Healthy people, healthy planet

How can we provide excellent healthcare while caring for our planet?

Healthcare is a large part of the UK’s economy, with total expenditure estimated at £269 billion in 2020. The National Health Service (NHS) alone employs 1.3 million people and accounts for 4% of Britain’s carbon footprint. Any actions to ‘green’ healthcare have a huge potential to influence our national sustainability performance.

Healthcare is intrinsically linked to nature through the products and medicines it uses and the positive treatments that harness nature. In this article, we consider both how the healthcare sector negatively influences the environment and potential solutions and the opportunities nature offers for improving patient outcomes.

Key challenges the healthcare sector faces in becoming more environmentally friendly

Health and safety requirements

Health and safety in hospitals is assured by using large quantities of chemicals to minimise the spread of infection, thus ensuring all surfaces and devices are sufficiently sterilised or disinfected. However, the active components in disinfectants and cleaning chemicals are harmful when they are allowed to be released into water courses. Finding alternative systems to sterilise and disinfect items without compromising on health and safety will be key to developing sustainable healthcare.

Plastics have revolutionised healthcare, providing safer, simpler and lower-cost methods to prevent the introduction or spread of pathogenic microbes. Overall, this has resulted in safer surgery and better patient outcomes. This, however, comes with a cost, as the production methods and waste created from single-use plastics are harmful to the environment.

Cost pressure

There is rising financial pressure in the NHS due to an ageing population and increased pressures arising from the coronavirus pandemic. This is reducing the time and money available to invest in environmental innovation. For example, the primary reason for not adopting reusable devices in the NHS is the initial cost. However, there are many studies that have found that reusable items are more cost-effective in procedures such as laparoscopic cholecystectomy and in operating theatres generally, although another study found that disposable equipment for endoscopic carpal tunnel release was more cost-effective. Therefore, more investment is needed to research and trial new initiatives, many of which can provide both cost-effective and environmentally sustainable solutions.

Recycling and disposal methods

Healthcare produces a significant amount of waste, estimated at 5.5 kg per day for each NHS patient. During infectious disease outbreaks, such as COVID-19, the volume of healthcare waste increases substantially due to the high number of hospitalisations and the increase in the use of personal protective equipment (PPE). For example, the World Health Organization (WHO) requested a 40% increase in the manufacture of disposable PPE in 2020. This has increased the amount of it in litter, with the proportion of face masks in litter increasing 80-fold during the pandemic. Additionally, there is limited scope for the recycling of PPE because it is made from a mixture of different materials and to recycle it would increase the chance of viral transmission. The pre-treatment needed to recycle PPE increases both the cost and the time it takes, posing a financial challenge to environmentally sustainable solutions.

Sustainable solutions in healthcare

Green cleaning

There are many environmentally sustainable methods to maintain health and safety standards in healthcare. Green cleaning is the adoption of cleaning products or methods that minimise the harmful effects of cleaning on human health and the environment. This includes the use of products certified by Green Seal that use ‘no touch’ disinfection methods involving UV light or non-chemical cleaning technologies. For example, using a floor cleaning machine that uses electrically charged water to remove dirt reduces the demand for conventional chemicals. Green cleaning also has many non-environmental benefits, such as improved indoor air quality, decrease in sick leave for cleaners and a reduction in expenditure on chemicals. The upfront cost of green products and technologies may act as a barrier but investing in these will provide long-term savings in lower chemical costs.

Circular economy principles

To address supply chain and waste management challenges, the healthcare sector should introduce circular economy principles. For example, the environmental challenges of single-use plastics can be addressed using reusable medical and non-medical devices. For PPE, one study found that reusable face shields and gowns could reduce the environmental impact up to five times compared to the single-use version. Another study found that switching from single use to reusable anaesthetic equipment in operating theatres in the UK would reduce carbon emissions by 84%. The introduction of reusable items in healthcare will undoubtedly come with an upfront cost. However, this will be recuperated in the long-term through the reduction in single-use item costs. Concerns about increased infection risk should be addressed by manufacturers by ensuring the item is designed for effective reprocessing. Any non-hazardous waste should be recycled like domestic waste using marked containers, clearly labelled items and information posters by recycling bins to facilitate the segregation of recyclable waste.

Benefits of biodiversity in healthcare

Further to the challenges and solutions faced by the NHS, there are greater opportunities to use biodiversity to improve patient outcomes, known as green social prescribing. It is well known that access to green spaces has a positive impact on mental and physical health. Spending more time in nature can reduce stress, minimise the time spent in hospital and provide a relaxed setting for patient–visitor interactions. One study found that all patients who had a room overlooking nature had a shorter post-operative stay after surgery compared to those who did not. As well as improving patient satisfaction levels, introducing nature into healthcare facilities will also yield cost savings from a shorter patient stay.

Many drugs used in healthcare are derived from nature. Around 80% of medicines are inspired by, or come from plants, according to the Convention on Biological Diversity. In total, the global trade of plants for medicinal purposes exceeds US$ 2.5 billion. It is the chemical diversity of plants and fungi which is of interest for drug manufacturing companies. For more information, you can read our article on the pharmaceutical sector.

Looking forward…

There are many opportunities for introducing sustainable principles into the heart of the healthcare sector. Utilising green cleaning methods and circular economy principles provides a chance to transform healthcare without compromising on infection control or budgetary limits.

Nature Positive is an environmental management consultancy with expertise in sustainable business transformation. Visit our services page to find out how we can help lead you to a nature-positive future.

Nature Positive article authors: Luka Brown & Katherine Risk

*Banner photo by Anne Nygård on Unsplash