The guiding principle in healthcare is the ‘do no harm’ principle. Global climate change means that more people are falling ill and even dying prematurely, for example due to heatwaves and air pollution. Against this backdrop, it is particularly important for the healthcare sector to reduce its own impact, according to Linn Hemberg, who recently completed her PhD at the Faculty of Medicine with the thesis “Critical Care, Critical Emissions: Applying life cycle assessment on intensive and perioperative care” on the climate impact of healthcare.
“Today, the healthcare sector accounts for around five per cent of global greenhouse gas emissions. That is more than aviation and shipping combined. I believe that the healthcare sector has got away with excessive resources use because healthcare is about saving lives,” she says.
Linn Hemberg, who has a background in environmental science, has calculated the climate and environmental impact of intensive and perioperative care using life cycle assessments in her doctoral studies. The method makes it possible to estimate the total impact of products and systems, from raw material extraction and manufacturing to use and waste management. In her analysis, she has included instruments and consumables, energy use and ventilation, medical imaging, anaesthetic gases, pharmaceuticals and fluids.
Today, the principle of ‘first, do no harm’ needs to be interpreted more broadly. It cannot be only about not harming individual patients, it must encompass safeguarding public health in the long term, and to secure the health of future generations.
The results show clear differences between Sweden and many other countries around the world. In Sweden, the single most important measure is to reduce the use of single-use products, which account for 63 per cent of the climate impact from intensive care. From a global perspective, however, it is energy consumption that dominates emissions, meaning that a transition to renewable energy is the most effective measure in countries dependent on fossil fuels.
When Linn Hemberg has met staff at hospitals in Helsingborg, Landskrona, Lund and Malmö, she has observed that it is often traditions and personal preferences that dictate what is purchased for the units.
“I don’t want to blame healthcare staff; they already work incredibly hard in their day-to-day roles. But it’s often a matter of habit. That’s why more training is needed, including for procurement staff, and at the policy level regulations need to be sorted out so that the necessary changes can be implemented.”
The thesis identifies hotspots for emissions in intensive care, where the top five single-use items are gloves, single-use aprons, syringes, compresses and washcloths – products that are sometimes used unnecessarily. Many single-use items could also be replaced with reusable alternatives. For textiles, a change from single-use to reusable alternatives represents an opportunity to reduce climate impact by up to 90 per cent and costs by about 40 per cent, which equates to approximately SEK 35 per use for central venous catheter insertions.
Linn Hemberg would like to see environmental and climate impacts considered earlier in decision-making processes, for example by including environmental outcomes in clinical research. If two treatment options provide equally good care for the patient, climate impact should be part of the decision-making process. This way, the healthcare sector can reduce its emissions without compromising the quality of care, argues Linn, who has explored statistical methods to assess precisely this.
Reducing the healthcare sector’s climate impact is therefore not just an environmental issue, but also a preventive health measure. Climate change leads to both direct and indirect increases in morbidity and mortality, for example through increased air pollution and more frequent periods of extreme heat, which in turn increases the burden on the healthcare system.
“Today, the principle of ‘first, do no harm’ needs to be interpreted more broadly. It cannot be only about not harming individual patients, it must encompass safeguarding public health in the long term, and to secure the health of future generations,” says Linn Hemberg.