GRAND RAPIDS, Mich. (WOOD) — The world has been tasked with some major objectives, including drastically reducing greenhouse gas emissions, to combat climate change.
President Joe Biden announced last year that the United States has pledged to cut its greenhouse gas emissions by 50% by 2030. That will take big changes from virtually every industry across the nation, including the health care sector.
Studies show the health care industry accounts for roughly 8.5% of the United States’ total greenhouse gas emissions.
One year after the president’s announcement, a team of doctors has put together a series of objectives for how the industry can do its part to go green.
“It’s a four-part plan,” Victor Agbafe told News 8.
Agbafe is a medical student at the University of Michigan who led a study to develop the objectives. The study was published in March in the Journal of Clinical Oncology. Agbafe was involved with Biden’s campaign on shaping health policy but says it was the president’s 2021 address that sparked his mind to investigate greenhouse gas emissions.
“How can we look to reduce our contribution to climate change?” Agbafe opined. “How can we bring our voice to the table?”
He believes being environmentally conscious is simply an extension of the oath that health care workers take to do what’s best for their patients.
“I think a big part of the Hippocratic oath are the beneficents, doing things that will help patients, or what we call non-malfeasance, so not actively harming your patients,” he said. “Members of the medical workforce and those in public health (are called to) be good stewards of our climate.”
FOCUS ON OPERATING ROOMS, ANESTHESIA
For Agbafe, who plans to become a surgeon, the focus started on the operating room.
“Number one, we want to reduce the waste in the (operating room) directly. The O.R. (comprises on average) 70% of a hospital’s greenhouse gas output and waste,” he said.
A 2011 study measured the amount of greenhouse gasses from surgical suites. It found the surgical suites at one American hospital were responsible for 4.18 million kilograms of carbon dioxide equivalents over the course of one year, or roughly the same output as what 909 standard automobiles produce annually.
The biggest sources: energy consumption and gases used for anesthesia. That has sparked a debate among anesthesiologists.
“This is a topic of fairly intense discussion in the field,” Dr. George Mashour said in a university blog post.
Mashour is a professor at and the chair of the Department of Anesthesiology at the University of Michigan.
“Unlike other industries, I don’t think that we require massive disruption in order to make progress because, fortunately, we have options,” he said.
According to Mashour, many inhaled gases used for anesthesia are major offenders, including nitrous oxide or “laughing gas.” Nitrous oxide directly eats away at the ozone layer and takes more than 100 years to completely dissipate from the Earth’s atmosphere.
His department at Michigan has launched GAIA — the Green Anesthesia Initiative. The goal: to become more environmentally conscious about the products used and to promote more environmentally friendly alternatives.
“Right now, we’re starting the conversations, getting people on board and making structural choices in the department to help make it easy for people to do the right thing,” Mashour said.
Health care systems are constantly adapting to the latest technologies and updating their facilities. Agbafe says another big way to reduce emissions is to keep greenhouse gases in mind during construction.
“We talk about being more climate informed; being more efficient with the heating and ventilation systems, using more energy-efficient lighting,” Agbafe said. “With the technologies we have, maximizing the impact there within the O.R. and then incorporating environmental impact assessments when we’re designing new operating rooms.”
DESIGNING A LOCAL SUPPLY CHAIN
In the big picture, transportation is one of the biggest factors in greenhouse gas emissions. Health care systems are no different. Hospitals go through massive numbers of supplies and those supplies need to be manufactured and transported to their facilities. That all involves generating greenhouse gases.
The COVID-19 pandemic amplified the importance of supply chains and how the United States relies on exported goods.
“We are in a geopolitical moment right now, whether it’s semiconductors or our medicine supply chain,” Agbafe said.
While supply chain issues have mostly been looked at from a national security or economic standpoint, local resources can go a long way to reducing environmental impacts. Agbafe said investing in manufacturing supplies stateside would be both environmentally and economically profitable, especially for the Midwest.
“Given the history of the Rust Belt, I think it could be really good for our local economies, revitalizing a lot of communities that have lost jobs in recent decades,” Agbafe said.
One of the sore spots in the health care sector is the amount of waste produced. Agbafe pointed to the number of tools that are prepped for operations out of an abundance of caution and the number of tools that get thrown out after each procedure.
“There are a lot of opportunities in the medical supply chains for us to increase the use of reusable medical supplies and devices,” he said. “And I think safety is something that tends to pop up in the conversation and something that people tend to worry about. But a lot of the evidence suggests that it’s just as safe, maybe even more safe at times, to use reusable supplies.”
A study done in 2011 polled experts in medical green practices. The two strategies that had the most support were waste reduction and reusable medical devices.
Agbafe wants to take that a step further and analyze what tools are needed in any given procedure, instead of producing a tray full of utensils that likely won’t be needed.
“We have all these instruments here and that’s just a part of the protocol,” Agbafe said. “But why not specialize the instrument lists for a certain procedure? Sometimes it’s like, ‘Let’s have it all there just in case,’ but a lot of the way the procedures are done today, 20% to 30% of our instruments on that tray are not even used at all.”
Some of those tools, even if they aren’t used, get thrown out because they are no longer sterile. Reusable tools that aren’t used are unnecessarily exposed and forced to be cleaned a second time.
“A lot of them don’t actually get used, so things are being sterilized for a second time when it may not necessarily need to be. We need to be more conscientious of the sterilization process,” he said. “Safety is the number one concern. We can never compromise on that. But let’s also realize that we have existing technology options in our supply chain that are reusable.”
LOOKING BIG PICTURE
Another way to cut greenhouse emissions outside of health care facilities is to expand access for telehealth. Not only do virtual visits keep cars off the road, but it saves time and money for patients.
“We can integrate telemedicine, particularly into the pre-operative and the post-operative part of surgical care,” Agbafe said. “A lot of time in surgery, before you get the surgery, we have the checkup to sort of understand the health status. And then after the surgery, we want to catch up and see how the patient’s doing. … A lot of patients who come to the University of Michigan Medical System, they’re coming from Midland, they’re coming from Holland or Grand Rapids. They’re coming from the Upper Peninsula.”
Agbafe says the health care industry, just like the rest of the world, needs to adapt to climate change and take responsibility for how we impact the planet.
“(Experts) found that because of the greenhouse gases that are produced, we lose about 500,000 disability-adjusted life years annually, just in the United States. And that adds up to over $800 billion in health care costs (each year),” he said. “These are costs, right? Both in terms of life, which is, I think, what it is about at the end of the day. … And also, in terms of dollars, right? We are losing taxpayer dollars because of our care system and of climate change.”