is integral to improving health; however, it has profound environmental effects by acting as a major contributor to greenhouse gas emissions through incineration and can be toxic to environmental life. Also, oral medication, especially cancer drugs, have become increasingly expensive, causing people to carry a large financial burden. To combat the environmental and financial implications of medication, many states have implemented Drug Repository programs for cancer medication, where individuals can donate their excess and unused medication for other individuals. Specifically, in 2023, a Cancer and Hematology center in Grand Rapids, Michigan, launched its own Cancer Drug Repository Program in Western Michigan. The program has aimed to enable Michigan residents to donate and exchange unused cancer medication, with hopes to alleviate the financial burden of cancer drugs as well as reduce environmental repercussions through waste reallocation. It was established in the United States of America (USA) in 1996 after a team of health care professionals realised the bi-products of the medical waste incinerators were having a direct negative impact on the health of the local population. The aim of the organisation is centred around minimising the health impacts of climate change and encouraging the health co-benefits achieved by tackling climate change. In order they are ‘Prevention’ Quality Improvement in healthcare is when health care professionals familiar with these processes and pathways use a systematic approach to address specific problems in their field, thereby improving the process or pathway with a measurable effect. Traditionally this measurable effect may be improved clinical outcomes, time saved or money saved. Sustainable quality improvement (SusQI) looks to take a broad view of the measurable effect, considering social and environmental outcomes alongside financial ones. This is also known as the Triple Bottom Line. This principle was applied to the sustainable value of healthcare by including sustainability as a domain of quality in healthcare. Rather than just assessing a treatment or interventions value against its clinical outcome and financial cost, social and environmental cost are also considered. == References ==