When you think of climate change, hospitals and care clinics may not be the first things that come to mind.
But if global healthcare were a country, it would be the fifth largest greenhouse gas (GHG) emitter in the world, the Canadian Medical Association has found — which somewhat undercuts the sector’s presumed focus on good health.
Healthcare is responsible for close to five per cent of global emissions, more than double the rate of aviation, which clocked in at 2.5 per cent in 2023. Because hospitals have no down times, their HVAC systems are constantly running.
They also require an endless supply of single-use disposables, such as personal protective equipment (PPE), syringes and intravenous drug packaging.
While these items are a key part of maintaining sterile environments, they are invariably made of plastic amalgams that are produced through pollution-heavy processes and do not easily biodegrade, meaning that they wind up in landfills or incinerated — leading to more GHG emissions.
The institutions and equipment that protect our well-being also contribute to us getting sick. Climate change is affecting our health and will have increasingly adverse effects as extreme weather intensifies. Statistics Canada found that people living within 50 kilometres of wildfires are 4.9 per cent more likely to have lung cancer and 10 per cent more likely to develop brain tumours.
Globally, extreme heat is linked to an estimated five million deaths a year; higher temperatures have also sparked an increase in vector-borne diseases, such as malaria, dengue fever and Lyme disease. It’s a catch-22: climate change creates more need for treatment, and yet healthcare is a major contributor to climate change.
With healthcare, “most of the environmental harm is not in what you see,” says Fiona Miller, a professor at the University of Toronto’s Institute of Health Policy, Management and Evaluation. “It’s actually in everything that went into producing it.”
In fact, 80 per cent of the sector’s GHG emissions are from indirect categories, such as transport and energy usage and pharmaceuticals, the latter of which accounts for a quarter of those emissions. These environmental challenges aren’t easily solved, and issues need to be addressed across the sector and along the supply chain while prioritizing patient care and sanitation requirements.
Raising awareness about healthcare’s sustainability problem
The need for sustainable alternatives has inspired a variety of advocates, from care providers and hospital administrators to academics and entrepreneurs looking to catalyze meaningful change. Among those voices is Myles Sergeant, a physician, assistant professor at McMaster University and executive director of the Canadian Coalition of Green Health Care.
By the time he co-founded Partnerships for Environmental Action by Communities within Health Care Systems (PEACH) in 2021, Sergeant had been trying to tackle the sector’s carbon footprint for more than a decade, primarily through charitable work planting trees at hospitals and long-term care facilities.
The organization’s name prompted Sergeant and his co-founders to encapsulate its MO in a diagram: a peach tree heavy with low-hanging fruit to reduce emissions (i.e., phasing out ineffective or harmful prescriptions; finding anesthetic options other than desflurane, which is 2,500 times worse for the environment than carbon dioxide). Higher branches hold loftier (and more expensive) goals, such as net-zero buildings.
Like PEACH, CASCADES (Creating a Sustainable Canadian Health System in a Climate Crisis), which Fiona Miller co-founded in 2021, aims to raise awareness of the need to adapt healthcare to growing climate shocks, to reduce pollution within the healthcare system and to encourage adoption of innovative solutions through key partnerships.
Miller, who is also the director of U of T’s cross-faculty Collaborative Centre for Climate, Health and Sustainable Care, recognizes the need to work across silos.
For organizations looking to implement green adaptations, CASCADES provides implementation support resources; the group also trains healthcare workers, managers and leaders in sustainable practices and encourages them to promote and build capacity for equitable, accessible, sustainable and resilient healthcare systems.
In 2023, CASCADES worked with 336 trainees, disseminating playbooks that break down greener approaches for different areas.
In the case of chronic kidney disease, the energy demands of pharmaceutical manufacturing and dialysis come with a hefty environmental toll, one that is amplified by the progressive nature of the illness.
The organization’s kidney care playbook includes recommendations that can be implemented at different stages, such as creating designated sustainability leads or teams within kidney-care programs, and optimizing transplant procedures, infrastructure and outcomes.
This work extends beyond the organization’s immediate trainees: through knowledge-sharing and networking, CASCADES provided 6,844 individuals with the resources to further grow the sustainable web across Canada.
Shrinking healthcare’s carbon footprint (and costs)
At a time when healthcare systems across the country are already struggling to serve the needs of physicians and patients, prioritizing sustainability may seem like an impossible goal.
However, many of these steps are actually money savers that provide additional benefits for patients — such as serving more plant-based foods, which, according to Sergeant, is cheaper and improves patient recovery.
As outlined in PEACH’s business case and implementation guide, swapping meat for veg-friendly proteins in entrées could result in savings of 10 to 20 per cent: when NYC Health + Hospitals incorporated meat-free dishes as a default option in 2023, the network was able to save US$0.59 per meal (compared to the cost of its conventional menus).
The decreased costs for the planet are also notable: at Vancouver General Hospital, a flexitarian pilot project reduced carbon emissions by 42 per cent.
To capitalize on opportunities, organizations must be strategic and forward-thinking. The Children’s Hospital of Eastern Ontario started with the low-hanging fruit on PEACH’s diagram and leveraged those savings to help drive momentum.
“They take that money and put it in a little green piggy bank,” Sergeant explains. “As they’re moving higher up the tree, they’ve got money to pay for more expensive things.”
Mandatory building updates provide a chance to implement sustainable improvements. Older boilers and chillers are hospitals’ largest source of emissions, so a necessary HVAC replacement can be a big win for reducing GHG emissions.
In 2010, the Haliburton Highlands Health Services shifted toward renewables by tapping into geothermal energy as part of a bundled engineering initiative focused on energy management (other, smaller initiatives involved LED lighting and optimizing reclaimed heat from waste). This saved the hospital between 100,000 and 150,000 litres of fuel per year, benefiting both the planet and its bottom line.
As the director of environmental compliance, energy and sustainability at Toronto’s University Health Network (UHN), Michael Kurz is responsible for compliance, energy management, waste reporting and paying utility bills.
Over the last 11 years his role has shifted to include more projects that reduce GHG emissions and improve sustainability. “Even at the executive level, the CEO level has been acknowledging that projects that reduce GHG emissions effectively mean they contribute to fewer people needing to be admitted to hospitals in the future, including ours.”
In 2022, UHN, which is made up of four hospitals with services spread over 10 sites, broke ground on what it billed as “the world’s largest raw wastewater energy transfer system.”
Incorporating elements such as an innovative pumping mechanism from the German company HUBER, this technology is able to recover thermal energy from wastewater as it courses through pipes to the sewers, with the aim of redirecting that energy to provide as much as 90 per cent of the power required to heat and cool facilities on the UHN campus.
According to estimates, the system could save UHN more than 141 million kw/h of energy and reduce the organization’s GHG emissions by 250,000 tonnes as well as significantly reduce operational costs over the coming decades.
Cutting down on waste
Hospitals generate more than 29 pounds of waste per bed each day, which adds up to approximately 5 million tons of waste each year. As part of the overall effort to reduce reliance on single-use disposables, innovators are tackling another one of the three Rs: reuse.
“Reusables are not new to healthcare, and, through proper design choices, we can make them safely reusable,” says Aditi Sitolay, the founder of Synoro Med, a Canadian startup trying to keep medical supplies out of the trash. The company’s initial project involves developing a reusable IV bag that can be cleaned, sterilized and refilled safely through a proprietary reprocessing method before re-entering the healthcare system.
Plenty of healthcare waste is unnecessary: IV-administered drugs have a more energy-intensive manufacturing process than their ingestible counterparts, and because disposable bags often still hold the unused portion of whatever they originally contained, they result in more medications going down the drain (literally, in some cases).
Single-use plastic may seem like a convenient way to ensure equipment is sterile, but it’s also hazardous to our health.
Microplastics were found in human bodies for the first time in 2022; though researchers are still working to determine the full scope of how these infinitesimal particles affect our bodies, but they have been found to cause changes to the gut microbiome, create respiratory problems and interfere with hormones, which can affect metabolism, development and reproduction.
Even when single-use disposables are unavoidable due to the risks of infection and cross-contamination — such as supplies for dialysis, IV infusions, urinary incontinence, blood and ostomies — oversight regarding materials can ensure these supplies are more ecologically sound.
In 1989, a coalition of representatives from Norway, Sweden, Finland, Denmark and Iceland launched The Nordic Swan Ecolabel, a body that assesses consumer goods based on strict green standards for materials (plastics cannot contain phthalates, for example), manufacturing and end-of-life.
Participation is voluntary, but as noted on the Nordic Ecolabelling website, this certification is a great branding opportunity: it allows companies to differentiate themselves and is a testament to the quality of their products.
The Nordic Swan framework could be a model for comparable systems in Canada, where no such governance exists.
Developing alternative materials
Environmentally harmful materials can also be swapped for more sustainable options.
Sergeant is optimistic about novel developments such as washable gowns made out of fabric that includes silver nanoparticles with antimicrobial properties.
Canadian innovators include small businesses such as Aruna Revolution, co-founded by Halifax-based biomedical engineer Rashmi Prakash, who has said she was inspired to start the company after witnessing the amount of waste produced by the healthcare industry.
Aruna’s first foray into the alternative-materials space comes in the form of menstrual-hygiene products. The company’s compostable pads are made by weaving together fibres sourced from agricultural byproducts that would otherwise be discarded.
Aruna’s manufacturing process generates nearly three-and-a-half times less carbon dioxide compared to that of other menstrual pad brands and when the products are composted, they break down into components that enrich the soil.
Prakash, who recently found success on Dragons’ Den, is hoping that Aruna’s tech can be used to produce other disposable textiles essential within healthcare, such as diapers, gowns, masks and gauze. “What we really want to be is that responsible manufacturer that gives people the ability to consume responsibly,” Prakash says.
Creating lasting change
The challenge of shifting the sector is compounded by greenwashing, which can significantly hinder the prospect of long-term environmental impact.
Few clearly defined standards mean that bad actors can make false claims about any potential improvements, or that perceived successes may not actually be backed up by empirical evidence. Fiona Miller, who has a background in policy, says change must come from above.
“There are things we need to do with respect to market access regulation,” she says. Among her suggestions: parameters around end use, government-imposed criteria dictating how industry players develop and design products, even Right to Repair legislation for health-related products.
Both PEACH and CASCADES stress the importance of networking among advocates.
Growing networks can become self-sustaining via communication, education and ingenuity, and with institutional support, they can extend into supply chains.
With funding it received from the Trottier Foundation, PEACH is reaching out to foundation boards at hospitals across Canada to discuss ways of investing in sustainable products and initiatives. Because hospitals are anchor institutions in communities, Sergeant notes, they can use their purchasing power to create sustainable shifts.
At Hamilton Health Sciences, for instance, the procurement lead reached out to as many as 1,000 suppliers with a recommendation to update the RFP process.
“Typically,” Sergeant says, “those companies are competing on cost and quality. We need to add sustainability.”
It’s a win-win situation, adds Miller, who is adamant about amplifying the message that sustainable options don’t compromise quality of care: “We don’t need to talk about sacrifice, let’s talk about improvement.”
Caitlin Stall-Paquet writes about technology for MaRS. Torstar, the parent company of the Toronto Star, has partnered with MaRS to highlight innovation in Canadian companies.
