FIA Health Award 2024 – sustainability in healthcare

It is the natural changes and unnatural changes (caused by humans) in the weather and temperature of our planet, which threaten the environment and its balance, in addition to the well-being and lives of humans.

The consequences of climate change appear mainly in:

Global warming, air pollution with its declining quality and increasing allergies, increasing human diseases, global food crises, social and economic impacts, and profound health crises.

So, to mitigate its effects, it is necessary to:

Periodic assessment and preparedness to confront disasters, adapt to them and move towards environmental sustainability, cooperation to promote health, and climate-resilient development.

Unfortunately, healthcare is directly affected by climate change in the current century, which can also be seen as a "health emergency".

It is now well established that pollution (air pollution, water pollution, soil pollution) contributes significantly to climate change and the destruction of ecosystems, causing the death of about 9 million people worldwide from pollution-related diseases (mainly Respiratory Diseases, Heart Diseases, Endocrine Disorders, Neurological Disorders, cancer, Thermal Stress, Malaria, Malnutrition, etc.), with an expected additional annual increase in these deaths between 2030 and 2050 by 250 thousand deaths.

The Environmental Quality is affected by the production of energy from fuels that pollute the air by increasing harmful emissions of: carbon monoxide, carbon dioxide, sulfur oxides, nitrogen oxides and others, causing global warming and rising global temperatures. On the other hand, we must acknowledge the painful truth that health care is a significant daily contributor to the climate crisis, through approximately 4.6 % of global greenhouse gas emissions.

Therefore, we must shift to clean and renewable energy sources such as solar energy, and the healthcare sectors must take the initiative toward more environmentally sustainable individual and collective practices, whether in clinics or operating rooms.

The health sector plays an important role in maintaining the health of people and the earth and at the same time plays an important role in the economic development of countries. This is optimally fulfilled by achieving the principle of sustainable health care that ensures the provision of its services at acceptable prices to all segments of society while reducing its environmental impacts.

This sector certainly contributes to climate change, as health care negatively affects the environment (air, soil, water, environmental balance …) through its generation of waste and pollutant emissions and greenhouse gases in addition to its consumption of resources. These result from the generation and consumption of the necessary energy, pharmaceutical preparations and their waste, the use of medical supplies and equipment, sanitation, and others.

This highlights the importance of achieving sustainability in healthcare, which will bring environmental, social and financial benefits.

• Climate change in the current century causes the premature death of about 9 million people every year and is therefore considered a "Health Threat".
• After the Industrial Revolution, climate change accelerated, as carbon in the atmosphere increased by 30 %, and global temperatures rose by about 1.1 degrees Celsius.
• Healthcare causes 4.4 % of total global greenhouse emissions (high-income countries are the main polluters), and 75 % of the waste generated from it is buried, and here it must be noted that this waste has increased during the Covid-19 pandemic.
• Operating rooms, despite their small area within the hospital, generate a third of its waste and consume 3 – 6 times more energy than the rest of its parts.
• More than 50 countries have committed to developing sustainable health systems, and at least 14 countries have committed to achieving zero carbon emissions by 2050 or earlier.
• Studies have reported that medical professionals are aware of the seriousness of climate change and are willing to contribute to sustainability strategies.

There are tremendous opportunities to improve environmental sustainability in the healthcare sector and achieve an environmentally sustainable health system, which can be defined as follows:

It is the health system that ensures health, maintains it, improves it, or even restores it, and at the same time reduces the negative repercussions of health care on the climate and environment, leading to positive results on the health and well-being of the Earth’s current and future inhabitants, with this being reflected on the three aspects: social, economic, and environmental.

To achieve this system, the following principles were proposed:

1. Focus on preventing diseases and thus reducing the required health services.
2. Achieving a balance between supply and demand for support and health services
3. Reducing polluting emissions from provided health services.

With increasing individual and collective environmental awareness of the contribution of health care to pollution and climate change, a non-governmental organization concerned with sustainability in this field has been established, called "Global Green and Healthy Hospitals" (GGHH).

Today, according to their official website, GGHH includes more than 1,900 members in addition to 70,000 hospitals and health centers, from 86 countries.

In 2021, this collaborative network launched a global roadmap for sustainable health care without carbon emissions, based on the following points:

1. Relying on renewable environmental sources to provide clean electrical energy.
2. Sustainability in the used infrastructure and places where health services are provided without emissions.
3. Transportation and supply without emissions.
4. Providing healthy foods from sustainably grown crops.
5. Encouraging and strengthening the pharmaceutical industries to produce low-carbon compounds.
6. Reducing waste generation and recycling it sustainably.
7. Achieving greater effectiveness of the health system.

Despite the seriousness of climate change and the effects of global warming on the Earth and humans, the risk of the effects of high temperature on human life & physical and mental health continues to be underestimated, which is especially exacerbated among vulnerable ages, young and old, and is also linked to several general factors (Economic and social), in addition to one of the past studies linking increased suicide rates to high-temperature rates (1 % versus +1 °C).

These effects result from a thermal imbalance through a series of physiological reactions and biological and psychological responses, that depending on the imbalance severity, lead to: Mild Discomfort - Thirst - Sweating - Dehydration - Anxiety and Confusion - Depression - Sleep Disturbance - Coma - Organ Damage. They are also accompanied by effects on the heart and circulatory system, and even increase the risk of a blood clot.

All of the above constitutes another incentive for us to implement the principle of environmental sustainability in the healthcare sector, as it is a major contributor to climate change and global warming.

Frugal Innovation may be for a product, technology, or even a service, and is characterized by simplicity and reducing the use and consumption of resources, as well as reducing emissions and pollution at various stages from production to usage and ending with recycling, to achieve triple gains (at the aspects of the environment, society, and economy). This innovation is driven by necessities for poor countries, while it is a choice for rich ones.

Frugal Innovation establishes the equation of low costs and availability at an acceptable cost for all, regardless of their income level. Therefore, we find that sustainable health innovations with low costs are mainly concentrated in both middle- and low-income countries.

The following are environmentally sustainable models of Frugal Innovation:

1. Using Kangaroo Mother Care (KMC) for premature infants as an alternative to incubators.
2. General Electric (GE MAC 400 ECG) portable and lightweight ECG machine.
3. Storing insulin in a cold environment in clay pots, especially in cases of climate disasters and the absence of electricity.
4. Portable MRI system "Swoop" that does not require cooling or special power sources.

Hospital operating rooms are the main source of waste and pollutants. Although they do not occupy a large area of the hospital, they generate about a third of the total waste.

Hence, great efforts have been made for more than a decade to achieve environmentally sustainable practices in operating rooms, or so-called green practices, to reduce waste and save the potential costs of destroying and recycling it. This is achieved through appropriate streamlining of procedures and processes with practices that generate recyclable waste and a focus on reusable equipment and materials in conditions of complete sterility and complete safety for patients.

Some recyclable materials can be mentioned:

Paper and cardboard packaging, polyethylene wrappers, packaging of medical gloves and syringes, Peel Pouch Sterilization, packaging of surgical sutures, plastic bottles, Sterilization wrapping paper.

Environmental sustainability is achieved through several things, most notably, shifting from polluting energy from fossil fuels to clean energy from renewable natural sources. At the same time, according to the Global Roadmap (2021) for Sustainable Healthcare, the effectiveness of the health system must be increased.

All of the above have been in the works for decades in China by increasing spending on health and promoting sustainability through energy generation from renewable sources. Based on the results of a Chinese study, it became clear that there is a positive correlation between the average lifespan of an individual and each of the previous two factors, which led to an increase in average life expectancy, with good general health and long-term productivity, which is reflected in endogenous growth and human capital.

Achieving environmental sustainability in the health system requires reducing individuals’ demand for health services, through promoting public health and preventing diseases, which leads to a decrease in healthcare costs and resulting emissions.

With the huge increase in the number of mobile phone users, it was necessary to use and benefit from this technology to find innovative solutions in the field of health education and awareness to achieve the previous principle within what is called mobile health (Mobile Health / m-Health) through health literacy and behavioral reinforcement. Proper health skills and chronic disease management. The short message service (SMS) was used in this, which has proven its usefulness and effectiveness in promoting health self-management, because SMS is common, popular, and low-cost with the possibility of applying it in developing and advanced countries, and its superiority over other educational methods such as lectures and booklets has been proven.

Doctors from various specialties are interested in climate change and want to contribute to upcoming strategies towards environmental sustainability. However, they face many obstacles and barriers, including the need for more information on this topic, a lack of support and resources, and a lack of time and incentives.

From their perspective, physicians see the need for systematic and fundamental change in the health care system, with sustainability being incorporated into plans, curricula, and continuing medical education.

They also emphasize enhancing sustainability in the work and basic practices of doctors so that it becomes part of their daily routine, recycling and sustainability in operating rooms, with the necessity of providing environmentally sustainable surgical equipment and supplies without neglecting quality standards.

Environmental sustainability must be an additional goal for health care, because this sustainability supports it in achieving its basic goals, while health care effectively contributes to environmental pollution and climate change, which requires reconsidering traditional practices and services provided in this field, with taking the initiative to make systemic change, even if it is radical, to ensure human health and well-being.

Here, we can mention a set of recommendations to realize environmentally sustainable health care:

1. Encouraging joint research between the disciplines of health, environment, economics, and energy, and investing its results in developing policies that achieve sustainability in its various patterns in the field of health care.
2. Awareness and collective education about environmental sustainability in all fields, and guidance towards achieving it in the healthcare sector.
3. Following sustainable health policies based on prevention, relying on sustainable reusable and recyclable products, while providing incentives to fulfil sustainable health care.
4. Focus on the strategy of reducing waste resulting from the provision of health care services.
5. Applying quality standards and requirements with sustainability in the healthcare sector.
6. Stimulating frugal innovation and directing technology to achieve smart and sustainable healthcare.
7. Applying sustainability in healthcare buildings and relying on clean renewable energy.
8. Encouraging low-carbon pharmaceutical manufacturing, with more research on the safe use of herbal extracts as prevention or treatment.
9. Optimal investment for artificial intelligence algorithms within various fields of healthcare.