First do no harm. Why healthcare needs to change

health 19

(Credit: Unsplash)

This article is brought to you thanks to the collaboration of The European Sting with the World Economic Forum.

Author: Robert Metzke, Global Head of Sustainability, Philips


If I’ve learned one thing working in the healthcare sector, it’s the earlier you can diagnose a disease, the better chance you have of curing it – or at least mitigating its impact on the patient. When it comes to the health of the planet – on which all human health ultimately relies – the symptoms and the scientific evidence already point to a clear diagnosis: anthropogenic global warming.

The increasing severity of extreme weather events, consistent with predictions made by climate scientists, is already having a dramatic impact on healthcare. In Europe’s heatwave of summer 2003, for example, more than 70,000 excess deaths were recorded. While climate change is affecting healthcare, however, healthcare is also affecting climate change.

The world’s healthcare systems account for 4% of global CO2 emissions, more than aviation or shipping. This interdependence between healthcare and climate change represents a unique opportunity to act in a way that will both mitigate climate change and have a positive impact on human health. The evidence suggests mitigating climate change so global warming remains below 2°C, the target set out in the Paris Agreement, would have a positive effect on people’s health.

Health carbon footprint (HCF) as percentage of national carbon footprint (CF) grouped by region where the emissions occurred (a) and health carbon footprint per capita grouped by financing scheme (b) in 2014, for all available countries in 2014.

Health carbon footprint (HCF) as percentage of national carbon footprint (CF) grouped by region where the emissions occurred (a) and health carbon footprint per capita grouped by financing scheme (b) in 2014.
Image: IOP Science

The necessary reduction in CO2 emissions from fossil fuels, together with the associated reduction in short-lived climate pollutants (SLCPs) such as black carbon particulates and nitrous oxides that increase tropospheric ozone, would prevent millions of deaths from respiratory disease.

Encouraging people to eat more fruit and vegetables and less meat, something each of us can do to reduce our carbon footprint, would result in reductions in heart disease, obesity, diabetes and cancer. Even the economics add up. The resulting savings in healthcare costs would outweigh the cost of the climate change mitigation and adaptation measures needed to stay below the 2°C threshold.

Limit global warming to 1.5°C or less and the world could also continue to meet the UN Sustainability Goals, especially those related to eradicating poverty and reducing inequality. In terms of SDG3 ( “Ensure healthy lives and promote well-being for all at all ages”) it would make it much easier to build climate-resilient healthcare systems. We could continue to leverage telehealth to improve access to care, reduce healthcare’s carbon footprint and provide early warnings of health risks due to climate-related events such as heatwaves and the spread of infectious diseases.

Shares of health carbon footprint (HCF) attributable to OECD health care expenditure categories in 2014 (all OECD countries with available 2014 data, but excluding non-OECD countries China and India). Full names of the expenditure categories are: retailers and other providers of medical goods, hospitals, providers of ambulatory health care, residential long-term care facilities, providers of health care system administration and financing, providers of ancillary services, 'other' is a combined category of 'rest of the economy' and 'rest of the world', and providers of preventive care.

Shares of health carbon footprint (HCF) attributable to OECD health care spending in 2014.
Image: IOP Science

If, on the other hand, warming is allowed to exceed 2°C, the implications for human health could be catastrophic. Building climate-resilient healthcare systems requires stable socio-political structures, institutions and infrastructures that could easily break down in a post 2°C world. Conflict, forced migration, poverty and malnutrition are all bad for people’s physical and mental health. Yet, with rising sea levels and more frequent extreme weather events, all three could be inflicted on a significant proportion of the world’s population. The biggest impact will be on disadvantaged and vulnerable communities unable to buy themselves out of the problems.

First do no harm

Hospitals, health services and medical supply chains across the world’s major economies currently generate around 4% of global CO2 emissions. They are also a significant emitter of short-lived yet potent climate pollutants such as black carbon, methane, hydrofluorocarbons and anaesthetic gases. For an industry based on the principle of “first do no harm,” it’s therefore imperative the healthcare industry acts quickly, collectively and globally to mitigate its own climate impact.

We cannot wait for national policies, which will inevitably develop at different rates with different agendas, to set the pace of change. We need to globally unite, quickly, and lead by example, developing best-practice international guidelines and standards for sustainable, climate-resilient healthcare development in the same way our healthcare professionals develop best-practice guidelines for treating patients. It’s going to require technology innovation, outside-the-box thinking and multi-disciplinary multi-sector collaboration, the like of which has not been seen before in the industry.

NHS carbon dioxide emissions

NHS carbon dioxide emissions are greater than the annual emissions from all aircraft departing from Heathrow Airport.
Image: The King’s Fund

Speak up

Until recently, the healthcare sector’s voice has not been loud enough in the climate change debate. Yet two things mark out why it has a lot to say. First, the entire healthcare industry is based on a “duty of care,” and second, anyone who works at the frontline of healthcare delivery has seen for themselves the impact poor health has on people’s lives. In terms of action on climate change, few if any industries are as free from vested interests, potentially stranded assets or political bias, and few are as committed to evidence-based decision making.

The good news is this voice is beginning to be heard. In last year’s Call to Action on Climate and Health, organizations representing more than five million doctors, nurses and public health professionals and 17,000 hospitals in more than 120 countries made commitments to accelerating climate change mitigation and adaptation. One of those commitments: to use renewable electricity to power their facilities. Philips has already achieved this milestone in its North America and Netherlands operations, by disrupting the accepted generator-supplier-consumer value chain.

Act now

“Greening” the healthcare industry will involve myriad other initiatives such as the intelligent use of low-carbon technologies, low-carbon building design and construction, greater energy efficiency, sustainable waste, water, transport and anaesthetics management and greater use of telemedicine. It will require low-carbon supply chains based on circular-economy solutions minimizing raw material extraction and greenhouse gas emissions.

Many of the lessons that need to be learned, such as implementation of circular-economy solutions reducing raw materials consumption, are cross-sectoral. As a founding partner in PACE, the Platform for Accelerating the Circular Economy, Philips has already committed to recycling and/or repurposing all large capital equipment (medical systems) our customers are prepared to return to us. By 2020, we will be carbon neutral. By 2025, as part of the Global Plastics Action Partnership, we will quadruple our use of recycled plastic to 7,600 tons, recycle 90% of our operational waste and send zero waste to landfill – changes requiring stakeholder engagement throughout the entire value chain.

What is the World Economic Forum’s Sustainable Development Impact summit?

It’s an annual meeting featuring top examples of public-private cooperation and Fourth Industrial Revolution technologies being used to develop the sustainable development agenda.

It runs alongside the United Nations General Assembly, which this year features a one-day climate summit. This is timely given rising public fears – and citizen action – over weather conditions, pollution, ocean health and dwindling wildlife. It also reflects the understanding of the growing business case for action.

The UN’s Strategic Development Goals and the Paris Agreement provide the architecture for resolving many of these challenges. But to achieve this, we need to change the patterns of production, operation and consumption.

The World Economic Forum’s work is key, with the summit offering the opportunity to debate, discuss and engage on these issues at a global policy level.

Embrace change

With its highly complex and diverse supply chains and $8 trillion global purchasing power, healthcare has the ability to pull climate mitigation levers across many different sectors: upstream in areas such as plastics, pharmaceuticals, chemicals and paper production; downstream in areas such as e-waste recycling and clinical waste disposal; and day-to-day in operational areas such as energy supply and food sourcing. It’s also an industry with one of the biggest vested interests in maintaining biodiversity as a valuable source of new drugs and antibiotics.

Healthcare is one of the world’s most technologically advanced sectors, highly adept at recognizing and exploiting the benefits technology can bring to patients. In little over 10 years it’s driven a 100-fold decrease in the cost of genome sequencing, helping to diagnose and treat diseases such as cancer. It’s using the latest secure communication, cloud-based computing and artificial intelligence technologies to create connected care solutions that monitor and follow patients through every stage of the care cycle. It’s connecting remote and under-resourced communities to world-class clinical expertise on the other side of the world.

There’s already a social enterprise initiative in Rwanda exploiting the telehealth capabilities of Philips’ Lumify portable ultrasound solution to allow expert sonographers in the United States to teach local Rwandan doctors how to use ultrasound as a diagnostic tool. Thanks to remote intensive care monitoring technology, patients in intensive care units in the United States are already being monitored overnight by wide-awake clinicians in Australia.

Lead by example

The level of expertise, cooperation and commitment needed to bring about these transformations can only be achieved through long-term partnerships that co-create solutions and allow them to evolve in response to changing environments.

Whether mitigating climate change or improving access to quality care, the healthcare sector needs to lead by example. It should apply its dictum of “first do no harm,” and the ethical standards its practitioners commit to in the Hippocratic Oath, as much to the planet as it does to its patients. The good news is: if it applies those principles to mitigating the worst effects of climate change, improved human health comes as an added bonus. Together, through innovation, responsible leadership and cooperation to create sustainable climate-resilient ecosystems, we can not only combat climate change, we also can expand access to quality healthcare and improve health outcomes for all.

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