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Climate change presents an unprecedented public health emergency and the global healthcare sector is contributing to the worldwide crisis, argues Jodi Sherman, M.D., associate professor of anesthesiology at the Yale School of Medicine in a commentary published Aug. 2 in the Journal of the American Medical Association.

"The healthcare industry is responsible for responding to the many of the most dangerous effects of pollution and climate change, and yet it is a significant source of greenhouse gases and other deadly environmental emissions itself," said Sherman, who is also an associate professor of epidemiology in environmental health sciences at the Yale School of Public Health. "We must act to reduce waste and prevent pollution—work that is crucial to protecting public health and improving patient safety, which is at the heart of everything we do. "

Sherman and her coauthors—Andrea MacNeill, M.D., of the University of British Columbia and Cassandra Thiel of New York University—lay out a multi-faceted approach to incorporate environmental sustainability into value assessments in healthcare, which includes quality, safety, and costs. Their "green print" plan to improve sustainability would engage clinicians and hospital administrators, regulatory bodies, policymakers, and healthcare-related industries in minimizing the healthcare sector's environmental impact.

The U.S. healthcare system contributes 10% of the nation's carbon emissions and 9% of harmful non-greenhouse air pollutants. (Air pollution was associated with an estimated 9 million premature deaths worldwide in 2015 or 16% of all deaths.) Its rate of greenhouse gas emissions increased 30% between 2006 and 2016, Sherman said. The healthcare sectors of the United States, Australia, Canada, and England combined emit an estimated 748 million metric tons of greenhouse gases each year, an output greater than the carbon emissions of all but six nations worldwide, Sherman noted.

Sherman and her co-authors advocate applying the principles and tools of sustainability science—a multi-disciplinary field that addresses complex problems threatening the earth's systems—to the healthcare sector to critically examine how the current provision of healthcare depletes natural resources and produces toxic emissions that undermine public health.

Sherman says that patient safety regulations are frequently made in isolation without considering how they impact health systems and public health. That narrow view must change, she asserts.

"Everything we do must factor in public health considerations," Sherman said. "Patient care and public health go hand in hand. We can no longer make patient care and regulatory decisions in silos without considering the implications on public health."

The commentary piece highlights the need for international standards and metrics for measuring the energy and material use and environmental impact of healthcare facilities and practices. The co-authors urge consideration of the public health effects of pollution caused by healthcare-related activity up and down the supply chain, including natural resource extraction, manufacture and packaging, transportation, utilization, and disposal.

They call on government funding bodies, such as the National Science Foundation, the Agency for Healthcare Research and Quality, and the National Institute for Environmental Health Sciences to create funding mechanisms to support healthcare sustainability science, and cite the need for policy-relevant research to facilitate innovation.

Sherman and her co-authors suggest establishing a "Global Commission for the Advancement of Sustainability in Healthcare" to stimulate scientific research into healthcare sustainability and guide policymaking.

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