Reduce greenhouse gas emissions in the healthcare sector »Yale Climate Connections
The health sector is in some ways dangerous for our health. Responsible for protecting patients, the healthcare sector is itself a deadly source of pollution from greenhouse gases and other air pollutants.
This reality prompted the National Medical Association (NMA) in July 2021 to pass a resolution on the sustainability of anesthesia education and research to take action against this threat from within.
The resolution was devised by Stephen Houser, MD, an anesthesiologist from Greensboro, NC. He had never learned about sustainability or climate change during his medical training, but he began to notice the real consequences of global warming in the operating room. As the temperatures rose, he found he was called upon to do many more epidurals for women in labor. In hot weather, he might see a few other outdoor workers with broken bones from “dehydration”-related falls.
As Houser learned more about the effects of climate change on health, he sought solutions in his own life and work. It was then that he learned that the healthcare industry is responsible for about 8.5% of total U.S. greenhouse gas (GHG) emissions. Specifically, anesthesia plays an important role, contributing approximately 51% of GHG emissions from hospital operating rooms. Many commonly used anesthetic gases, such as nitrous oxide, are also greenhouse gases that are typically vented directly into the air without pollution control.
âWe need to be educated about this within the anesthesia community,â says Houser.
With his resolution passed by the NMA, the largest and oldest national organization representing African American physicians in the United States, Houser plans to do just that.
Education at the intersection of climate change, health and equity
Houser says reports from the United Nations Intergovernmental Panel on Climate Change, IPCC, have prompted him to act. He feels even more urgent with the latest IPCC update in 2021 which predicts dire consequences for health, especially for communities of color, without radical interventions to limit GHG emissions.
In the last days of August, the Department of Health and Human Services (HHS) of the Biden administration announced the creation of the Office of Climate Change and Health Equity (OCCHE): its objective is, in part, to tackle the role of the health sector in food climate change. Another goal of the new office is to tackle health inequalities made worse by climate change.
The NMA has already worked at the intersection of climate change, health and equity for almost a decade.
Founded in 1895 as a professional home for African American physicians not invited to join the American Medical Association (AMA), NMA physicians consider eliminating health disparities a critical part of their mission. This focus on environmental health and climate change developed naturally from this mission, as many of the 50,000 member physicians of the NMA practice in communities most affected by global warming.
Mark Mitchell, MD, preventive care physician and co-chair of the NMA’s Commission on Environmental Health, has been a key leader in this effort, leading the training of healthcare professionals on climate risks for nearly seven years. He also worked on a collaboration with the Medical Society Consortium on Climate and Health to launch the Climate and Health Equity scholarship earlier this year. (Houser is one of six Climate and Health Equity Fellows in the inaugural class.)
âThe scholarship program aims to train leaders of color in climate, climate and health, and to talk about how communities of color are disproportionately affected,â Mitchell said. Ultimately, he says he hopes the fellows will be seen as trusted voices to advocate for climate action, both within and beyond the health system.
For Houser, the scholarship provided an in-depth opportunity to learn the science behind climate change and its impact on health and use that knowledge to promote and advocate for equitable and health-focused ways to mitigate the worsening. impacts of climate change.
He says he was able to immediately focus on his own specialty as a target in efforts to limit GHG emissions from the healthcare industry. He notes the disproportionate role anesthesiology, a specialty in which providers typically work behind the scenes, plays in GHG emissions.
“It’s quite interesting because people don’t really know [their] anesthesiologistâ¦ But there is actually a lot we can do to protect the public from climate change.
The inhaled anesthetic gases commonly used for general anesthesia can be gases strong enough to trap heat, Houser says. Gases inhaled during general anesthesia do not break down in the human body, so patients exhale them, virtually unchanged. These gases are then vented directly into the atmosphere.
One of the more expensive inhaled anesthetics, desflurane, can stay in the atmosphere for 14 years. Standard use of desflurane per hour during surgery is equivalent to driving 235 to 470 miles. Compare this to a readily available and less expensive alternative, sevoflurane, which has an atmospheric “shelf life” of about a year. An hour of use warms the atmosphere about as much as driving a car 71 miles.
Another gas that can cause more damage, nitrous oxide, is relatively inexpensive and is widely used around the world. It can stay in the atmosphere for over 100 years and can also damage the ozone layer, making it particularly problematic.
The problem with GHG emissions arises because human bodies don’t really break down gases when we breathe them in during general anesthesia, so we exhale them virtually unchanged. These gases are then vented directly into the atmosphere.
The NMA resolution seeks to raise awareness of differences in GHG emissions in order to encourage as much as possible the use of alternative agents. The aim is also to encourage research on better ways to recycle anesthesia gases and potentially use recovery systems to collect these anesthetics rather than letting them vent into the air.
There are other benefits to being a climate-conscious anesthesiologist, according to Houser. âIf you are careful you can use regional nerve block when appropriate,â potentially limiting the side effects of general anesthesia.
Houser hopes that with this now official policy resolution from the NMA, more suppliers will become climate conscious.
Global solutions to solve a global problem
Houser’s work fits well with the larger work of many anesthetists nationally and internationally. Practice Greenhealth, a nonprofit organization that works with member healthcare organizations, helps facilities “green the operating room”, and anesthetic gas reduction is a major area of ââfocus.
The work of Brian Cheseboro, MD, an anesthesiologist in Portland, Ore., Has been highlighted by Practice Greenhealth. He is the medical director of environmental stewardship for the Oregon region of Providence Health & Services, a seven-state health care system and 55 hospitals. Since 2016, he has been working with anesthesiologists in his network of hospitals to move away from desflurane and towards anesthetic gases that contribute less to GHG pollution.
âThis program was successful, we reduced our anesthesia emissions by 95%,â Cheseboro said. The decline in emissions has been accompanied by lower costs, throughout education and changes in voluntary practices.
His data show no change in clinical grade outcomes for any type of surgery. He also found no significant difference in the time it took for patients to recover when comparing similar types of surgery and alternative inhaled anesthetic gases.
Armed with its data, Cheseboro was able to encourage most providers in its own institution and surrounding areas to change their practices. Internationally, according to Cheseboro, anesthesia governance bodies are working together to find ways to share best practices for safe, high-quality care delivery that also takes into account environmental and climate impacts.
Houser says he, too, is working within the NMA and the wider anesthetic community to help spread the message.
With no time to waste, he worries about the heat impacts of climate change on his daughters during the upcoming football season in South Carolina. He laments that he can’t help but wonder what the world will be like for them.
âWith the most recent IPCC report,â says Houser, âit really feels like we need everyone on deck. This is the role that I can play.
Neha Pathak is a physician and medical writer who discusses the effects of climate change on health. She is a member of Public Voices on the Climate Crisis with the Op-Ed Project and the Yale Program on Climate Change Communication, editor of this site. Twitter: @nehapathakmd