The Environmental Impact of Healthcare

Overall Sustainability3

The health care industry affects the lives of nearly every person in the United States. Nearly 6,000 hospitals include almost a million staffed beds, admit almost 37 million patients (not including outpatient visits), employ nearly 5 million people1, and directly or indirectly support one in every nine jobs. Today, the sector accounts for 17 percent of the GDP.

Health care is resource intensive with significant input of materials, water, and energy that results in output of waste, effluents, and emission pollution. Health care generates material in almost every category of waste and emissions.

Hospitals consume two-and-a-half times more energy than other commercial buildings, spending more than $8.7 billion per year according to the EPA Energy Star program. Energy Star for Healthcare and the U.S. Department of Energy (DOE) Hospital Energy Alliance (HEA) both have challenged the health care sector to significantly reduce its energy use. The goal of the DOE initiative is to see commercial buildings reduce energy consumption by close to 70 percent based on today’s building codes. What’s clear is that the health care sector can save billions of dollars by reducing its energy use, helping to reduce the nation’s dependence on foreign fossil fuels and the industry’s climate change impacts in the process.

Supply chain expenses alone represent the second largest expense line on a hospital's balance sheet, following labor: the average hospital provider spends more than $72 million a year on supply chain functions, nearly one-third of its annual operating budget. The majority of the materials consumed in health care facilities ultimately become waste, costing health care consumers $10 billion annually in waste disposal costs. The opportunity for cost reduction through smart source reduction and waste management may be as high 40 to 70 percent, representing $4 to $7 billion for the health care industry.

• Health care realities: Rising costs, lower reimbursements, aging population, aging facilities, staff retention, diverse operations
• Energy realties: Rising costs, $8 billion annually, growing demand, carbon emissions, energy security, increasing intensity (DOE)

Energy

• Hospitals use 836 trillion Btu of energy annually. (DOE - 1—2. 2003 CBECS)
• Hospitals have more than 2.5 times the energy intensity and CO2 emissions of commercial office buildings, producing more than 30 lbs. of CO2 emissions per square foot.2 (1—2. 2003 CBECS)
• A 2006 survey published in Health Facilities Management identified the top factors that stop energy efficiency improvements:
• Lack of funds
• Other priorities
• Long payback periods
• Underfunded O&M budgets
• Lack of senior management commitment and support
• 91 percent of hospitals reported higher energy costs over the previous year, and more than half cited an increase of more than 10 percent (ASHE survey, Health Facilities Management, June 2006.)

Waste

General

• Materials consumption in health care facilities costs health care consumers $10 billion annually in waste disposal costs. The opportunity for cost reduction through smart source reduction and waste management may be as high 40 to 70 percent, representing $4 to $7 billion for the health care industry.
• Hospitals in the US generate upwards towards 7,000 tons of waste per day.
• A small but significant amount of that waste, about 15–20 percent, is highly regulated by multiple regulatory agencies including EPA, OSHA, DOT, Joint Commission, DEA and others. Items like regulated medical waste, pharmaceutical and hazardous chemical waste, radiological waste, sharps and others are expensive to manage—up to 10–100 times more than solid waste or recycling.
• The non-regulated waste, the other 80+ percent, is no different from that generated by a hotel, up to 60 percent of which is either recyclable or compostable.
• Landfill facts: In the early 1970s, about 20,000 landfills, most of which were actually unlined dumps, were being used. Today, as a result of the regulations, the dumps are closed and slightly more than 1,700 MSW landfills are in use. New landfills are difficult to site and build due to community pressure (not in my backyard) and the cost of the required technology. The strategy today is to extend the operating life of a landfill by recycling and reusing materials that don’t need to be landfilled.
• Methane gas: When waste is landfilled, methane gas is created by organic materials decomposing in an oxygen poor environment. Methane, a powerful greenhouse gas (GHG), is 8 times more potent as a GHG than CO2. The strategy for improvement is an integrated waste management plan that includes reuse and recycling, and composting programs to remove organic materials. Also ensuring your landfill has mitigation strategies for capturing the methane gas as an energy source or at least burning it off to reduce methane emissions.

Recycling

• Cardboard alone makes up almost 15-20 percent of the waste stream of a typical hospital.
• Cardboard is used to ship 90 percent of all products in the United States.
• Recycled cardboard (sometimes called old corrugated containers—OCC) only takes 75 percent of the energy needed to make new cardboard and lessens the emission of sulfur dioxide that is produced when making pulp from wood trees.
• Recycling 1 ton of cardboard saves 9 cubic yards of landfill space and 46 gallons of oil.
• While OCC is very recyclable, finding opportunities to reduce it is a priority—like implementing a reusable tote program.
• Beverage containers (glass, plastic, aluminum containers) make a combined rate of about 6&ndash10 percent of healthcare waste. (Practice Greenhealth)
• Blue sterilization wrap accounts for up to 19 percent of waste generated in the Operating Room (www.premierinc.com/quality-safety/tools-services/safety/green-link/green-corner/Harbor_Blue_Wrap_MDH2E.pdf).
• A standard recycling program in a hospital consists of cardboard, confidential paper collection (HIPAA), mixed fibers (magazines, newspapers, non-confidential mixed office paper, boxboard), beverage containers, metal, recyclable construction/building materials, some non-traditional mixed plastics. This level of program can reduce waste by 30–40 percent.

Water

• Hospitals use an average of 139,214 gallons of water per day.
• Water is finite; it cannot be created or manufactured. What is available on the planet is all there is. Only 3 percent is fresh water, and only a fraction of that is available for our water consumption needs. Water conservation has two main categories: (1) using less waste through better technologies in systems and fixtures and (2) capturing rainwater and other “used” water for other purposes. (IFMA Water Sustainability Guide)

EPA—Profile of the Healthcare Sector—2002 Census of the Healthcare Industry.

1. U.S. Healthcare Costs - www.kaiseredu.org/topics_im.asp?imID=1&parentID=61&id=358 (Back)
2. http://www.sustainabilityroadmap.org/resources/

Resources

Health Care Without Harm

"...shares a vision of a health care sector that does no harm, and instead promotes the health of people and the environment.

To that end, we are working to implement ecologically sound and healthy alternatives to health care practices that pollute the environment and contribute to disease."

Healthcare Environmental Resource Center This site provides pollution prevention and compliance assistance information for the healthcare sector. It is intended to be a comprehensive resource, covering all the varieties of hospital wastes, and all the rules that apply to them, including both federal regulations and the specific rules that apply in your state.

Practice Greenhealth is the nation’s leading membership and networking organization for institutions in the healthcare community that have made a commitment to sustainable, eco-friendly practices. Members include hospitals, healthcare systems, businesses and other stakeholders engaged in the greening of healthcare to improve the health of patients, staff and the environment.

MedShareis a nonprofit organization dedicated to improving the environment and healthcare through the efficient recovery and redistribution of surplus medical supplies and equipment to underserved healthcare facilities in developing countries.

Stop Trashing the Climate provides compelling evidence that preventing waste and expanding reuse, recycling, and composting programs — that is, aiming for zero waste — is one of the fastest, cheapest, and most effective strategies available for combating climate change.

Teleosis Institute The Teleosis Institute is devoted to developing effective, sustainable health care provided by professionals who serve as environmental health stewards.

Toxic Use Reduction Institute The Institute is located at the University of Massachusetts Lowell, and provides services to all Massachusetts companies, communities and agencies. Our Mission is Clear :

• Research, test and promote alternatives to toxic chemicals used
• Improve efficiency in energy and water use
• Provide training, resources and tools
• Promote economic competitiveness through improved efficiency, compliance stability, reduced risk and new markets.

Healthier Hospitals Initiative (HHI) is a coalition of major health systems and organizations committed to improving sustainability and safety across the health care sector. HHI is partnering with Health Care Without Harm, Practice Greenhealth, and The Center for Health Design to provide expertise and technical assistance and to develop and implement training and other programs to help hospitals carry out the HHI agenda recommendations.