Here’s another reason why health care costs so much—massive amounts of waste and energy use.
An example: Flu season is coming up and health care workers are required to get a flu shot, generally by colleagues using single-use gloves. A medical facility with 30,000 employees that requires everyone to be vaccinated using gloves would release over three metric tons of greenhouse gas emissions if landfilled, and six metric tons if incinerated. (Each pair of gloves weighs 33 grams, totaling nearly one metric ton of gloves).
If all 18 million health care workers in the U.S. receive a flu vaccine this year, that would be 594 metric tons of garbage, and over 1,800 metric tons of greenhouse gases (if the gloves are landfilled). That’s the same amount of greenhouse gases as emitted from 391 passenger vehicles on the road this year. Yet both the Occupational Safety and Health Administration (OSHA) and the Center for Disease Prevention and Control (CDC) do not require using gloves for routine vaccine administration because there is little risk involved.
In developed economies, health care activities emit an enormous amount of greenhouse gases. Health care is responsible for 5% of the UK's greenhouse gases, 4.6% of Canada's, 7% of Australia's, and 10% of U.S. greenhouse gases. If U.S. health care were a country, it would be the thirteenth largest emitter of greenhouse gases in the world. And it’s not just greenhouse gases, U.S. health care is also responsible for 9% of the country’s air pollution, 12% of acid rain emissions, and 10% of smog-forming emissions. This has a tangible effect on human health, with air pollution and smog causing increases in asthma-related hospitalizations.
It does not have to be this way: Hospitals can cut down on their greenhouse gases and other emissions. India-based Aravind Eye Care System, for instance, used lessons from McDonald’s—and its command of supply chains and process standardization—to create top-of-the-line eye hospitals that now treat thousands of underserved people every day at one-tenth the cost, one-tenth the solid waste, and one-twentieth the carbon emissions of developed nations. They focused on optimizing the flow of patients and supplies through their hospitals, task shifting to more effectively utilize their trained staff, minimizing and standardizing surgical materials, selecting reusable supplies whenever possible, and setting clear performance indicators. All of this means surgery costs less to deliver, and Aravind can charge their patients far less.
And Gundersen Health System, a Wisconsin-based non-profit, implemented a large scale energy plan, including geothermal wells, methane capture from landfills and cow manure, wind power, solar hot water, and an onsite biomass boiler. They’re not carbon neutral, but they now produce 80% less carbon dioxide, particulate, and mercury emissions. They generate more energy than they use, and its dairy biogas project has also reduced phosphorus runoff and created compost. The hospital has saved $20.3 million cumulatively since 2008. Their energy cost in 2018 was $1.98 per square foot versus $2.60 per square foot in 2008. This was despite having approximately 30% higher electricity prices compared to its 2008 baseline.
Health care still lags behind other industries (like product manufacturing, building construction, and energy production) when it comes to sustainability, but those that lead the way have a competitive advantage. Cleveland Clinic is one of the few medical systems that reports its sustainability goals and accomplishments through both the UN’s Global Compact and the Global Reporting Initiative and has reduced their energy use intensity in 2017 by 15% from their 2010 baseline. This reduction led to $2 million in savings—making them more competitive, without any impact on the level of care.
Hospitals can both set environmental goals and save money. One study conducted by Health Care Without Harm found that energy and water reductions and more efficient purchasing in operating rooms could save U.S. hospitals $5.4 billion over 5 years, and $15 billion over 10 years. A more focused study from the University of California in San Francisco found that by eliminating unused items from surgery, the neurosurgical department could save up to $2.9 million per year in supply costs.
So when you go to get your flu vaccine, do your bit: Ask that they don’t use plastic gloves. You can then claim credit for reducing greenhouse gas emissions—which is good for our health—and reduce costs for the provider. If enough providers reduce general waste, water and energy use, they can cut their costs and, thus, cut our costs. It’s a sustainable way to make health care more affordable.
Cassandra Thiel is an assistant professor in the NYU Langone Health’s Department of Population Health, the NYU Wagner School of Public Service, and the NYU Tandon School of Engineering. Tensie Whelan is the clinical professor for Business and Society and director of the NYU Stern Center for Sustainable Business.
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