Research
Didactics
Jonathan Slutzman, MD
Massachusetts General Hospital / Harvard Medical School
Disclosure Relationship(s): Nothing to disclose
Do you think pollution is a problem for factories but not hospitals? Do you recycle your trash at home and wonder if hospitals should too? Are you curious if all these disposable supplies are the right things to use? Is there a way we can answer these questions with data? Environmental degradation causes human health impacts, leading to excess morbidity and mortality. For example, ambient air pollution is estimated to cause approximately 3 million premature deaths worldwide. Healthcare activities, which comprise almost 20% of US economic activity, contribute significantly to environmental pollution. One estimate of the total impact of healthcare activities in the United States showed that physicians and healthcare providers are responsible for 10% of total US greenhouse gas emissions, 12% of acid rain production, 10% of smog formation, and 9% of particulate emissions. This all translates to over 600,000 disability-adjusted life years (DALYs) lost due to environmental impacts of healthcare delivery. A similar magnitude impact led to the Institute of Medicine calling medical errors an “epidemic,” suggesting that the environmental impacts of healthcare should be at least as concerning. Emergency medicine is responsible for approximately 13% of all outpatient care in the US and between 2 and 5% of all healthcare costs. We also see the disproportionate impact of environmental health effects such as children with asthma, elderly with heat intolerance, and the myriad disasters that are the effect of climate change. Despite these significant impacts and the role of emergency medicine, there is a paucity of research addressing the environmental footprint of healthcare, and none specifically in emergency medicine. Led by an environmental engineer and emergency physician, this session provides an introduction to the problem of environmental impacts of healthcare and exposes our specialty to the state-of-the-art tool of life cycle assessment (LCA). Administrators can learn how to use LCA to improve their departments’ performance. Researchers can incorporate LCA thinking and techniques to expand existing projects and create new scholarship in a growing field. First, we will go through a brief review of environmental impact work to date, focusing on healthcare delivery at large and the segments that affect emergency medicine. Then, using existing LCA case studies in healthcare, we will discuss the techniques and limitations of environmental life cycle assessment, looking at a product or process from cradle to grave. This example will serve to show that not all environmental questions are as simple to answer as perhaps initially believed. Showing that environmental questions cannot be answered in a vacuum, we will discuss the integration of financial cost modeling with environmental LCA, providing a basis for the business case of environmentally sustainable healthcare. Finally, we will have a very brief opportunity for participants to ask questions to clarify areas of uncertainty and the need for future research into the environmental impacts of our clinical practice. This will enable subsequent off-line discussions into networking and collaboration to help apply life-cycle thinking to environmental questions.