Just Read: Environmental Impacts of the U.S. Health Care System – (Carbon as a currency for health)?

This review could be considered an update to the brief analysis that appeared in 2009 describing US Health Care’s contribution to green house gas (GHG) emissions to be 8% of the country’s total.

And now it’s up to 9.8% (or maybe 9.3% since the models used to calculate the number are based on 2002 standards around energy generation).

I took the time in 2009 to review the models used carefully, because in life, I always read the whole paper, not just the abstract, and you should too. It’s fair to say that they are (a) complex, and (b) subject to a lot of uncertainty. I have actually been told that some of the assumptions made may not be correct, however, until I get that info, I’m just going to go with the numbers presented here.

2017.03.23 Impacts of Healthcare on the Environment 0157014
Fig 1. Time series of life cycle GHG emissions from US health care activities. Shown for 2003–2013, in absolute terms (orange bars) and as a share of U.S. national emissions (blue line). Mt = million metric tons.

Eckelman MJ, Sherman J (2016) Environmental Impacts of the U.S. Health Care System and Effects on Public Health. PLoS ONE 11(6): e0157014. doi:10.1371/journal.pone.0157014

2017.03.23 Impacts of Healthcare on the Environment (View on Flickr.com)

This paper goes beyond GHG emissions, though:

These impact categories include global warming; stratospheric ozone depletion (allowing higher levels of short-wave ultraviolet light through the atmosphere, increasing the health risks of skin cancer); respiratory disease from inhalation of primary and secondary particulate matter (PM) and from ground-level ozone (smog) stemming from emis- sions of criteria air pollutants; cancer and non-cancer disease through inhalation and ingestion routes of chemical exposure; environmental effects of acidification (from formation and deposition of acid rain) and eutrophication (algae blooms from excess nutrients) in soils and surface waters; and ecotoxicity that reflects the toxic burden of all emitted chemicals to aquatic organisms.

The tweet being made about the piece is that the US Healthcare System emits more carbon than all of the United Kingdom, but really that’s not a useful comparison because of the population differences.

Carbon as a Currency for Health/Life

It’s probably better to note that the National Health Service in the UK contributes 3-4% of the national GHG emissions, which mirrors to some extent the difference in GDP spend on health care, which was previously highlighted so eloquently to me by Brian Masterson, MD, who was then at the Military Health System in 2014, which I’ll repeat here:

20-20-20, 3-3-3

  • 20: % of GDP spent on health care in the United States
  • 20: % of youth out of high school who are fit for the military today
  • 20: % of the outcomes of health that come from health care

The delta on average between our expenditure on health care and other countries is about 12 %, with which

  • 3: % of the GDP is spent on defense today
  • 3: % of the GDP would fund every eligible student to attend a state university
  • 3: % of the GDP to make Social Security solvent for every American alive today
  • 3: % left over

If carbon emissions parallel use of services/supplies/people, then there’s an interest in using the right amount of these to obtain maximum achievement of life goals for a population (see numbers above). And therefore right amount will result in right amount of GHC emissions.

The physician role

The thing to notice carefully about the GHG emission sources, which are based on the expenditure categories of our health system (Table 1) is that they are 80% directed the things physicians do – not just providing medical services, but ordering tests, pharmaceuticals, hospitalizations.

The group physicians for climate (@DocsforClimate) recently convened in Washington, DC with this understanding:

And I have yet to meet a physician who wakes up hoping to provide too much or the wrong type of health care.

Beyond the right amount of things, there’s the way things are produced

Again the assumption (reality) that physicians work every day to perform well for their patients, it’s easy to walk into any health care environment and see opportunities. From the paint on the wall to the light bulbs in the fixtures, the soap in dispensers, the eventual location of discarded e-waste…

Physicians have a role in this too, as they did in the creation of the new Kaiser Permanente San Diego (@KPSanDiego) Medical Center (click here to see video, – LEED Platinum promotes health and it looks good too) .

Carbon not the goal, a better world is

A simple reminder…

091207usatoday global warming.91

Citation: Eckelman MJ, Sherman J (2016) Environmental Impacts of the U.S. Health Care System and Effects on Public Health. PLoS ONE 11(6): e0157014.

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