Prevention is always better than reaction when it comes to our health. When we eat well and exercise, for example, we generally have to spend less money on our health care and suffer fewer traumatic, expensive, and painful afflictions that can result from not taking care of ourselves. Preventative care is more efficient for the health system too: regular check-ups are much less expensive than ambulances and emergency room visits. But what does prevention look like when it is taken out of the sphere of an individual patient and their doctor and blown up to the scale of a city and its hospital? To the scale of the entire United States population and its health care system? If prevention is efficient at the level of an individual, would it not be more so when amplified by hundreds of millions? These are the questions we should ask when thinking about the intersection of healthcare and the environment. It takes no stretch of the imagination to picture how the environment impacts the health of an individual or population, but we do not often think about how the health care system impacts the environment. Only recently have we begun to realize how significant of an impact it really is.
According to a study published by the Public Library of Science, in 2013 the United States healthcare industry accounted for 10% of our country’s greenhouse gas emissions and 10% of our smog formation. The authors estimate the consequences of this amount of pollution to be 470,000 DALYs. DALYs, or Disability Adjusted Life Years, is a measure of years of life lost due to health damages, and to put this measure in context, the authors equate 470,000 DALYs to the 44,000 to 98,000 premature deaths that occur annually in hospitals from preventable medical errors (1).
This data should be of particular interest to residents of St. Louis, the city ranked 29th out of 227 metropolitan areas by the American Lung Association for high ozone days. According to their “State of the Air” report, St. Louis County had 14 days in the last year with unsafe levels of ozone for people belonging to sensitive populations – populations which include but are not limited to children, the elderly, and people with conditions like asthma and cardiovascular disease – and three days when the particulate pollution levels were unsafe for people belonging to these sensitive populations. This is significant considering out of the 998,581 people living in St. Louis County, nearly 10% of them suffer from asthma, 7% suffer from Chronic Obstructive Pulmonary Disease, nearly 9% suffer from cardiovascular disease, and slightly over 9% have diabetes (2). Even accounting for overlap of individuals belonging to more than one of these sensitive populations, these are alarming portions of our friends and neighbors who have not been able to breathe safely for at least 14 days of this past year.
Barnes-Jewish Hospital and Washington University School of Medicine are national leaders in respiratory health research and treatment, with Barnes-Jewish housing one of just eleven asthma research centers in the country (3). While they study preventative care at the level of the individual, what can they do to practice prevention at the source of pollution? An important target for improvement is building efficiency. Washington University has a LEED (Leadership in Energy and Environmental Design) silver minimum requirement for all new construction, meaning that any new building must meet certain standards set by the US Green Building Council (4). However, silver is the second lowest of four possible LEED certifications. There is always room for improvement; even Gunderson Health System, the first healthcare system in the United States to become energy independent – that is, produce more energy than they consume – acknowledges that they have not done all they can to reduce their environmental impact (5). Taking steps such as purchasing food from local growers, reducing hospital waste by choosing reusable options whenever possible, and conserving water in landscaping will all increase the overall sustainability of hospitals and thus the health care industry at large.
It is a sad irony that our health care system is responsible for a tenth of the pollution that causes and makes worse the very diseases it treats. However, this irony does not have to remain truth; the industry does not need to keep producing pollutants and waste at its current levels in order to continue treating the number of patients it currently does. With the health care system beginning to turn a critical gaze on itself, the implementation of programs that minimize waste and increase energy efficiency will become more commonplace, and the healthcare industry will pollute less and prevent more.
Edited by: Rachel Brace
Illustrated by: Michelle Le