Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-30T19:13:24.881Z Has data issue: false hasContentIssue false
  • English
  • Français

Can United States Healthcare Become Environmentally Sustainable? Towards Green Healthcare Reform

Published online by Cambridge University Press:  27 January 2021

Cristina Richie
Get access Rights & Permissions [Opens in a new window]

Abstract

In 2014, the United States health care industry produced an estimated 480 million metric tons of carbon dioxide (CO2); nearly 8% of the country's total emissions. The importance of sustainability in health care — as a business reliant on fossil fuels for transportation, energy, and operational functioning — is slowly being recognized. These efforts to green health care are incomplete, since they only focus on health care structures. The therapeutic relationship is the essence of health care — not the buildings that contain the practice. As such, this article will first postulate reasons for a lack of environmental sustainability in US health care. Second, the article will focus on current green health care initiatives in the United States in which patients and physicians participate. Third, the rationale for participation in green initiatives will be explained. Fourth, the article will propose that, based on the environmental values of patients and physicians, health care insurance plans and health care insurance companies can be targeted for green health care reform, thereby closing the loop of sustainable health care delivery.

Type
Symposium Articles
Information
Journal of Law, Medicine & Ethics , Volume 48 , Issue 4: Climate Change and the Legal, Ethical, and Health Issues Facing Healthcare and Public Health Systems , Winter 2020 , pp. 643 - 652
Copyright
Copyright © American Society of Law, Medicine and Ethics 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Pichler, P., et al., “International Comparison of Health Care Carbon Footprints,” Environmental Research Letters 14, no. 6 (2019): 064004.CrossRefGoogle Scholar
Costello, A., et al., “Managing the Health Effects of Climate Change,” Lancet 373, no. 9676 (2009): 1693–1733.Google Scholar
See Costello, supra note 2.Google Scholar
See Pichler, supra note 1.Google Scholar
Richie, C., Principles of Green Bioethics: Sustainability in Health Care (East Lansing: Michigan State University Press, 2019): 16.CrossRefGoogle Scholar
Eckelman, M. J. and Sherman, J., “Environmental Impacts of the U.S. Health Care System and Effects on Public Health,” PLoS ONE 1, no. 6 (2016): e0157014.Google Scholar
Tomson, C., “Reducing the Carbon Footprint of Hospital-Based Care,” Future Hospital Journal 2, no. 1 (2015): 57–62.CrossRefGoogle Scholar
McGain, F. and Naylor, C., “Environmental Sustainability in Hospitals — A Systematic Review and Research Agenda,” Journal of Health Services Research & Policy 19, no. 4 (2014): 245–252.CrossRefGoogle Scholar
Law, A., et al., “Medical Organisations Must Divest From Fossil Fuels,” BMJ 363 (2018): k516.Google Scholar
Wolske, K. and Hoffman, A. J., Hydraulic Fracturing in the State of Michigan — Public Perceptions Technical Report 2, no. 8 (2013): 1–36.Google Scholar
Coates, P. A., The Trans-Alaska Pipeline Controversy: Technology, Conservation, and the Frontier (Lehigh: Lehigh University Press, 1991).Google Scholar
Slone, D., “The Michigan Environmental Protection Act: Bringing Citizen-Initiated Environmental Suits into the 1980’s,” Ecology Law Quarterly 12, no. 2. (1984): 271–362.Google Scholar
Houck, O., “The Endangered Species Act and its Implementation by the US Departments of Interior and Commerce,” University of Colorado Law Review 64, no. 2 (1993): 277–358.Google Scholar
Hersher, R., “U.S. Formally Begins to Leave the Paris Climate Agreement,” NPR, November 4, 2019, available at <https://www.npr.org/2019/11/04/773474657/u-s-formally-begins-to-leave-the-paris-climate-agreement> (last visited August 11, 2020).+(last+visited+August+11,+2020).>Google Scholar
Sovacool, B., The Dirty Energy Dilemma: What’s Blocking Clean Power in the United States: What‘s Blocking Clean Power in the United States (Santa Barbara: ABC-CLIO, 2008).Google Scholar
Obama, B., “United States Health Care Reform: Progress to Date and Next Steps,” JAMA 316, no. 5 (2016): 525–532.Google Scholar
Blendon, R., et al., “Voters and Health Reform in the 2008 Presidential Election,” New England Journal of Medicine 359, no. 19 (2008): 2050–2061.Google Scholar
Oberlander, J., “Repeal, Replace, Repair, Retreat — Republicans: Health Care Quagmire,” New England Journal of Medicine 377, no. 11 (2017): 1001–1003.Google Scholar
Hacker, J. S., The Divided Welfare State: The Battle Over Public and Private Social Benefits in the United States (Cambridge: Cambridge University Press, 2002).CrossRefGoogle Scholar
Blumenthal, D., “Employer-Sponsored Health Insurance in the United States — Origins and Implications,” New England Journal of Medicine 355, no. 1 (2006): 82–88.CrossRefGoogle Scholar
Topf, M., “Psychological Explanations and Interventions for Indifference to Greening Hospitals,” Health Care Management Review 30, no. 1 (2005): 2–8.Google Scholar
American Psychological Association Task Force on the Interface Between Psychology and Global Climate Change, Psychology and Global Climate Change: Addressing a Multi-faceted Phenomenon and Set of Challenges (2009): 1–230.Google Scholar
Practice Greenhealth, “Sustainability Solutions for Health Care,” 2020, available at <https://practicegreenhealth.org/> (last visited November 4, 2020).+(last+visited+November+4,+2020).>Google Scholar
Health Care Without Harm, n.d., available at <https://noharm.org/> (last visited August 11, 2020).+(last+visited+August+11,+2020).>Google Scholar
Practice Greenhealth, “The Legacy of Healthier Hospitals,” 2020, available at <https://practicegreenhealth.org/healthierhospitals> (last visited August 11, 2020).+(last+visited+August+11,+2020).>Google Scholar
Buffoli, M., et al., Healthcare Sustainability Evaluation Systems. Improving Sustainability During Hospital Design and Operation (Cham: Springer, 2015).Google Scholar
See American Psychological Association Task Force, supra note 22.Google Scholar
Schneiderman, L. J. and Jecke, N. S., Wrong Medicine: Doctors, Patients, and Futile Treatment (Baltimore: Johns Hopkins University Press, 2011).Google Scholar
Richie, C., “Greening the End of Life: Refracting Clinical Ethics through an Ecological Prism,” in Lysaught, M. T. and McCarthy, M., eds., Catholic Bioethics and Social Justice: The Praxis of US Health Care in a Globalized World (Collegeville: Liturgical Academic Press, 2018): 129–142.Google Scholar
Bauer, U. E., et al. “Prevention of Chronic Disease in the 21st Century: Elimination of the Leading Preventable Causes of Premature Death and Disability in the USA,” The Lancet 384, no. 9937 (2014): 45–52.CrossRefGoogle Scholar
See American Psychological Association Task Force, supra note 22.Google Scholar
Emanuel, E., et al., “Fair Allocation of Scarce Medical Resources in the Time of Covid-19,” New England Journal of Medicine 382 (2020): 2049–2055.CrossRefGoogle Scholar
DiPaola, M. and Garasic, M. Daniel, “The Dark Side of Sustainability: On Avoiding, Engineering, and Shortening Human Lives in the Anthropocene,” Rivista di Studi sulla Sostenibilita 3, no. 2 (2013): 59–81.Google Scholar
Brundtland, G. H., Report of the World Commission on Environment and Development: “Our Common Future” (New York: United Nations, 1987): 16.Google Scholar
England, P., “Problems and Prospects for the Implementation of Sustainable Development in Developing Countries: A Critique of the Brundtland Report,” Griffith Law Review 2 (1993): 147.Google Scholar
Dhillon, V. and Kaur, D., “Green Hospital and Climate Change: Their Interrelationship and the Way Forward,” Journal of Clinical and Diagnostic Research: JCDR 9, no. 12 (2015): LE01.Google Scholar
Casey, E., “Changing Hearts: The Future of the Environmental Movement,” Global Tides 5, art. 8 (2011): 1–19.Google Scholar
NHS Sustainable Development Unit, Saving Carbon, Improving Health: NHS Carbon Reduction Strategy for England (London: NHS Sustainable Development Unit, 2009).Google Scholar
Morgan, D. J., et al. “Setting a Research Agenda for Medical Overuse,” BMJ 351 (2015): h453.Google Scholar
Bebinger, M., “Has Your Doctor Talked To You About Climate Change?” NPR, July 13, 2019, available at <https://www.npr.org/sections/health-shots/2019/07/13/734430818/has-your-doctor-talked-to-you-about-climate-change> (last visited October 19, 2020).+(last+visited+October+19,+2020).>Google Scholar
King, L. and Brown, J., “Clinical Case: Educating Patients as Medicine Goes Green,” Virtual Mentor 11, no. 6 (2009): 427–433.Google Scholar
Duane, B., et al. “An Estimated Carbon Footprint of NHS Primary Dental Care Within England. How Can Dentistry Be More Environmentally Sustainable?” British Dental Journal 223, no. 8 (2017): 589–593.CrossRefGoogle Scholar
Morris, D. S., et al., “The Carbon Footprint of Cataract Surgery,” Eye 27 (2013): 495–501.CrossRefGoogle Scholar
Berners-Lee, M., How Bad Are Bananas? The Carbon Footprint of Everything (London: Profile Book, 2010).Google Scholar
Lim, A.E., et al., “The Carbon Footprint of an Australian Satellite Haemodialysis Unit,” Australian Health Review 37 (2013): 369–374.Google Scholar
Campion, N., et al., “Life Cycle Assessment Perspectives on Delivering an Infant in the US,” Science of the Total Environment 425 (2012): 191–198.CrossRefGoogle Scholar
Murtaugh, P. and Schla, M. G., “Reproduction and the Carbon Legacies of Individuals,” Global Environmental Change 19 (2009): 14–20.CrossRefGoogle Scholar
Woods, D., et al., “Comparison of the Environmental Impact of Commonly Used Surgical Approaches to Hysterectomy,” Gynecologic Oncology 1, no. 130 (2013): e143.CrossRefGoogle Scholar
Pollard, A. S. et al., “The Carbon Footprint of Acute Care: How Energy Intensive is Critical Care?” Public Health 128, no. 9 (2014): 771–776.Google Scholar
Lyle, K., et al., “Carbon Cost of Pragmatic Randomised Controlled Trials: Retrospective Analysis of Sample of Trials,” BMJ 339 (2009): b4187.CrossRefGoogle Scholar
See Duane, et al., supra note 42.Google Scholar
Maugha, D. L., Determining an Approach to Estimating the Carbon Footprint of Mental Health Care that is Fit for Purpose, Dissertation, University of Warwick, 2016.Google Scholar
Richie, C., “What Would An Environmentally Sustainable Reproductive Technology Industry Look Like?” Journal of Medical Ethics 41, no. 5 (2015): 383–387.Google Scholar
Sackett, C. R., “Ecotherapy: A Counter to Society’s Unhealthy Trend?” Journal of Creativity in Mental Health 5, no. 2 (2010): 134–141.CrossRefGoogle Scholar
Reuben, A., “Science’s Newest Miracle Drug is Free,” Outside Magazine, May 1, 2019, available at <https://www.outside-online.com/2393660/science-newest-miracle-drug-free> (last visited August 11, 2020).+(last+visited+August+11,+2020).>Google Scholar
Dadvand, P., et al., “Lifelong Residential Exposure to Green Space and Attention: A Population-Based Prospective Study,” Environmental Health Perspectives 125, no. 9 (2017): 1–8.Google Scholar
Hawkins, B., et al., “Nature-Based Recreational Therapy for Military Service Members: A Strengths Approach,” Therapeutic Recreation Journal 50, no. 1 (2016): 55–74.Google Scholar
Fraser, S., “Extinction Rebellion: Who is The BMJ Calling Radical Environmentalists?” BMJ 365 (2019): l2256.CrossRefGoogle Scholar
Physicians for Social Responsibility, “Environment and Health,” n.d., available at <https://www.psr.org/issues/environment-health/> (last visited August 11, 2020).+(last+visited+August+11,+2020).>Google Scholar
Sarfaty, M., Gould, R. J., and Maibach, E. W., “Medical Alert! Climate Change is Harming our Health,” presented at the Medical Society Consortium on Climate and Health, Fairfax, VA, 2017.Google Scholar
Crowley, R., “Climate Change and Health: A Position Paper of the American College of Physicians,” Annals of Internal Medicine 164, no. 9 (2016): doi: 10.7326/M15-2766Google Scholar
Thiel, C., Duncan, P., and Woods, N., “Attitude of US Obstetricians and Gynaecologists to Global Warming and Medical Waste,” Journal of Health Services Research & Policy 22, no. 3 (2017): 162–167.CrossRefGoogle Scholar
Riaz, A., Younis, A., Ali, W., Hameed, M., “Well-Planned Green Spaces Improve Medical Outcomes, Satisfaction and Quality of Care: A Trust Hospital Case Study,” International Conference on Landscape and Urban Horticulture 881 (2009): 813–818.Google Scholar
Casey, M.L., et al., “Health Problems and Disinfectant Product Exposure Among Staff at a Large Multispecialty Hospital,” American Journal of Infection Control 45, no. 10 (2017): 1133–1138.CrossRefGoogle Scholar
Jameton, A. and McGuire, C., “Toward Sustainable Health-care Services: Principles, Challenges, and a Process,” International Journal of Sustainability in Higher Education 3, no. 2 (2002): 113–127.Google Scholar
Institute of Medicine, Green Healthcare Institutions: Health, Environment, and Economics: Workshop Summary (Washington, DC: The National Academies Press, 2007).Google Scholar
Ghersin, Z., et al., “Going Greener: Decreasing Medical Waste in a Pediatric Intensive Care Unit,” The New Bioethics 26, no. 2 (2020): 93–110.Google Scholar
Scarborough, P., et al., “Dietary Greenhouse Gas Emissions of Meat-Eaters, Fish-Eaters, Vegetarians and Vegans in the UK,” Climatic Change 125, no. 2 (2014): 179–192.Google Scholar
Barnard, N. D., “The Physician’s Role in Nutrition-Related Disorders: From Bystander to Leader,” AMA Journal of Ethics 15, no. 4 (2013): 367–372.Google Scholar
Storz, M. A., “Plant-Based Nutrition and Chronic Illness,” The New Bioethics 26, no. 2 (2020): 141–157.Google Scholar
Garnett, E. E., et al., “Impact of Increasing Vegetarian Availability on Meal Selection and Sales in Cafeterias,” Proceedings of the National Academy of Sciences 116, no. 42 (2019): 20923–20929.CrossRefGoogle Scholar
Teherani, A., et al. “Identification of Core Objectives for Teaching Sustainable Healthcare Education,” Medical Education Online 22, no. 1 (2017): 1386042.CrossRefGoogle Scholar
Medical Students for a Sustainable Future (MS4SF), Guide to Climate and Health Curriculum Reform in Medical Schools, n.d., available at <https://docs.google.com/document/d/1lwLv-PZXZTymWbPLTB3604dvnOvg2gKntIoBo7QH-6c/edit> (last visited August 11, 2020).+(last+visited+August+11,+2020).>Google Scholar
Walpole, S., et al. “Exploring Emerging Learning Needs: A UK-Wide Consultation on Environmental Sustainability Learning Objectives for Medical Education,” International Journal of Medical Education 6 (2015): 191–200.CrossRefGoogle Scholar
American Board of Internal Medicine, Choosing Wisely: An Initiative of the ABIM Foundation (Philadelphia: ABIM Foundation), 2020, available at <https://www.choosingwisely.org/> (last visited August 11, 2020).+(last+visited+August+11,+2020).>Google Scholar
British Medical Journal, “Too Much Medicine Initiative,” n.d., available at <https://www.bmj.com/too-much-medicine> (last visited August 11, 2020).+(last+visited+August+11,+2020).>Google Scholar
Nottinghamshire Healthcare NHS Trust, “NICE ‘Do Not Do”’Recommendations,” 2013, available at <https://www.nice.org.uk/media/default/sharedlearning/716_716donotdobookletfinal.pdf> (last visited August 11, 2020).+(last+visited+August+11,+2020).>Google Scholar
Harris, A. M., Hicks, L. A., and Qaseem, A., “Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care from the American College of Physicians and the Centers for Disease Control and Prevention,” Annals of Internal Medicine 164, no. 6 (2016): 425–434.Google Scholar
Schwartz, A., et al., “Measuring Low-Value Care in Medicare,” JAMA Internal Medicine 174, no. 7 (2014): 1067–1076.Google Scholar
Gutiérrez, L. Quecedo, et al., “‘Do Not Do’ Recommendations of the Spanish Society of Anaesthesiology, Critical Care and Pain Therapy,” Commitment to Quality by Scientific Societies,” Project Revista Española de Anestesiología y Reanimación (English Edition) 63, no. 9 (2016): 519–527.Google Scholar
Saine, A., “Sustainability and the Patient Experience,” Green-health Magazine, October 16, 2015, available at <https://magazine.practicegreenhealth.org/sustainability-and-the-patient-experience/> (last visited August 11, 2020).+(last+visited+August+11,+2020).>Google Scholar
Dietz, T., Fitzgerald, A., and Shwom, R., “Environmental Values,” Annual Review of Environmental Resources 30 (2005): 335–372.Google Scholar
Naess, A. and Sessions, G., “The Basic Principles of Deep Ecology,” The Trumpeter 3, no. 4 (1986).Google Scholar
Maughan, D., Berry, H., and Davison, P., “What Psychiatrists Should Know About Environmental Sustainability and What They Should Be Doing About It,” International Psychiatry 11, no. 2 (2014): 27–30.Google Scholar
Doherty, T. and Clayton, S., “The Psychological Impacts of Global Climate Change,” American Psychologist 66, no. 4 (2011): 265.CrossRefGoogle Scholar
Watts, N., et al. “The Lancet Countdown: Tracking Progress on Health and Climate Change,” The Lancet 389, no. 10074 (2017): 1151–1164.CrossRefGoogle Scholar
Macpherson, C. C. and Wynia, M., “Speaking Up: Are Health Professionals Obligated to Advocate for Actions to Reduce the Health Risks of Climate Change?” AMA Journal of Ethics 19, no. 12 (2017): 1202–1210.Google Scholar
Pearson, D., Walpole, S., and Barna, S., “Challenges to Professionalism: Social Accountability and Global Environmental Change,” Medical Teacher 37, no. 9 (2015): 825–830.CrossRefGoogle Scholar
Yarlagadd, S., et al., “Sustainable Psychiatry in the UK,” The Psychiatrist 38, no. 6 (2014): 285–290.Google Scholar
Sarfaty, M., et al., “A Survey of African American Physicians on the Health Effects of Climate Change,” International Journal of Environmental Research and Public Health 11, no. 12 (2014):12473–12485.CrossRefGoogle Scholar
Tinney, V., et al., “Medical Education for Obstetricians and Gynecologists Should Incorporate Environmental Health,” American Journal of Obstetrics and Gynecology 212, no. 2 (2015): 163–166.CrossRefGoogle Scholar
Chandra, P., Franzco, J. G., Franzco, N. Murray, “New Zealand Ophthalmologists Opinions and Behaviours on Climate, Carbon, and Sustainability,” Clinical & Experimental Ophthalmology, 2020, available at <10.1111/ceo.13727> (last visited August 11, 2020).+(last+visited+August+11,+2020).>Google Scholar
Jameton, A., “Dilemmas of Moral Distress: Moral Responsibility and Nursing Practice,” AWHONN”s Clinical Issues in Peri-natal and Women’s Health Nursing 4, no. 4 (1993): 542–551.Google Scholar
Jameton, A., “A Reflection on Moral Distress in Nursing Together with a Current Application of the Concept,” Journal of Bioethical Inquiry 10, no. 3 (2013): 297–308.Google Scholar
Fischer, M., “Fit for the Future? A New Approach in the Debate about What Makes Healthcare Systems Really Sustainable,” Sustainability 7, no. 1 (2015): 294–312.Google Scholar
Lee, L. M., “A Bridge Back to the Future: Public Health Ethics, Bioethics, and Environmental Ethics,” The American Journal of Bioethics 17, no. 9 (2017): 5–12.CrossRefGoogle Scholar
Berchick, E. R., Barnett, J. C., and Upton, R. D., “Health Insurance Coverage in the United States: 2018,” Report Number P60-267 (RV) (November 08, 2019), at 2.Google Scholar
Folger, J., “How to Choose Between Bronze, Silver, Gold and Platinum Health Insurance Plan,” Forbes, October 1, 2013, available at <https://www.forbes.com/sites/investopedia/2013/10/01/how-to-choose-between-bronze-silver-gold-and-platinum-health-insurance-plans/#1fbcb1c22b2e> (last visited August 11, 2020).+(last+visited+August+11,+2020).>Google Scholar
Blue Cross of Massachusetts, “Perks,” 2015, available at <http://www.studentbluema.com/perks.php> (last visited August 11, 2020).+(last+visited+August+11,+2020).>Google Scholar
Beauchamp, T. and Childress, J., Principles of Biomedical Ethics, 4th ed. (New York: Oxford University Press, 1994), 16.Google Scholar
Darling, H., “Health Care Reform: Perspectives from Large Employers,” Health Affairs 29, no. 6 (2010):1220–1224.Google Scholar
Petri, J., “Airline Carbon Plan Takes a Step Forward While Carriers Suffer,” Bloomberg, March 15, 2020, available at <https://www.bloomberg.com/news/articles/2020-03-16/airline-carbon-offset-plan-moves-forward-as-the-industry-suffers> (last visited August 11, 2020).+(last+visited+August+11,+2020).>Google Scholar
In British Columbia (Canada) the Climate Change Accountability Act and the Carbon Neutral Government Regulation required that all public sector organizations achieve carbon neutrality. Under this program, Providence Health Care and other health care companies purchase carbon off-sets. See Providence Health Care, Carbon Neutral Action Report (2019), available at <https://www2.gov.bc.ca/assets/gov/environment/climate-change/cnar/2019/ha/final_providence_health_care_2019_overview.pdf> (last visited August 11, 2020).+(last+visited+August+11,+2020).>Google Scholar
Network for Business Sustainability, “Three Reasons Job Seekers Prefer Sustainable Companies,” Green Biz, June 28, 2013, available at <https://www.greenbiz.com/article/three-reasons-job-seekers-prefer-sustainable-companies> (last visited August 11, 2020).+(last+visited+August+11,+2020).>Google Scholar
Biviano, E. L., et al., “Is Fossil Fuel Investment a Sin?” Health Care Ethics USA 26, no. 1 (2018): 1–8.Google Scholar
See Practice Greenhealth, supra note 23.Google Scholar
See Health Care Without Harm, supra note 24.Google Scholar
See Practice Greenhealth, supra note 25.Google Scholar
Catholic Health Association and Practice Greenhealth, Environmental Sustainability: Getting Started Guide (St. Louis: The Catholic Health Association of the United States, 2010).Google Scholar
Deo, R. P., “Pharmaceuticals in the Surface Water of the USA: A Review,” Current Environmental Health Reports 1, no. 2 (2014): 113–122.CrossRefGoogle Scholar
Roberts, I., “The NHS Carbon Reduction Strategy,” BMJ 38, no. 7689 (2009): 248–249, at 248.Google Scholar
Sustainable Development Unit for NHS England and Public Health England, “Reducing the Use of Natural Resources in Health and Social Care: 2018 Report,” 2018, available at <https://www.sduhealth.org.uk/documents/Policy%20and%20strategy/20180912_Health_and_Social_Care_NRF_web.pdf> (last visited August 11, 2020).+(last+visited+August+11,+2020).>Google Scholar
Ehrenreich, B. and Ehrenreich, J., “The Medical industrial Complex,” The Body Politic 1, no. 1 (1970): 16–29.Google Scholar
Mitchell, A. and Helsel, P., “Drug CEO Will Lower Price of Daraprim After Hike Sparked Outrage,” NBC News, December 18 2015, available at <https://www.cnbc.com/2015/09/22/drug-ceo-will-lower-price-of-daraprim-after-hike-sparked-outrage.html> (last visited August 11, 2020).+(last+visited+August+11,+2020).>Google Scholar
Macpherson, C. C., et al., “Does Health Promotion Harm the Environment?” The New Bioethics 26, no. 2 (2020): 158–175.CrossRefGoogle Scholar