Healthcare supply chain poses a major new environmental challenge

In recent years, healthcare companies have mainly focused on reducing greenhouse gas emissions as they strive to become more environmentally sustainable. While this focus has spawned several innovations in energy conservation and alternative energy use, critics argue that these actions have only touched the surface of reducing the health impact of climate change.

Hospitals remain one of the largest sources of environmental pollution in the world, despite increasing calls for a solution to climate change. As of December 2020, health care greenhouse gas emissions increased 6% from 2012 to 2018. For health care study. Overall, industry now accounts for more than 8% of all US emissions.

“The health sector is far behind in terms of climate,” said Jessica Wolf, director of climate and health for Health Care Without Harm, an international advocacy organization that advocates for environmental health practices. “In corporate America, many, many companies have taken full greenhouse gas inventories and set ambitious targets — this is not the case in this sector.”

Much of the problem stems from a lack of progress in addressing the single largest source of health-related greenhouse gas emissions, the supply chain. Research estimates that more than 80% of greenhouse gas emissions come from sources such as hospital waste disposal services, food and pharmaceutical manufacturing, and medical device and equipment manufacturers.

These health-related greenhouse gases are classified as Tier 3 emissions, which include sources not directly owned or controlled by hospitals and health systems.

Several healthcare providers have launched Scope 3 emission reduction initiatives as part of their broader goal of becoming carbon neutral over the next few years. Service providers have set goals to limit business and employee travel well before the pandemic, and have also reduced emissions from their food service and waste disposal facilities. Kaiser Permanente used similar strategies as part of its process to become the first healthcare system in the country to achieve carbon neutral status in September 2020.

But in the years since healthcare systems began to strive to achieve this goal, the conversation among climate advocates has moved away from carbon neutrality. Many advocates believe that health systems need a more ambitious goal of achieving clean zero status.

“Carbon neutrality is a bit outdated as it allows over-reliance on carbon offsetting,” said Dr. Jody Sherman, founding director of the Health Sustainability Program at the Yale School of Public Health Climate and Health Center. “We have to mitigate everything that is directly under our influence before buying compensation payments, and we cannot ignore these [Scope 3] emissions “.

Both carbon neutral and net zero refer to organizations that offset the amount of greenhouse gases they add to the atmosphere by removing equal amounts of emissions. But carbon neutrality sets a lower bar. Healthcare providers can focus heavily on reducing their direct emissions and fossil fuel energy consumption by investing in unrelated ‘carbon offset’ programs that reduce greenhouse gas emissions elsewhere as a means of achieving carbon neutrality.

But net zero goes further because it includes the reduction and elimination of all direct and indirect carbon emissions associated with the operation of this health organization, regardless of carbon offsetting.

“This is the next phase because it really points to a higher rate of decarbonization in all areas,” Wolf said.

Striving for zero

There are growing calls for health stakeholders to be more proactive in tackling the greenhouse gases and pollutants emitted by their supply chains. In the author’s article published in New England Journal of Medicine On October 13, a group of authors, which included the president of the National Academy of Medicine, Dr. Victor Zau, wrote that tackling the carbon emissions that come from the healthcare supply chain is “… the centerpiece of the decarbonization of the sector.”

Wolf said Health Care Without Harm has worked with several vendors over the past year to conduct Tier 3 assessments and identify specific emission hotspots in the supply chain.

Kaiser Chairman and Chief Executive Officer Greg Adams said he sees his next big sustainability goal to tackle supply chain carbon intensity and other indirect emissions from integrated health care operations.

“We have already taken a thorough inventory of these indirect emissions and are exploring the following possibilities to address the inherent challenges of climate change and health,” Adams said.

Providence, based in Renton, Wash., Is working with its suppliers to reduce carbon emissions from purchases of goods and services. According to Alison Santore, Chief Advocacy and Sustainable Development Officer, this is vital to the overall health system goal of reducing carbon emissions by 2030.

She estimates that greenhouse gases emanating from their supply chain account for nearly 40% of Providence’s total carbon emissions.

Providence hopes to cut emissions from transport by 40% by 2028 and halve the amount of waste disposed of in landfills or incineration by 2030. At Providence Portland Medical Center in 2019, doctors began replacing anesthetic gases containing the agent desflurane, which can last for a long time after being released. up to 14 years in the atmospherewith sevoflurane, which affects the climate 20 times less and remains in the atmosphere for up to one year. Due to the transition, Providence Hospitals in Oregon have reduced their greenhouse gas emissions from surgical anesthesia by 70%.

Looking ahead, Santore said the health care system has made environmental sustainability an integral part of its commitment to improving supplier diversity. In June, Providence announced plans to buy out $ 1 billion from women and minority businesses over the next five years. The health system has collected data from all of its current suppliers to assess who buys where and where, and has implemented an environmentally preferable purchasing program in which sustainability expectations are embedded in supplier contracts.

“We have tremendous leverage, tremendous opportunity and responsibility to shape Scope 3 emissions in the supply chain,” said Santore, who has estimated Providence’s total annual supply chain budget at between $ 4 billion and $ 5 billion.

The Providence plan is the first, she said, because the healthcare system is striving to meet its carbon-free emission reduction targets.

“We may be carbon negative tomorrow in bulk buying offsets, but we want to do it right,” Santore said. “We are committed to doing this job.”

Other health systems have also sought to use their purchasing power to improve environmental sustainability in their supply chains.

Boston-based Mass General Brigham has set a goal of being carbon neutral through direct emissions by 2025 and has reduced its emissions by 78% from 2008 levels.

But the healthcare system is also actively addressing supply chain issues. In 2016, Mass General Brigham, along with nine other major healthcare systems, formed Greenhealth Exchange, a joint purchasing organization focused on finding suppliers of organic products.

The exchange plans to roll out a new Greenhealth Approved program to evaluate products and certify green products.

“In this way, we hope to make it easier for healthcare supply chain managers, as well as supply chain managers in other market sectors, to select a high quality, environmentally responsible product,” said Dennis Villanueva, senior manager, Energy and Sustainability, Real Estate and Facilities. for the mass General Brigham.

Healthcare in general needs to make a more concerted effort to tackle Category 3 emissions, says Yale University’s Sherman. The lack of progress is largely due to an over-reliance on the voluntary actions of individual suppliers. This could change if regulators require healthcare providers to report on their efforts to reduce emissions and mitigate their impacts.

“This is a very serious business – we have to do it, and we have to do it quickly,” Sherman said.

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