Health-care providers don’t have to choose between patients and the planet
If the U.S. health-care system were a country, it would rank 13th in the world for greenhouse gas emissions. You read that right: Our nations health-care system by itself contributes more to the climate crisis than the entirety of most other countries. After a recent column on how much health care is worsening climate change, I was struck by reactions that this shouldnt be a priority for practitioners and patients. As Jane from Virginia wrote: Isnt health care dealing with bigger problems right now? Shouldnt we be more concerned about how unaffordable medicines are and that nurses are quitting in droves? This is understandable, as there is no shortage of problems in our health-care system. But reducing the emissions from health care isnt at odds with mitigating other challenges. In fact, factoring in the environmental cost of care could be a catalyst to improve the industry more broadly. I have heard from many fellow health-care professionals who pride themselves on being environmentally conscious. Like me, they had no idea that their clinical decisions probably contribute far more to carbon emissions than their driving or recycling habits. I recently interviewed two physicians, Jonathan Slutzman and Gregg Furie , who are leading environmental sustainability efforts at Mass General Brigham in Boston. They told me their work has been met with enthusiasm and encouragement from their colleagues. Clinicians care deeply about the connection between the environmental impacts of clinical care and the downstream harm that has on human health, Furie said. Slutzman added that being part of the solution can help address burnout. Hundreds of clinicians across our health-care system are yearning for this type of work, he said. They feel satisfaction with their employer when they learn about what were doing and how they can take part. Everyday decisions can make a big impact. I wrote before about how reducing the use of desflurane, an anesthetic gas, can dramatically cut hospitals greenhouse emissions. The alternatives are clinically equivalent, less costly and also have a small fraction of desfluranes global warming potential. Two months ago, Scotland became the first country to ban desflurane use. Another example: Metered dose inhalers (MDIs) are commonly used for asthma and other respiratory diseases, but they contain hydrofluorocarbon propellants, which are potent greenhouse gases. Americans use about 144 million MDIs annually, making their use the equivalent of driving half a million cars. For years, medical societies in Sweden have worked with clinicians and patients to switch from MDIs to lower-carbon alternatives, such as dry powder inhalers. Though MDIs constitute 75 percent of inhaler prescriptions in the United States, they are now only 13 percent of Swedens and Sweden produces superior clinical outcomes to the United States. Britains National Health Service similarly launched an initiative to reduce MDI use that would both reduce emissions and improve health outcomes. This is the key point: There doesnt need to be a trade-off between health of the patient and the health of the planet. Rather, understanding the environmental cost of treatment options can lead to more thoughtful decisions that enhance patient care in the short term and reduce longer-term environmental consequences. Furie and Slutzman believe this approach is consistent with the drive toward high-value care, which requires efficiently using resources to achieve optimal care for each patient. That, in turn, requires the industry to quantify the environmental impacts of different interventions. For example, Slutzman told me that researchers are studying the impact of different circumcision methods. While most parents who choose to circumcise their children opt for the procedure in the first 48 hours, others do so much later. The former is quick, easy and uses little equipment; the latter could require an operating room, anesthetic gases and additional staff. If insurers dont cover newborn circumcisions but will cover the procedure months or years later, they would be incentivizing the more resource-intensive option. Quantifying the environmental impact can help. There will be circumstances in which people opt for more carbon-intensive treatments, either because they are better for patients or because they make more sense financially. But I believe many people would think differently about their choices if there were an easily accessible environmental scorecard. I, for one, will be swapping out my kids asthma MDIs for dry powder, and Ill be a lot more conscious when prescribing MDIs to patients. After all, many people make climate-conscious decisions in other aspects of our lives. Why not give them the tools to do so in evaluating health-care choices, too?