• Tue. Feb 27th, 2024

Comment | Healthcare should not pit patients against the environment

Comment |  Healthcare should not pit patients against the environment

If the US healthcare system were a country, it would be the 13th largest greenhouse gas emitter in the world. You read that right: Our nation’s health-care system alone contributes more to the climate crisis than most other countries.

After a recent column about how health care exacerbates climate change, I was struck by the responses that this should not be a priority for practitioners and patients. As Jane from Virginia wrote: “Isn’t health care dealing with bigger problems now? Shouldn’t we care more about how unaffordable drugs are and how nurses are leaving their jobs in droves?

This is understandable, because our health-care system has no shortage of problems. But reducing emissions from healthcare is not at odds with mitigating other challenges. In fact, factoring in the environmental cost of care is a catalyst for improving 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 contributed far more to carbon emissions than their driving or recycling habits.

I recently interviewed Jonathan Slutsman and Greg Furey, two physicians who lead environmental sustainability efforts at Mass General Brigham in Boston. They told me that they received enthusiasm and encouragement from their colleagues.

“Physicians care deeply about the relationship between the environmental impacts of clinical care and downstream harm to human health,” Furey said.

Slutzman added that being part of the solution can help heal burnout. “Hundreds of clinicians across our health care system are yearning for this type of work,” he said. “When they learn about what we do and how they can participate, they feel satisfied with their employer.”

Everyday decisions can have a big impact. I have previously written about how to minimize the use of the anesthetic gas desflurane. The alternatives are clinically equivalent, less expensive, and have a fraction of the global warming potential of desflurane. Two months ago, Scotland became the first country to ban the use of desflurane.

Another example: metered dose inhalers (MDIs) are commonly used for asthma and other respiratory ailments, but they contain hydrofluorocarbon propellants, which are potent greenhouse gases. Americans use about 144 million MDIs annually, which equates to driving half a million cars.

Over the years, Sweden’s medical societies have worked with physicians and patients to switch from MDIs to lower-carbon alternatives such as dry powered inhalers. Although MDIs account for 75 percent of inhaler prescriptions in the United States, they now account for only 13 percent of Sweden’s—and Sweden produces better clinical outcomes than the United States. Britain’s National Health Service has similarly launched an initiative to reduce MDI use, which will reduce emissions and improve health outcomes.

And here’s the bottom line: There’s no trade-off between the patient and the patient’s health The health of the planet. Instead, understanding the environmental costs of treatment options may lead to more thoughtful decisions that enhance patient care in the short term. And Minimize long-term environmental impacts.

Furey and Slutsman believe this approach is consistent with the drive toward high-value care, which requires efficient use of resources to achieve optimal care for each patient. In turn, industry is required to quantify the environmental impacts of various interventions.

For example, Slutsman told me that researchers are now studying the effects of different circumcision methods. While most parents who decide to circumcise their children choose to have the procedure done within the first 48 hours, others do it later. The first is quick, easy, and uses little equipment; The latter may require an operating room, anesthetic gases, and additional staff. If insurers do not cover newborn circumcision but do cover the procedure months or years later, they may encourage a more resourceful option. Estimating environmental impact can help.

There will be situations where people choose more carbon-intensive treatments, either because they are better for patients or because they make more economic sense. But I believe many people would think differently about their choices if they had an easily accessible environmental scorecard. I, for one, will switch my children’s asthma MDIs for dry powder, and I will be more aware when prescribing MDIs to patients.

After all, many people make climate-conscious decisions in other aspects of our lives. Why not give them tools in evaluating health care choices, too?

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