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The paradox
Health care exists to protect health, yet the energy, supply chains and waste it depends on add to the pollution and climate change that harm health. A planetary health perspective asks nurses to see this as part of their responsibility for population health.
How large is the footprint?
In the United States. Using economic input–output life cycle assessment of national health expenditures from 2003 to 2013, Eckelman and Sherman (2016) estimated that in 2013 the health care sector was responsible for about 10% of US greenhouse gas emissions, 12% of acid rain, 10% of smog formation and 9% of criteria air pollutants. They estimated the resulting health damages at 470,000 disability-adjusted life years (DALYs) lost from pollution-related disease. The authors noted that this indirect burden is of the same order as the harm from preventable medical errors in hospitals, but it isn't attributed to the health system.
Globally. A multiregional input–output analysis found that health care's share of global environmental impacts ranged from 1% to 5% depending on the indicator, including greenhouse gas emissions, particulate matter, air pollutants, malaria risk, reactive nitrogen in water and scarce water use, and was above 5% for some national impacts (Lenzen et al., 2020). The authors described adverse feedback cycles: expanding health care to treat environment-related disease increases its environmental impact.
Where the emissions come from
Both studies show that most of the footprint lies in supply chains, such as electricity, pharmaceuticals, medical devices and food, rather than in emissions from hospital buildings alone. This matters for nursing, because many supply-chain decisions are clinical ones.
A nurse-led reduction plan for a hospital
| Area | Nursing-led actions |
|---|---|
| Clinical supplies | Review standard procedure packs to remove items that are routinely discarded unopened; use reusable items, such as gowns and sharps containers, where safe |
| Waste | Train staff to segregate regulated medical waste from general waste, since regulated waste needs more energy-intensive treatment |
| Pharmaceuticals | Work with pharmacy to reduce waste from discarded doses; support appropriate prescribing |
| Low-value care | Join efforts to reduce unnecessary tests and treatments, which avoid both cost and environmental impact |
| Energy | Partner with facilities teams on switching off equipment and lighting in unused areas |
| Anesthesia and respiratory care | Support anesthesia colleagues in reviewing gases with high warming potential, and teach correct inhaler use so inhalers aren't wasted |
Measuring progress
The project will track regulated medical waste per patient-day, the cost and weight of unused supply items in procedure packs, and staff participation, and will report emissions estimates with the hospital's sustainability office.
Equity and advocacy
Pollution and climate effects fall hardest on communities already facing poor health. Nurses can advocate for health systems to report their emissions, set reduction targets and include environmental impact in quality and safety efforts, as Eckelman and Sherman (2016) recommend.
Conclusion
Health care's environmental footprint is large and largely invisible to clinicians. Because so much of it flows from everyday clinical choices, DNP-prepared nurses are well placed to lead change that protects both patients and the planet.
References
Eckelman, M. J., & Sherman, J. (2016). Environmental impacts of the U.S. health care system and effects on public health. PLOS ONE, 11(6), Article e0157014. https://doi.org/10.1371/journal.pone.0157014
Lenzen, M., Malik, A., Li, M., Fry, J., Weisz, H., Pichler, P.-P., Chaves, L. S. M., Capon, A., & Pencheon, D. (2020). The environmental footprint of health care: A global assessment. The Lancet Planetary Health, 4(7), e271–e279. https://doi.org/10.1016/S2542-5196(20)30121-2
