Episode 7: The Carbon Footprint of Healthcare Systems 

[00:00:00] Sophia Gauthier: Welcome back to our last episode. I am Sophia Gauthier, and I’m Graham Aufricht. We are pediatricians and hosts of this podcast, Clinicians, Kids, and the Changing Climate.

[00:00:13] Graham Aufricht: It is our last episode, and I’m feeling

[00:00:16] Sophia Gauthier: philosophical. You’re going to talk about Hippocrates, aren’t you?

[00:00:20] Graham Aufricht: He had a lot of relevant things to say.

[00:00:23] Sophia Gauthier: Like, first, do no harm?

[00:00:25] Graham Aufricht: We’ve been talking a lot about climate change and health and how we as pediatricians can help screen and counsel and treat our patients. But I have a feeling that as a healthcare industry, we’re also contributing to the problem.

[00:00:38] Sophia Gauthier: Hopefully, we can use this episode to identify ways in which we can improve the carbon footprint of our own profession.

[00:00:45] Graham Aufricht: All right, Sophia, hit me with the facts.

[00:00:47] Sophia Gauthier: All right. So, in the US, it is estimated that healthcare contributes to about 9 to 10 percent of annual greenhouse gas emissions. Globally, the healthcare sector is estimated to contribute to about 4. 4 percent of annual emissions around the world. Plus, it is estimated that the amount of disability adjusted life years Loss from health care pollution is equivalent to that due to medical error.

[00:01:10] Graham Aufricht: So it looks like there’s a lot of room for improvement. Let’s talk about what that might look

[00:01:14] Sophia Gauthier: like. So on Earth Day in 2022, the U. S. Department of Health and Human Services launched the Healthcare Sector Climate Pledge. This is a voluntary commitment to decrease greenhouse gas emissions by 50 percent by 2030 and net zero emissions by 2050.

As of now, over 100 organizations have signed it. Sign the pledge and it’s currently open for additional signatories. The same year, the double AMC conducted a survey to try and understand what medical schools, teaching hospitals and healthcare systems were doing to respond to climate change. They estimate that about half of their affiliated health systems and teaching hospitals were taking some kind of climate action, whether that has to do with having relevant executive level discussions or actually creating climate goals.

[00:01:58] Graham Aufricht: Do we have examples of successful initiatives?

[00:02:01] Sophia Gauthier: So many. Okay, so this is like the part in the podcast that I’ve been waiting for. It’s like the part we can have some hope in this scenario. There is real work happening, and it’s pretty inspiring. So for our pediatric anesthesiologist, Back in 2020, the American Society of Anesthesiologists created the Inhaled Anesthetic Challenge to encourage providers to decrease their center’s carbon emissions from anesthetics like nitrous oxide and desulfurane by 50 percent by substituting them with intravenous methods.

of anesthesia and upgrading older leaky pipe systems that carry those gases, for example. And perhaps maybe a little bit more relevant to pediatrics, the American Board of Internal Medicines Choosing Wisely campaign aims to decrease unnecessary testing, which is great from a high value care delivery perspective, but also decreases unnecessary waste.

[00:02:51] Graham Aufricht: Are there any pediatric specific interventions we can

[00:02:54] Sophia Gauthier: target? So, albuterol metered dose inhalers, or MDIs, are commonly prescribed in the pediatric world. They contain hydrofluorocarbon propellants. One MDI is actually estimated to have the carbon footprint equivalent of driving 180 miles. There are dry powder and soft mist inhalers.

These are shown to have similar efficacy and about one fifth of the carbon footprint. Hmm.

[00:03:18] Graham Aufricht: So our hospital recently restarted its green team initiative. What kinds of things can a green team advocate for and implement in hospitals? And can physicians join?

[00:03:28] Sophia Gauthier: Absolutely. Physicians can join and even spearhead green team initiatives.

Recycling programs are always a good place to start. And one of my favorite target areas also includes advocating for plant based and sustainably sourced cafeterias. I think that hospitals have a wonderful opportunity to set an example of healthy eating and providing nutritious food for patients. For example, Boston Medical Center actually has a rooftop garden that provides thousands of pounds of fresh, healthy produce for their food pantry.

We can also pivot away from things like disposable plates and cuts and cutlery in our cafeterias.

[00:04:01] Graham Aufricht: You mentioned single use food containers. In light of PPE shortages and the recent pandemic, what about single use medical waste?

[00:04:08] Sophia Gauthier: So UCLA Medical Center and Carilion Clinic in Roanoke, Virginia have done studies that demonstrate that reusable isolation gowns are more cost effective, safer, and more sustainable than the traditional disposable gowns used in 80 percent of US hospitals.

They actually showed a 30 percent reduction in greenhouse gas emissions by switching and over 90 percent reduction in solid waste generation, which is more economical.

[00:04:33] Graham Aufricht: So you mentioned cost effectiveness. However, it seems that one of the most commonly cited barriers to instituting sustainable change is cost.

Yeah. So

[00:04:43] Sophia Gauthier: according to that double MC. Like the survey that I mentioned earlier, health care CEOs overwhelmingly report costs being the biggest barrier to green initiatives. I think often they are referring to upfront costs and not necessarily cost savings over time. That being said, the more hospitals that trial these initiatives and are able to demonstrate financial benefit, the more palatable and realistic these solutions might become.

[00:05:04] Graham Aufricht: We’ve talked a lot about systems improvement. What about advocacy?

[00:05:08] Sophia Gauthier: Advocacy is another great opportunity for physicians to get involved. So this can include writing op eds, meeting with local and state representatives, and partnering with climate savvy organizations.

[00:05:19] Graham Aufricht: So what are some examples of organizations that pediatricians can look into?

[00:05:23] Sophia Gauthier: The American Academy of Pediatrics has a Council on Environmental Health. It’s really easy to join their listserv and kind of get linked in. The American College of Physicians has a Climate Change and Health Toolkit, and other organizations include Physicians for Social Responsibility, the Global Climate and Health Alliance, and the Medical Consortium for Climate and Health.

I spoke to an adult colleague who also does a lot of work with climate change to get her perspective on how we as physicians can get involved as well.

[00:05:52] Jessica Chambers: My name is Dr. Jessica Chambers. I’m an assistant professor of medicine at the University of Texas at Austin, Dell Medical School, as well as an associate program director for the internal medicine residency program.

I hold a doctorate of medicine from Texas A& M University and a master of public health from the University of North Texas.

[00:06:10] Sophia Gauthier: How did you As a physician become interested in work in the realm of climate change.

[00:06:16] Jessica Chambers: Every year I notice people getting sicker when they shouldn’t. Why is the food available in some communities more conducive to health than others?

Why are some neighborhoods built without sidewalks and green spaces and public transportation that would support the ability to be active around their homes? And why are some patients in my 20s and 30s getting aggressive cancers? These nagging feelings were only compounded by the recent extreme weather events in central Texas, especially heatwaves, that disproportionately affected patients experiencing housing instability or those who work outside without adequate water breaks.

For me, it became an equity issue. Physicians should lobby for climate friendly legislation emphasizing emissions reductions, bans on carcinogenic pesticides and hygiene products, and protection of vulnerable populations. Most local advocacy groups are constantly looking for clinicians to testify before state legislators regarding the health effects of climate change, air pollution, and water

[00:07:11] Graham Aufricht: pollution.

I’ll be honest, physicians are often already very busy with exhausting workloads and may not have the bandwidth to take on these initiatives. Are there any little steps that we

[00:07:22] Sophia Gauthier: can do? Yeah, definitely. So first, we can just start documenting what we see. There is an ICD 10 code, it’s Z77. 1, for quote, contact with and suspected exposure to environmental pollution and hazards in the physical environment.

This might help with establishing preliminary data collection. But more loosely, I think that personal actions are always a good place to start as well. By modeling sustainable behavior, we can inspire small cultural shifts that have Potentially rippling effects,

[00:07:51] Graham Aufricht: things like carrying a reusable water bottle, turning off unnecessary lights, carpooling, or taking public transit options, upcycling old items or buying used and greenifying your diet

[00:08:02] Sophia Gauthier: and educating yourself by doing things like listening to this podcast.

And whether you’re listening as part of a curriculum or just for your own fancy, we really, really appreciate you tuning in. We hope you have snagged some takeaways for your own practice. So thanks so much for listening. Happy greening. This podcast was researched and written by myself, Dr. Sophia Gauthier.

A massive thank you to my friend and co host, Dr. Graham Aufricht, as well as Dr. Jessica Chambers for her insights into climate change health policy. The podcast was produced by the fantastic audio engineers at the University of Texas at Austin Liberal Arts Instructional Technology Services team, with funding via a pediatric medical education grant and instructional support from the Medical Education Fellowship.

at the University of Texas Dell Medical School.