Is Healthcare Pollution Making Us Ill?
Pollution from the healthcare industry disproportionally impacts the lives of people of color. Our columnist explores how we can heal the Earth—and ourselves.
Earth Day is upon us, and as I sit with my daughter and color paper replicas of the planet in blues and greens, I can’t help but think about the ways the United States’ treatment of the Earth impacts our health as Black folks living in America.
What I already knew: air pollution is the fourth greatest overall risk factor for poor health worldwide (slotting behind only high blood pressure, dietary risks, and smoking). It kills a whopping 18,000 people a day. But before it kills you, it opens the door to chronic illnesses like lung cancer and asthma. We’ve long known that people of color in the United States carry a higher pollution burden than our white counterparts—it’s 1.28 times the burden of the overall population. For Black folks like me, it’s 1.54 times higher than the overall population. Why?
Even controlling for socioeconomic factors, studies show that in America, we are more likely to live in areas with toxic air.
But what I learned when I put down my colored pencils and picked up my laptop was equally mindblowing and saddening: the institution that we task with keeping us healthy is a major reason we’re breathing toxic air. In 2019—the most recent year for which the Environmental Protection Agency (EPA) has released data—emissions of greenhouse gas (gases that trap heat in the Earth’s atmosphere) in the United States totaled 6,577 million metric tons of carbon dioxide equivalents. And fully 8% of those planet-heating emissions are directly related to the healthcare system.
I tend to think of heavy polluters as Big Bads; the nefarious villains dressed in floor-skimming trench coats and dark sunglasses who throw back their heads and cackle as they covertly dump sludge into rivers and pump toxins into the airspace. I don’t picture the industry that employs people like my sister the EMT, who put their lives on the line every day, even as COVID-19 continues to infect more than 75,000 people per day in the United States.
These healthcare emissions come from three main sources: those emitted from health facilities (things like boilers and medical gases), those that come from energy purchased to run those facilities (running CT machines and printing bills), and the gases emitted up and down the supply chain that create the goods and services used in the system (think single-use items like syringes, masks, and gloves).
Of course two things can be true, but it had never occurred to me that an industry created to enhance health was also creating byproducts that do the opposite. And a recent study from researchers at Yale University, Northeastern University, and the Icahn School of Medicine at Mount Sinai says that those U.S. numbers are on the rise. Emissions jumped 6% from 2010 to 2018, and now represent about a quarter of all global healthcare greenhouse gas emissions—more than any other healthcare system in the world.
“Healthcare pollution is significant, and is harming health, which goes against the mission of healthcare,” says Jodi Sherman, M.D., senior author of the study and director of the Yale Program on Healthcare Environmental Sustainability at the Yale Center for Climate Change and Health. “Other industries are electively performing environmental impact assessments and instituting practices to reduce emissions in accordance with science-based target and timelines. However, the U.S. healthcare sector is not doing so voluntarily.”
And that’s dangerous; the study also found that this damaging behavior has snatched 388,000 “disability-adjusted life years” from U.S. residents—that’s a measure of the years lost due to poor health, disability, and early death. “Harm from healthcare pollution is on the same order of magnitude as harm due to medical errors. Whereas much effort goes into preventing medical errors and keeping patients safe, no one is paying attention to protecting public health from healthcare pollution. This must change,” says Dr. Sherman.
And as our healthcare system continues to work overtime to save lives, it only makes sense that the emissions it creates will climb.
The weather is warming in my area, and I have finally headed back outside for cloth-masked walks with my daughter. Mixed into the crumbled leaves along the side of the road that didn’t make it into collection bins are dingy paper masks and bright blue latex gloves, tumbled out of coat pockets and tossed from moving cars after they served their purpose. Every new COVID-19 case, every vaccination, every trip to the grocery store adds additional fuel to this public health fire. But Dr. Sherman says it doesn’t have to be this way.
“It’s common sense, really. Healthcare organizations and clinicians should be leading the way in sustainability solutions and practices, not lagging behind. We need to both reduce the environmental emissions intensity embedded in the care we provide, and we need to reduce wasteful non-value-added practices,” Dr. Sherman says. “This means things like electrifying energy to run building, equipment, transportation and manufacturing, and shifting to renewable energy sources.”
She says it also means that doctors need to avoid unnecessary tests, prescriptions and procedures—all of which increase emissions. Also key: disrupting a system where medical devices are continually made obsolete and replaced rather than updated to keep pace with innovation. And Dr. Sherman says we need to embrace and incentivize a circular economy, a system designed to keep manufactured products in circulation for more than one use, which benefits not only the business end of the industry, but also the environment and society as a whole. There are glimmers of this change happening in Europe as groups assemble to remake the industry, and experts like Dr. Sherman hope there can be positive change in the United States.
As someone with multiple chronic conditions who has multiple interactions with the healthcare system each week, saving the Earth and Black and Brown lives while also skipping unnecessary tests and streamlining systems sounds like a win-win situation.
- Pollution and Race: American Journal of Public Health. (2018). “Disparities in Distribution of Particulate Matter Emission Sources by Race and Poverty Status. ncbi.nlm.nih.gov/pmc/articles/PMC5844406/
- Pollution And White Consumption: Proceedings of the National Academy of Science of the United States of America. (2019). “Inequity In Consumption Of Goods And Services Adds To Racial–Ethnic Disparities In Air Pollution Exposure.” pnas.org/content/116/13/6001
- Air Pollution Kills: International Energy Agency. (2020). “World Energy Outlook.” iea.org/reports/world-energy-outlook-2020
- Asthma: Centers for Disease Control and Prevention. (2020). “Most Recent National Asthma Data.” most_recent_national_asthma_data.htm
- Air Pollution and Asthma: American Journal of Respiratory and Critical Care Medicine. (2017). “Long-Term Coarse Particulate Matter Exposure Is Associated with Asthma among Children in Medicaid.” atsjournals.org/doi/10.1164/rccm.201706-1267OC
- Air Pollution and Lung Cancer: CA: A Cancer Journal for Clinicians. (2020). “Outdoor Air Pollution And Cancer: An Overview Of The Current Evidence And Public Health Recommendations.” acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21632
- Greenhouse Gases (1.): Environmental Protection Agency. (2021). “Greenhouse Gas Emissions.” epa.gov/ghgemissions/inventory-us-greenhouse-gas-emissions-and-sinks
- Greenhouse Gases (2.): Environmental Protection Agency. (2021). “Draft Inventory of U.S. Greenhouse Gas Emissions and Sinks: 1990-2019.” epa.gov/ghgemissions/draft-inventory-us-greenhouse-gas-emissions-and-sinks-1990-2019
- Health Industry Greenhouse Emissions (1.): Health Affairs. (2020). “Health Care Pollution And Public Health Damage In The United States: An Update.” healthaffairs.org/doi/full/10.1377/hlthaff.2020.01247
- Health Industry Greenhouse Emissions (2.): YaleNews. (2020). “U.S. Health Care Emissions Continue To Rise.” news.yale.edu/2020/12/07/us-health-care-emissions-continue-rise
- Health Industry Greenhouse Emissions (3.): Health Affairs. (2020). “Transforming The Medical Device Industry: Road Map To A Circular Economy.” healthaffairs.org/doi/10.1377/hlthaff.2020.01118
- Electrifying Energy: Resources for the Future. (2019). “Electrification 101.” rff.org/publications/explainers/electrification-101/
- Circular Economy: Ellen MacArthur Foundation. (2015). “The Circular Economy in Detail.” ellenmacarthurfoundation.org/explore/the-circular-economy-in-detail
- Circular Economy and Health Care Industry: Health Affairs. (2020). “Transforming The Medical Device Industry: Road Map To A Circular Economy.” healthaffairs.org/doi/10.1377/hlthaff.2020.01118