Sustainability + Health Systems: US and EU Perspectives

While health systems ready themselves to address the emerging health challenges that are resulting from climate change — according to the World Health Organization, “It is expected that climate change will lead to an additional 250,000 deaths each year between 2030 to 2050 from malnutrition, malaria, diarrhea and heat stress,” — they also have to take a close look in the mirror at their own environmental footprints.

The global healthcare industry is responsible for two gigatons of carbon dioxide each year, which amounts to 4.4% of net emissions worldwide. Hospitals generate about five million tons of medical waste annually from everyday trash such as medical packaging and food to regulated medical waste, surgical gowns, gloves, syringes, IV bags and more.

The recent panel discussion, “Sustainability + Health Systems,” facilitated by mHealth Israel, brought together an impressive roster to discuss this issue. Panelists included:

• Dr. Reed Omary, MD, MS, is the Carol D. & Henry P. Pendergrass Professor of Radiology and Biomedical Engineering at Vanderbilt University Medical Center (VUMC) with over 25 years as a practicing interventional radiologist. Dr. Omary stepped down from his position as Chair of Radiology to make a full career pivot towards sustainable healthcare to motivate US healthcare to decarbonize their operations and adopt sustainable practices. You can follow Dr. Omary’s blog on making healthcare more sustainable: The Green Leap
• Dr. Elizabeth Morris, MD, is the Chair of the Department of Radiology at UC Davis Health, an institution with a history of commitment to sustainability. Dr. Morris approaches sustainability through the academic lens, exploring how to think holistically about planetary health within our healthcare system.
• Bert Hartog, Interim VP of Sustainability & Transformation at The Digital Medicine Society (DiMe), a professional society for the digital medicine community that focuses on driving scientific progress and broad acceptance of digital medicine to enhance public health.
• Philip Guster, Director of System Sustainability at Henry Ford Health. Philip previously worked at DTE Energy, which partnered with Henry Ford in 2021 to help the health system reduce its greenhouse gas emissions through DTE’s voluntary renewable energy program with the purchase of wind and solar energy at increasing rates over the years.

Below is a selection of insights to questions raised during the webinar. Responses have been edited for length and clarity. You can view the full panel discussion here:

https://cdn.embedly.com/widgets/media.html?src=https%3A%2F%2Fwww.youtube.com%2Fembed%2FBjCpeI45wfc&display_name=YouTube&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DBjCpeI45wfc&image=http%3A%2F%2Fi.ytimg.com%2Fvi%2FBjCpeI45wfc%2Fhqdefault.jpg&key=a19fcc184b9711e1b4764040d3dc5c07&type=text%2Fhtml&schema=youtubeSustainability + Health Systems: U.S. and EU Perspectives Webinar

What made you decide to turn your focus towards sustainability in healthcare? And what do you see as the greatest challenges facing healthcare when it comes to sustainability?

Bert Hartog, DiMe: I’ve spent my career in clinical research, looking at clinical trials and ways to make them not only scientifically robust but also very attractive for participants to take part in, and part of that is convenience for the participants. That’s where digital health technologies can make a huge difference.

The light bulb moment for me was when I realized that many digital health solutions come from digital health devices produced for single use. At the beginning of the 2020s, 100 million devices were newly issued into the global market. I realized this is a mountain of electronic waste that nobody has given much thought to.

Everybody acknowledged that this is an underserved part of the digital health transition we see happening. It’s something that warrants attention.

Dr. Morris, UC Davis Health: When I took the job at UC Davis, I found myself in an environment highly geared towards sustainability. UC Davis is number one in the country for sustainability, and being in that environment made me start looking around at our department. As chair of radiology, which is one of the greatest contributors to greenhouse gas emissions in healthcare, I realized we need to figure out how to make our machines work more sustainably.

I am also interested in AI research, which, as Bert pointed out, is a double-edged sword. AI can help us achieve greater sustainability, but these storage systems can consume significant energy.

Sustainability is our number one problem. We need to start talking about it, communicating, and working together. It’s crucial to collaborate with industry partners to get this right. The biggest challenge is that doctors tend to be conservative. New technology often takes 16 to 20 years to gain traction, but we cannot wait that long. This issue is imminent, and we need to be nimble and act fast.

Dr. Omary, VUMC: I used to think about being green in my personal life, but I didn’t consider how to bring that mindset to my work as a physician. It felt like I was living two separate lives. The pandemic made me realize that as healthcare professionals, we have not just an opportunity, but a responsibility to step out of our medical centers and benefit our communities and nations.

During the pandemic, we saw how events in one part of the world could impact another, seemingly unconnected part. This realization hit me during lockdown — I wanted to do everything I could to help during the pandemic and take on the larger, more complex challenge of climate change.

The more I read about it, the more I realized that climate change, like COVID, disproportionately affects those who can least tolerate it. This led me to pivot my career towards generating the most impact. In healthcare, we think about our patients, but with climate change, we suddenly have 8 billion patients to consider, including future generations.

Philip Guster, Henry Ford Health: Midway through my career, I was working for the largest utility in Michigan, one of the largest in the country. My background is in manufacturing, and then I moved to utilities, working there for 13 years. My expertise is in engineering, energy efficiency, and systems. Healthcare has large systems behind the scenes that are crucial to patient care.

At Henry Ford Health, I’ve seen the crucial role we play as a safety net hospital in Detroit’s revitalization. Our hospital has been here for over 100 years, and we’re building a new 21-story tower that will anchor Midtown Detroit. This project will change the skyline and address the health and poverty challenges in our population. Our patients expect us to lead the way in sustainability and healthcare innovation. I’m excited to be part of a team with a culture of inclusion and collaboration, and our success will depend on our partnerships.

Clinicians have a lot on their minds — patients, improving outcomes, integrating new technologies, dealing with burnout, and staying up to date with the latest research. How does sustainability even have space in your mind as a clinician?

Dr. Morris, UC Davis Health: Sustainability shouldn’t be an additional burden. It needs to be pervasive in all aspects of our work. Sustainability can make a clinician’s day better by improving efficiencies. For example, in my area, we can improve patient protocols to make them shorter and more efficient. Small initiatives like installing motion detector lights can collectively make a significant impact across the system. These small steps create a better working environment and improve patient care.

Dr. Omary, VUMC: Dr. Morris is right. We don’t want sustainability to be seen as separate from our other duties. There’s a massive staffing crisis in healthcare — two-thirds of nurses are burnt out, and roughly half of physicians, depending on their specialty, are burnt out too. One-quarter of physicians in the US are clinically depressed. If we think about these statistics, it’s clear we need to improve our work environment.

When we care for the planet, we care for our patients. For example, telehealth reduces the need for patients to travel and deal with parking, which can be stressful. Telehealth is a sustainable intervention that benefits both the environment and patient care. Measuring the carbon cost of our care algorithms is a great opportunity for research and innovation. Sustainable practices can save money, enhance workforce satisfaction, and benefit our patients.

Philip Guster, Henry Ford Health: This is my first time working with clinicians, but we’re all focused on continuous improvement. The key is making sustainability visible and part of our daily operations. Accurate data is crucial for this. For example, we’ve been working on our energy data for three years to ensure it’s accurate. This visibility can engage hospital presidents, clinicians, and staff.

We’ve made significant strides, such as reducing the use of harmful anesthetics like desflurane. From 2019 to 2023, we reduced its usage from 25 down to one. This data-driven approach can prevent greenwashing and help us track our progress accurately.

We need to continue working on reducing single-use plastics and other waste, but having concrete data like this helps keep everyone motivated and aligned with our goals.

Policy and regulation are crucial for ensuring that our efforts in sustainability and innovation have the intended impact. How is policy either helping or hindering the advancement of sustainability initiatives in health systems? And who’s learning from whom here? Is it the US learning from the EU, the EU learning from the US, or is it a little bit of both?

Bert Hartog, DiMe: The short answer is, the US is learning from Europe, Europe is learning from the US, and we’re both looking at the rest of the world for further inspiration.

The difficulty is scale. We need to transition from point solutions, proof of concept pilots, individual clinics, individual hospitals, and individual networks doing their own thing, which is good and should continue. But we need to move up to the network level where we start addressing issues at state level, country level, and region level to really have the impact we’re looking for. Every little bit helps, but we need to start transitioning from innovation into scaling. That is important, and that’s where policy can make a difference.

One example in Europe is the electronic waste resulting from digital health devices. This was the beginning of a consortium with academics, hospitals, business schools, pharma, med tech, and startups, funded by the European Commission to work on designing these technologies for recycling — be it reuse, repurpose, or any of the “Rs.” We look at incentives for people to return these devices after use, considering a behavioral science component. Downstream, we work with waste management companies so they are equipped to handle this medical waste properly, allowing for recycling and recovering rare earth materials and precious metals when the product has reached its end of life.

Dr. Morris, UC Davis Health: In my area, radiology, we have very big machines like MRI and CT machines. So there’s a lot of effort or thought put around refurbishing these machines so that we’re not just recycling them but making them better. This requires a huge amount of effort and connecting people who normally weren’t connected in the past, and creating new regulations and guidelines.

In the medical space, societies can be very strong in this area, putting out suggested guidelines for machines, for example. There’s the Energy Star program here in the US, which could impact regulations and guidelines. Building these relationships is crucial, and normally, I would never have talked to an Energy Star person until several years ago. But this is critical because we need to speak the same language and get guidelines that are used not just in the US but globally.

We look to Europe because they are usually ahead in environmental policies and ideas. For instance, in MRI, we use gadolinium, a contrast agent that gets excreted into the water. Europe is very concerned about rising levels of gadolinium, which we weren’t even measuring in the US. Now that Europe has highlighted this, we’re starting to think about it too. We can learn a lot from Europe as they often lead in these areas, and I tip my hat to them.

What is the role of innovation in accelerating the sustainability transformation? And what’s the business opportunity in it?

Dr. Omary, VUMC: There’s a lot of money being left on the table when sustainability isn’t considered. Proper sustainability practices save money by reducing waste, and those savings can be reinvested into new growth areas. Entrepreneurs have a crucial role here. They bring a finance lens that can lead to faster adoption of sustainable practices.

If we pitch sustainability as an economic benefit, we meet the needs of the audience better. Entrepreneurs also teach us how to scale and grow quickly, which is essential for expanding sustainability initiatives.

Philip Guster, Henry Ford Health: As we’re building our new campus, sustainability is a priority. At Henry Ford, we’re implementing sustainability upfront in the contracting phase. When we seek partners through RFPs, we hold them accountable for sustainability. This approach ensures that sustainability isn’t an afterthought but a core part of our projects.

We understand there are incremental costs, but having the option to choose sustainable solutions and holding vendors accountable for innovation is crucial. It’s about integrating sustainability into every phase, from contracting to the materials we use in construction.

Bert Hartog, DiMe: In clinical research, which is the prelude to clinical care, we have an opportunity to scale sustainability benefits exponentially. We’ve started quantifying the environmental impact of clinical trials to establish a baseline and identify what good looks like. By understanding these metrics, we can address logistics, utilities, and packaging without compromising patient safety or scientific integrity.

For example, remote monitoring in clinical trials can reduce carbon footprints by 20%. If we multiply this impact across millions of instances, the benefits are substantial. Offering remote options for assessments and trials can significantly reduce environmental impact. More companies are becoming interested in this approach as they see the data proving its effectiveness.

How do we ensure these efforts and technologies are accessible and equitable to all communities, marginalized populations, and developing countries? How do we address these disparities?

Dr. Morris, UC Davis Health: It’s only recently that healthcare systems have started to address inequities and systemic racist policies. It’s crucial that we factor in these disparities completely to ensure we don’t leave behind marginalized communities.

As we scale up initiatives globally, particularly in lower and middle-income countries, we have the opportunity to improve healthcare access. For example, in our area, we’re investing in vans to reach remote communities, utilizing telehealth for primary care, and establishing clinics in rural areas. Shared best practices and collaboration are essential to make healthcare accessible for everyone, although I don’t have a perfect solution yet.

Bert Hartog, DiMe: Sustainability can be a byproduct of changing practices. Initiatives like hospital-at-home and telehealth not only improve access to care but also contribute to sustainability. Equity means reaching those populations who currently lack routine access to healthcare due to various barriers. By embedding sustainability in different practices, we can address both access and environmental concerns simultaneously.

Dr. Omary, VUMC: The transition to green technologies allows us to redesign systems with an equity lens. Sustainability and equity can go hand in hand, offering win-win solutions.

What gives you hope for healthcare’s ability to make the needed changes?

Dr. Omary, VUMC: What gives me hope is knowing that younger generations prioritize climate change, making it a top issue facing humanity. This mindset shift will lead to a workforce that’s committed to sustainability. When healthcare professionals see themselves as part of climate solutions, it gives me hope.

Bert Hartog, DiMe: What gives me hope is the blurring of traditional boundaries and the interconnectedness of the world. With knowledge sharing and collective efforts, we can address systemic issues and scale up solutions globally.

Philip Guster, Henry Ford Health: From a Henry Ford perspective, executive support for sustainability initiatives is encouraging. Top-level commitment ensures that sustainability is integrated into our practices from the ground up. It’s a significant shift from when production was the sole focus, and it gives me hope for our future.

Dr. Morris, UC Davis Health: Leadership plays a vital role, and I’m hopeful to see leaders across industries prioritize sustainability. There’s a growing market for green initiatives, which further drives change. It’s reassuring to know that sustainability is becoming a best business practice.

A Hopeful Future for Sustainable Health Systems

Following this conversation, three points stood out to me.

First, everyone has a role to play in making healthcare more sustainable. Clinicians can ensure their areas of health are optimizing resources to ensure their most efficient use (and reuse). Making practice more sustainable can bring an economic benefit. Optimizing costs means funds can be reinvested in other areas of care.

Second, professionals from other industries — the energy sector, materials industry, or waste management — can also “work in healthcare,” enabling the sustainable transformation of healthcare systems.

Finally, often what is good for patients can also be good for the environment. Remote care and telehealth can make care more accessible, equitable and convenient to patients while having an impact on emissions reduction related to transportation to and from healthcare institutions.

As health leaders continue to drive the integration of sustainability into every aspect of healthcare, from clinical practices to large-scale infrastructure projects, we begin to reveal a hopeful future for the global healthcare industry. Leveraging technology, fostering interdisciplinary collaborations, and prioritizing equity will enable healthcare systems to address climate change and improve health outcomes globally.