Joining the Forces of Policy, Green Teams, and Chemistry to Build a Sustainable Healthcare System in a Post-Covid World

By: Molly Tipping

In global discussions of environmental sustainability targets, the healthcare sector is an often-overlooked area for improvement. In the U.S., the manufacturing of healthcare products is estimated to account for 8.5% of the country’s annual carbon emissions (“Health Care’s Climate Footprint,” 2019; Eckelman et al., 2020). The COVID-19 pandemic’s unprecedented demand for single-use plastics (SUPs) and personal protective equipment (PPE) counteracted emerging SUP reduction initiatives (“Advancing Sustainable Materials,” 2020) and resulted in an estimated 500% increase in medical plastic waste (8.85 million tons by the end of 2020, Shams et al., 2021). This COVID-driven spike is by no means a temporary obstacle in a transition to a more sustainable future, as current models predict no notable decline in annual global plastic waste by 2050 (Rai et al., 2023). The U.S. healthcare system, which relies on mostly non-recyclable SUPs that are hazardous to both the environment and humans, should recognize that our PPE-littered post-COVID world necessitates environmentally sustainable healthcare systems. A joint effort between global leaders, individual hospitals, and scientists is required to organize sustainable economies and strengthen the dependability of renewable materials. 

The most foundational prerequisite to a sustainable healthcare system is a government-led shift away from the prevailing linear economy (LE) towards a circular economy (CE) (Sharma et al., 2021).

The hallmark of the LE is the single-use, “cradle-to-grave” nature of products. PPE, for example, is composed of rarely recycled polymers (Kahlert and Bening, 2020), and in 2020, it is estimated that only 4.25% of PPE in the U.S. was recycled, a 50% decrease compared to 2018. The remaining ~8.6 million tons of PPE were combusted, landfilled, or illegally dumped. These disposal methods each contribute to various forms of pollution; in 2020, a pandemic-attributed 70% increase in marine plastic waste was detected during ocean cleanups (Shams et al., 2021). COVID’s ability to overwhelm proper healthcare waste disposal procedures (Benson et al., 2021) illustrates the necessity for a CE, which employs “cradle-to-cradle” production (Figure 1). In a CE, products are designed for repeated use and then recycled into new recyclable products, in contrast to a SUP-reliant LE. 

 Figure 1: A comparison of the traditional linear economy (LE) and a more sustainable alternative, the circular economy (CE). (Sharma et al., 2021). 

Such a paradigm shift in economic structure will, of course, face significant and expensive obstacles. For example, the current lack of systemically distributed biorefineries (facilities that convert plastic into reusable raw materials) must be addressed if SUP alternatives are to become widespread (Silva et al., 2020). Considering that the healthcare sector corresponds to 18.3% of the U.S.’ GDP, promoting sustainable healthcare has the power to catalyze changes in current LE manufacturing practices (“Historical,” 2023; North & Halden, 2013). The government should increase funding towards research that advances the implementation of a CE-aligned healthcare system in the U.S. (Sharma et al., 2020). To accelerate widespread behavioral changes in manufacturers and consumers, the U.S. could impose taxation upon SUPs and provide manufacturers with incentives like tax credits for CE-aligned manufacturing. (Silva et al., 2020). Proponents of the CE argue that economic obstacles are diminished by "green job" creation. A $1 million (USD) contribution to sustainable infrastructure creates an estimated eight to twenty-one jobs, while only three jobs are created by the same investment in the fossil fuel sector (Sharma et al., 2021). Circularizing healthcare has already demonstrated economic benefits at the local level, as U.S. hospitals in the process of phasing out SUPs have seen annual savings as high as $51,000 from swapping out only one single-use product (North & Halden, 2013). If the U.S. heeds COVID’s lessons of the environmental dangers of SUP reliance and provides the necessary resources for a CE transition, it is estimated that the CE could be implemented within a few decades (Geels, 2019). 

In the interim before a concerted LE to CE transition, the impact of individual hospitals’ sustainability efforts should not be understated. Local nurse-led teams known as “Green Teams,” which identify opportunities for sustainable improvements within their healthcare facilities, are emerging across the U.S. and abroad. Green Team strategies include designating recycling bins for high-traffic areas and collaborating with materials managers to ensure environmentally conscious material procurement. To establish a more structured national network of sustainable healthcare facilities, the WHO has stressed the necessity of government involvement in Green Team funding and operations, which are currently funded primarily by grants from NGOs like Healthcare Without Harm. (Mejia et al., 2009). Regardless of the presence of government funding, the WHO encourages all hospitals to follow a general plan for establishing a Green Team that can identify areas for improvement in current hospital practices and implement sustainable solutions (Figure 2; “WHO Guidance,” 2020). 

Figure 2: The WHO’s five-step plan for creating a Green Team (“WHO Guidance,” 2020) 

The most significant challenge in creating a sustainable healthcare system is phasing out difficult-to-recycle, non-renewable SUPs in favor of bioplastics: recyclable, renewable plastics derived from degradable biomass like cellulose, microbes, and starch as opposed to petroleum (Jiang et al., 2022). The most promising bioplastic in the medical context is FDA-approved Polylactic Acid (PLA) because of its similar physical properties to Polystyrene (PS). PS is one of the most common polymers found in healthcare devices and disposables (Trail, 2021) despite being difficult to recycle and likely carcinogenic (“Styrene,” 2011). Unlike PS, PLA is biocompatible due to being derived from harmless lactic acid, indicating future applicability to both healthcare equipment and bodily inserts like heart pumps and catheters (Jiang et al., 2022). While the most efficient recycling methods remain a developing component of bioplastic research (Rai et al., 2023), the large-scale integration of PLA (among other bioplastics) into healthcare faces more significant challenges from economic and infrastructural standpoints, which would be addressed with the transition to a CE (Mittal et al. 2022).  

Sustainable healthcare can function as a core pillar of a circularized America.

A sustainable healthcare system is inherently beneficial to the health of the public, which grows increasingly at-risk to the harmful pollutants released during the production and degradation of our plastic-reliant world (Rai et al., 2023). A major change to the status quo would not be quick, easy, or cheap. However, both the U.S. government and its citizens cannot bury their heads in the sand and wish away the changing climate, plastic pileups, and ruined ecosystems that our single-use way of life has brought upon us.

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Images:

Sharma, H. B., Vanapalli, K. R., Samal, B., Cheela, V. R. S., Dubey, B. K., & Bhattacharya, J. (2021). Circular economy approach in solid waste management system to achieve UN-SDGs: Solutions for post-COVID recovery. Science of the Total Environment, 800, 149605. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9622352/#bb0545  

WHO Guidance for Climate-Resilient and Environmentally Sustainable Health Care Facilities. (2020). https://iris.who.int/bitstream/handle/10665/335909/9789240012226-eng.pdf?sequence=1