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Waste Reduction

Health care must be rethought to include the social and environmental

We must, therefore, make health care services more sustainable and efficient so that we can save money without compromising the quality of health care or damaging ecosystems that are vital to human health. In order to do this, we need to look beyond the traditional and exclusively cost-focused focus in order for us to consider a broader range of factors affecting human health and wellbeing.

To be sustainable, an organization must, therefore, balance its books and measure and manage environmental impacts, such as waste management and greenhouse gas emissions, and also consider its social obligations. Among these are the health and well-being of clients and employees.

The issues of health, climate, and society are no longer separate. On Sept. 6, 2019, Greta Thunberg, a Swedish environmental activist, demonstrated in New York in front of the United Nations. (AP Photo/Richard Drew)

Triple-bottom-line assessment has been used by businesses and organizations since its inception to improve environmental and social outcomes. This can enhance organizational value, according to systematic research.

The triple bottom line is important for the healthcare sector, as it generates high costs and opportunities in terms of economic, environmental, and socio-economic factors. There have been very few attempts to use the triple bottom-line approach in the evaluation of healthcare interventions.

The healthcare sector has a large environmental footprint. The healthcare sector contributes to the contamination of waterways and land, produces large quantities of waste, and is one of the major sources of greenhouse gas emissions.

The global pharmaceutical industry, for example, has a greater carbon footprint than the automobile industry. If the U.S. healthcare sector were ranked as a country, it would rank 13th in the world for greenhouse gas emissions — more than all of the U.K. economy’s sectors combined.

A single healthcare intervention could easily generate greenhouse gases equal to 12 flights between London and New York. Climate change is also causing droughts and flooding in places such as Chennai, India. (AP Photo/Manish Swarup)

As environmental impact on health and well-being is important, improving environmental performance can lead to significant savings. Directly through the reduction of waste and indirectly by reducing the pollution burden on public health and future impacts of climate changes on human health.

Social and living conditions are also closely related to health and well-being. Sustainability in health care must take into account the social determinants, which are contextual factors, such as whether a person has a paid job, social networks, and suitable housing, as well as individual risk factors, like genes and lifestyle, that can contribute to health and wellbeing.

There have been very few attempts to incorporate environmental and social factors into the evaluation of healthcare performance despite their importance for human health.

Calculating environmental and social costs

My colleagues and I calculated the economic, social, and environmental costs of an intervention to test if this was feasible. We used data from a clinical study of a mandatory intervention for patients suffering from chronic psychotic illness (mostly Schizophrenia).

The approximate cost of the intervention was calculated over an annual period based on how many nights patients stayed in the hospital and how many appointments they had with healthcare professionals. The financial costs were high – around PS40,000 per patient per year – but not surprising given the level of disability and needs of this patient group.

We then calculated the impact of the intervention on the environment in terms of greenhouse gas emissions, using standard U.K. government. We found that the intervention was associated with large greenhouse gas emissions — approximately 10,800 kilograms of CO2 per patient per year.

For comparison, a flight in economy class from London to New York emits around 900 kg of greenhouse gases. In contrast, the carbon footprint average of an individual living in the U.K. per year is approximately 7,100 kg. In the U.S., it is double at 16,400 kilograms.

We also examined the social outcomes of patients at a one-year follow-up. The majority remained unemployed, had low social functioning, and scored poorly in indicators of well-being and quality of life. This is more likely to be due to the chronic nature and persistence of psychotic illness than the quality and quantity of care and interventions received.

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Jane S. King

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