Health at the intersections: Between care and climate impact

By: Fiona Koeltringer
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The second place winner of our Spring 2022 Writing Competition explores the health care sector’s contribution to climate change, and its responsibility to address the climate emergency, inspired by the ‘Do No Harm’ oath.

Not the least since Fridays for the Future started to kick off, especially the younger generation is increasingly aware of the impact human activities can have on the Earth’s system. It is no longer a secret that doing regular daily things such as consuming certain food and manufactured products or moving ourselves from one place to another produces carbon emissions that do harm to our climate. On the other hand, it is certainly less common to think of a doctor’s visit as being a big contributor to one’s personal climate footprint. And indeed, it seems pretty paradoxical to think of the healthcare sector—whose ultimate goal is to promote and protect human health, treat illnesses and save lives—as a major contributor to what is known as one of the biggest global health threats: the climate crisis.

Two gigatons of global greenhouse gas emissions each year are attributable to just the health care sector alone. That equals 4.4 % of the global net emission. Doesn’t seem like that much? Let’s put it in other words: if the health care sector was a country, it would rank fifth among the largest carbon dioxide emitters in the world, right behind what some of the most populated countries like China, the United States, India, and Russia, contribute to the global climate footprint. That’s huge.

The health care sector is complex, consisting of many different components that collectively add to its carbon dioxide emissions. Differing in scale, indirect emissions of purchased energy for heating, cooling, and electricity; transportation; and product manufacture and disposal make up the climate footprint. The lion’s share, however, derives from carbon-intensive production and transportation of medical instruments, technical equipment, vehicles, and pharmaceuticals, as well as agricultural products, such as food and cotton that are used for providing care.

Next time you are getting a routine health check or a blood test, pay attention to how much equipment is needed for a simple task like this. Not to mention the technical equipment that is required to analyze samples in a lab and ultimately the health care facility itself. It is not rocket science to then imagine how much more material is required for complex medical interventions, such as surgeries. This leads us to another problem: many medical products are disposable goods with short life cycles. What is necessary to perform medical procedures safely and hygienically ends up generating a large amount of waste, often hazardous material, with significant environmental and climate impacts.

At the end of the day, it all comes back to a massive use of energy that is necessary to keep all the wheels inside the healthcare sector running – energy that is still primarily generated by the combustion of fossil fuels. According to Healthcare without harm, a rapid phase out of coal and a society-wide transition to renewable and clean energy sources would already cut down half the healthcare sector’s climate footprint and help mitigate human and planetary health consequences attributable to climate change.

Unfortunately, the world is not always just. This particularly applies when it comes to climate change. Direct health consequences of climate change, such as extreme weather events and the increased spread of vector-borne diseases, disproportionately affect low- and middle-income countries with resource-constrained healthcare sectors. Not only are the people living in places mostly affected by the climate crisis often the ones that contribute the least to the global carbon dioxide emissions, but they also marginally benefit from the services provided by the healthcare sector.

One of the most important things that I was taught during my training in medical school is the principle of the Hippocratic Oath: “First, do no harm.” I think this principle not only applies for our work as doctors, but for the entire healthcare sector that we are a part of. It makes it an imperative responsibility of the healthcare sector as a whole and health professionals individually to prioritize the climate emergency and take on a double mission in our fight against it. First, by responding at the frontline and treating those who fall ill or get injured due to climate change and its health consequences. Second, and most importantly, by practicing primary prevention of what ultimately causes the crisis. This includes drastically cutting down our own greenhouse gas contributions as well as advocating for others to do the same. Actors at all levels in the healthcare sector need to acknowledge that climate action ultimately is health action and that it is their responsibility to support decarbonization in every possible way.

A healthcare sector that aligns with the Paris Agreement and reduces carbon emissions to zero by 2050 without compromising the quality of care while at the same time working towards global health goals like universal health coverage is certainly a challenge, but by no means unachievable. Change is underway, and several health institutions all over the world have taken on their responsibility by joining initiatives like the Health Care Climate Challenge that was launched during the Paris Climate Conference in 2015. To date, over 200 health care institutions in 31 countries have committed to reducing 34 million metric tons of carbon emissions, and their example proves that sustainability can become reality at the intersection between health and climate.