The health service agrees: 55 percent CO2 reduction in 2030

When you think of polluting sectors, you think of airplanes or cars. Not to be indifferent. But more and more research shows that this sector also has a huge impact on the environment. Last month, RIVM concluded, for example, that the healthcare system accounts for no less than 7 percent of greenhouse gas emissions.

There are many reasons for this, an important one being the long-standing tendency to work as efficiently as possible. Many complicated medical devices (such as surgical staplers) are no longer cleaned today, but end up in the trash after one use. Waste sorting does not yet take place in many places, which causes too much trouble. A single heart operation in a few hours produces 27 kilos of waste, research from Radboud UMC shows.

Because the discomfort of this is growing, the health service closed one Green Deal Sustainable Care. It consists of dozens of agreements to make it more sustainable. In 2030, CO2emissions from the healthcare system (compared to 2018) are 55 percent lower. In 2050, the healthcare system must be climate neutral and work ‘maximum’ circularly. It also includes agreements to offer more sustainable (non-animal) food to patients and staff. Knowledge of environmental impact must also be increased and sustainability must be considered in treatment guidelines and education.

The previous green deal did not work

It is the third one green deal from the healthcare sector is the first version from 2015. Although it was seven years ago, the Health Council of the Netherlands made a very harsh judgment in September about making the healthcare system more sustainable. In summary, the Health Council found that it is not moving forward. “The effects on the environment are hardly taken into account when choices are made in the healthcare system.”

The celebratory signing of this ambitious new version should have taken place a month earlier. But it did not succeed. One of the stumbling blocks was the question, which also remained unanswered with the previous green agreements: Who should check whether the agreements are respected and who should enforce? There is no real answer to that question in the final version either.

We never really worried about waste. Now we start asking each other questions. Is it smart because of sustainability?

Diederik Gommers intensivist Erasmus MC

In order to reach the agreements in the new green deal, the sector must work radically differently. And as is often the case with big climate ambitions, it is still unclear how the sector will achieve this.

Bas Maier, health sector manager at MVO Nederland (an organization of sustainable entrepreneurs), wrote earlier this week in a blog on the professional website Skipr that healthcare needs more guidance and more public scrutiny. “In my opinion, VWS has three tasks in terms of sustainability: to oblige, to price and to encourage. At the moment, the ministry mainly handles the latter task. (…) The consequence of VWS inactivity is that the market must solve it.”

In September, the Health Council advised the ministry to make sustainability a legal requirement by amending the Act on Health Quality, Complaints and Disputes. But this is not reflected in the new green agreement, despite the ministry’s signature on it.

Not only does the Ministry of Health, Welfare and Sport not take real control of making the health service more sustainable, the regulatory authorities and health insurance companies in the health sector do not take on this role either.

And the managers of the health institutions themselves are not sufficiently concerned with sustainability, the Health Council previously concluded. Good initiatives that increasingly arise in the workplace against waste experience too little ‘support and sense of urgency’ in the care institution and receive too little budget. In total, the healthcare system produced 328 million kilos of waste in 2018. And an estimated 80 percent of the waste is still incinerated as residual waste.

A concrete example where there is still much room for improvement is medicine. Every year in the Netherlands, 100 million euros worth of unused medicine is thrown away. It is skewed, as medicine is usually manufactured in polluting factories in India and China and brought to the Netherlands by polluting ships. Research from RIVM shows that the large amount of drug residues in our water poses a risk to animals and plants, and that fish, for example, suffer tissue damage from painkillers.

The New Green Deal states: “The international consensus is that the climate crisis is the greatest threat to public health of this century.” “Climate change and environmental pollution are leading to increasing demands for care,” such as “an increase in infectious diseases, heat stress, mental disorders, allergies, lung disease, cardiovascular disease, neurological disease, and the introduction of zoonoses and ‘tropical diseases’ in the West.”

It is a growing nuisance in the sector, says Diederik Gommers, intensivist at Erasmus MC and one of the advocates for more attention to climate. “It can’t be the case that we contribute negatively to people’s quality of life? That we are making people sicker because of our negative impact on the environment?”

According to Gommers, the healthcare system should take a good look in the mirror. It was the sector itself that, for reasons of efficiency, asked the industry to offer all kinds of goods as a disposable variant from now on. “For example, the bronchoscope, an instrument that we now use to look into the lungs or do a lung lavage and then throw it away. Previously, such an instrument went to a sterilization department.”

The same applies to the covers, says Gommers, of which doctors and nurses put on a new one every time they enter a patient room. “It has been adapted for us to a one-off version. We never really worried about waste. Now we start asking each other questions. Is it smart because of sustainability?”

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