The role of healthcare in mitigating the climate crisis

By Wendy Levinson

Canada signed the historic Paris Agreement in 2015 and, since then, has taken some significant steps toward addressing climate change with a promise to be a global climate leader.

While there has been discussion in Canada – and much debate — about the role of fuel sources and transportation in lowering our carbon footprint, there has been very little discussion on the impact of healthcare.

It may surprise many Canadians to learn that the healthcare industry contributes five per cent of total carbon emissions in Canada — more than the airline industry, which contributes 3.5 per cent.

We can do better.

It’s well past time healthcare professions, institutions and organizations – and our governments – in Canada create a strategic plan for reducing carbon emissions from our health sector.

We are falling behind.

Other nations have already taken note of the significant impact the health sector has on climate change and pledged to address it. The UK, for example, has made a commitment for its National Health Service (NHS) to become the first healthcare system in the world to be net zero by 2040.  They have separated their carbon footprint into three different areas with a specific plan to address them one-by-one.

While many individual health practitioners, institutions and organizations in Canada have tried to lessen their carbon footprint, there is currently no overarching government plan, goals or concerted effort focused on the carbon footprint of our health systems.

So, where do all the emissions come from in the healthcare sector?

In Canada, we know hospitals account for about 35 per cent of carbon emissions from healthcare. Hospitals use energy for maintaining buildings and specialized facilities, like operating rooms, and vehicle usage, but there are also emissions from the supply chain for medical equipment, supplies (often disposable), anaesthetic gases and pharmaceuticals, among many other items and activities.

Not every major impact is obvious.

For example, one particular anesthetic gas commonly used by anesthesiologists, called desflurane, is responsible for three per cent of all the carbon emissions from healthcare. Some countries, including Scotland and England, have made this drug unavailable as there is a safe, equally effective gas that is significantly less toxic to the environment (this drug will also be unavailable in Newfoundland starting in December 2024).

Every test and treatment in healthcare has a carbon footprint.

Choosing Wisely Canada, an organization dedicated to decreasing the use of unnecessary tests and treatments that do not add value for patients, has worked with national medical societies to identify specific changes in practice that can decrease carbon emissions and waste. Since studies show that up to 30 per cent of tests and treatments don’t add value for patients, simply stopping these low value medications and procedures is an important first step.

Medical societies in Canada have already created 50 recommendations for reducing unnecessary tests and treatments with strong evidence to support change. For example, the College of Family Physicians says, “Don’t conduct in-person visits where virtual assessment would provide equivalent clinical value and is preferred by the patient.”

The Canadian Nursing Association says, “Don’t continue intravenous (IV) medications when an oral or enteral alternative is equally effective.”

These recommendations, and many more, do not affect patient outcomes but can decrease environmental harm.

Similarly, hospital administrators can work with clinicians to improve systems of care that lead to less carbon emissions and waste. For example, operating rooms account for roughly a third of hospital waste. Having proper systems in place to sort contaminated waste, which needs to be incinerated, from non-contaminated ones can decrease energy consumption.

Hospitals in Canada can become “green hospitals” and the healthcare system can contribute to human and planetary health at the same time.

The good news is many health care organizations across Canada are already doing some of these things. But like many things in Canadian healthcare, what we have is a patchwork of activities, and when set against the backdrop of an overworked and under-resourced sector, climate initiatives nearly always become secondary to other priorities of the day.

What the health sector needs is a clear set of climate goals driven by government directive.

Since our governments fund healthcare in Canada, and are ultimately responsible for hitting our climate targets, they have both the incentive and levers to ensure that Canadian healthcare does its part to bettering the health of citizens now and in the future.

It’s time for our governments to bring our health societies and institutions together, and task them with creating a targeted climate action plan for the healthcare sector in Canada.

Dr. Wendy Levinson is Chair of Choosing Wisely Canada and a Professor of Medicine at the University of Toronto.