“First, do no harm.” All doctors swear by the ancient Hippocratic oath. But we must ask ourselves, do hospitals really do no harm? The production, distribution, and eventual disposal of medical drugs and equipment are major contributors to climate change. In fact, if global healthcare was its own country, it would be the fifth largest emitter on the planet. The severity of healthcare’s carbon footprint contradicts the values of a system centered around protecting human health. Physicians are contributing, whether they realize it or not, to one of the largest public health crises in human history.
Yale Professor Jodi Sherman provides a solution as to how healthcare can strive to “do no harm” on a global scale. Her research focuses on creating sustainability metrics that help inform administrative and physician decision-making towards more environmentally sustainable operations. Sherman’s recent paper published in British Medical Journal introduces the idea of “planetary healthcare,” which expands the principle of “first, do no harm” beyond the patient to the environment. In an interview with Yale Scientific, Sherman isolated three ways in which physicians can adopt this planetary healthcare lens: first, reduce emissions from healthcare services; second, match the supply and demand of healthcare services; and third, reduce the demand for healthcare services.
On the first point, healthcare emissions are often embedded in the products and spaces physicians use when providing care. By using sustainability metrics, physicians can select drugs, equipment, and procedures that are less polluting yet still produce the same clinical outcome. For example, Sherman’s work on tracking the life cycle of anesthesia drugs reveals that certain gases, such as desflurane and nitrous oxide, are significantly higher contributors to emissions compared to other clinically similar options. In addition to guiding clinical practices, empowering physicians with the environmental information associated with certain medicines and products used in treatments helps them leverage organizational purchasing power to influence a more eco-friendly industry.
Secondly, healthcare resources are often inappropriately utilized, which creates unsustainable practices that fail to match supply and demand. “In the U.S. over fifty percent of healthcare is devoted to five percent of the population with advanced chronic disease… there are also alarming statistics on how much we spend on end of life [care] and it’s not frequently the care patients would choose if they were better informed,” Sherman said. It is necessary to both mitigate excessive resource consumption while also maximizing high value, clinically effective treatment, which ultimately leads to more positive environmental outcomes.
Finally, it is imperative that we reduce our demand for healthcare resources. This involves directing care resources upstream and incorporating non-pharmacological and lifestyle methods to preventing disease. Medical services contribute to only twenty percent of health and wellbeing, while the rest is attributed to social and environmental factors. Integrative healthcare aims to address this other eighty percent of human wellbeing by informing patients of healthier life choices (such as reducing alcohol consumption) and alternative pain management strategies (such as acupuncture and meditation). Moreover, consistent primary care enables early prevention, detection, and treatment, leading to better health outcomes. As such, it is important to invest in primary care and public health so that preventative measures can reduce the demand for acute treatment of advanced disease down the line.
Several sectors must come together if we wish to achieve net-zero emissions in healthcare. With the COVID-19 pandemic, the world witnessed global mobilization and cooperation in healthcare unlike anything ever seen before. “While we had an increased need for emergency care and critical care, and obviously increased consumption of personal protective equipment and other healthcare resources, the global medical community came together quickly, sharing information, redesigning models of care, increasing access to telehealth, and moving towards a circular economy—meaning, keeping materials in use for longer,” Sherman said. “This begs the question, why are we not doing this routinely?”
The pressures of the pandemic forced physicians to challenge the culture of disposability and excess consumption of resources within medicine. Medical practitioners safely succeeded at efforts to adapt practices, increase communication, and become better stewards of healthcare resources, proving that rapid change in response to a crisis is possible. Indeed, the world is now faced with a global crisis more urgent than anything we have dealt with before. The lives of all people and the planet are at stake. Doctors swore to “do no harm.” It is now time to “do no harm” to our environment.