Climate change has been called the biggest threat that humanity has ever faced yet is being propelled by the very system meant to enhance people's quality of life.
While healthcare institutions continue to contribute to greenhouse gas emissions, some are turning to telemedicine to curb the issue.
"The potential [of telemedicine] is very significant, and it allows us to increasingly treat people in their homes without patients needing to travel," Dr. Peter Yellowlees, the former president of the American Telemedicine Association and the current chief wellness officer at UC Davis Health, told MobiHealthNews. "It also allows, potentially, physicians and nurses to work from home, which again is a further savings."
The healthcare industry is one of the top carbon-emitting sectors in the world, according to research published in Health Affairs. It is responsible for about 4.5% of worldwide greenhouse gas emissions.
The United States' healthcare system creates the majority of those emissions, with about a quarter of global healthcare greenhouse gas emissions coming from the U.S., according to the report.
Making matters worse, the researchers found that emissions from the U.S. healthcare system rose by 6% over the last decade. These rising emissions make up around 8.5% of the United States' total greenhouse gas emissions.
The same solution that allowed patients and doctors to stay connected throughout the COVID-19 pandemic is also emerging as a way to reduce healthcare's carbon footprint.
Between healthcare workers traveling to and from work, and patient and medical supply transportation, traditional in-person care plays a significant role in the sector's carbon footprint, according to The Journal of Climate Change and Health.
"Therefore, shifting some aspects of healthcare to remote schemes with telemedicine could be a solution paving the way to eco- and patient-friendly healthcare," the report says.
Research conducted at two rehabilitation units at Umeå University Hospital in Sweden found that replacing physical visits where the patient and doctor had to drive to the facility with a virtual appointment led to a 40 to 70 times decrease in carbon emissions.
Although telemedicine does emit some levels of carbon, the researchers note that factors such as the teleconferencing platform being used, the length of the appointment and the bandwidth can influence how much is released.
"Careful planning is thus needed on the local level to make the best use of a video conference system, which could be a very poor investment if wrongly placed or when in low demand due to the rapid growth of high-quality desktop and mobile video conferencing solutions," the authors said.
Another study, conducted at the University of California Davis Health System, calculated the travel cost savings and environmental impact of its telemedicine program.
Between July 1996 and December 2013, telemedicine appointments saved patients a total of 5,345,602 miles, equal to almost nine years' time, for a total direct travel cost savings of $2,882,056.
On top of that, it led to a total emissions savings of 1,969 metric tons of CO2, 50 metric tons of CO, 3.7 metric tons of NOx and 5.5 metric tons of volatile organic compounds.
IN THE COMMUNITY
The green potential of telemedicine is not limited to the world of research. In 2017, the American Telemedicine Association convened a task force on the topic, spearheaded by Yellowlees' desire to spread telemedicine's potential.
"It was just a personal interest," said Yellowlees, who was president of the ATA at that time. "From my point of view, I've always been interested in climate change and how you can reduce the impact of humans on the Earth – well, the adverse impact of humans on the Earth."
The task force ran for two years with goals to make the ATA more environmentally friendly and to demonstrate how telemedicine can mitigate climate change.
"The outcomes, in reality, were really more about just educating the general public and educating people within the telemedicine community that this was an important topic, and so that was really what our main aim was," Yellowlees said. "We weren't trying to say that everybody should be doing telemedicine just because it's good for the climate. We were trying to argue that this was sort of a value-add to telemedicine."
A BIGGER PROBLEM
Although telemedicine offers one solution to one form of high-emitting healthcare activities, the industry contributes to climate change in a number of other ways.
"Now how does it do that? Primarily because we generate an enormous amount of waste, so plastics, paper, building materials, as well as energy consumption," Yellowlees said.
Hospitals are a major contributor to the waste problem, producing more than 29 pounds of waste per bed per day, according to Practice Greenhealth, a healthcare sustainability organization. That's more than 5 million tons of waste each year.
The majority (85%) of healthcare waste is non-hazardous, according to the World Health Organization. Items such as personal protective equipment, old medical devices and plastic packaging contribute the most waste.
The remaining 15% comes from hazardous materials such as waste contaminated with bodily fluids, needles and syringes, batteries and radioactive diagnostic materials.
One way to reduce waste is to eliminate the need for it in the first place through digitalization, Yellowlees said.
"Anything that stops us from using reams of paper, so electronic records are a good example," he said. "Anything that you can digitize that used to be a physical item is going to reduce the amount of waste you have and clearly also the number of trees you use to obtain that waste."
WHO agrees and also recommends setting up proper waste segregation, management and disposal strategies.
"So there's a huge waste issue, and then the second thing is we do a lot of feeding people," Yellowlees said. "We serve an enormous amount of food to both patients and staff, and as you well know, modern methods of food production have significant adverse events on the environment from both excessive water consumption and pollution – also the loss of biodiversity and obviously the depletion and erosion of the soil."
Hospitals feed an average of 237 patients per day, according to a Food Service Director survey. That doesn't include the staff and visitors, who also often eat meals provided by hospitals.
With so many mouths to feed and since many hospitals have purchase agreements that can require as much as 90% of their food be purchased from select distributors, implementing sustainable food service practices can be a challenge, according to Health Care Without Harm, a global healthcare sustainability NGO.
Even so, Health Care Without Harm encourages hospitals and health systems to make their food services more sustainable by buying locally and clean.
"By implementing environmentally preferable purchasing and other operational and maintenance strategies in food service, hospitals can help to reduce patient, worker and community exposure to toxic chemicals, preserve the effectiveness of antibiotics for treatment of human disease, prevent air and water pollution, reduce waste, conserve natural resources and potentially save money over the short and long term," the organization said in its sustainable healthcare food service report.
Climate change is a public health crisis that leads to increases in respiratory and cardiovascular disease, injuries and premature deaths from severe weather, increased prevalence of infectious disease, mental health implications and more, according to the Centers for Disease Control and Prevention.
As exemplified by President Biden's Leaders Summit on Climate going on this week, it will take action on everyone's part – from policy change and economic initiatives all the way to individual changes – to protect the planet.