Study prompts calls for more energy-efficient hospitals and for doctors to use general anaesthetic alternatives to gases

Australia’s healthcare system is contributing more than 7% of the nation’s carbon footprint, with hospitals and pharmaceutical companies forming the bulk of health-related emissions, an analysis led by the University of Sydney has found.

The findings, published in the international medical journal the Lancet on Tuesday, have prompted the climate lobby group Doctors for the Environment Australia (DEA) to urge the federal government to fund states and territories to make hospitals more energy-efficient.

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Researchers obtained 2014-15 financial data from the Australian Institute of Health and Welfare for 15 sectors of the healthcare industry, including public and private hospitals, dental services and private practice. They used this data in mathematical modelling to determine a carbon dioxide equivalent emissions factor for each sector, and to obtain an overall emissions footprint.

“We found that the carbon footprint attributed to healthcare was 7% of Australia’s total; that is, similar to the entire carbon emissions associated with the activities of 7% of Australians,” the study found. This represented 35,772 kilotonnes of Australia’s 494,930 kilotonnes of carbon emissions in 2014-15. The study found hospitals and the pharmaceutical industry were together responsible for two-thirds of the healthcare carbon footprint.

It is the first time the carbon footprint stemming from healthcare has been determined for Australia. Similar analyses conducted overseas found healthcare contributed 3% of total emissions in England and 10% in the US.

The co-author of the study, Dr Forbes McGain, an anaesthetist and intensive care physician with Western Health in Melbourne, said anaesthetic gases were a significant contributor to hospital carbon emissions. DEA has called on physicians to use general anaesthetic alternatives to gases, such as intravenous drugs.

“The anaesthetic gases we pump into the atmosphere have a very high global warming potential, up there with chlorofluorocarbons,” McGain said. The gases desflurane and nitrous oxide, known as laughing gas, were especially bad for the environment, he said.

Intravenous drugs or less potent gases could be used instead, with no impact on the quality of patient care.

“Though there are some reasons why gases might be used, such as fast onset and offset, Denmark for example uses intravenous anaesthesia much more commonly than gases,” he said. “So cultural factors are extremely important, as well as marketing by pharmaceutical companies to influence doctors. Gases won’t be completely replaced, but they don’t need to be used as commonly as they are.”

He agreed with DEA that more hospitals needed to turn to renewable energy. Short payback times for photovoltaics and rising energy prices meant solar panels should become an increasingly viable option, McGain said.



In an accompanying comment piece published in the Lancet, public health researchers Professor Peng Bi and Dr Alana Hansen from the University of Adelaide wrote that reducing the number of patients attending hospitals would also curb carbon emissions. General practitioners would be essential to this, by detecting disease early and promoting disease prevention measures.

“Health promotion efforts to encourage healthy lifestyles will help to reduce the need for access to healthcare and on the reliance for pharmaceuticals, the sectors with the highest direct carbon dioxide equivalent emissions emissions,” the authors wrote.

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“Messages on how to maintain a healthy lifestyle might help to reduce individual and community vulnerability to the health effects of climate change and, ironically, help lower the main contributing factor – carbon emissions.”

McGain said it was promising that many states had committed to becoming carbon neutral by 2050.

“But to achieve emissions reductions in healthcare will be a massive effort, requiring support and funding at the federal level,” he said. “Climate change is a health problem, and the health sector should be leading the way in addressing it.”