Why the health system needs to be more sustainable, and how you can help Oliver Hunt, Medsalv, www.medsalv.com
For a number of years now, consumer distaste for waste, carbon emissions, and unsustainable practices have had some very real impacts on the way all kinds of industries deliver products. Businesses have realised pollution is not so cool, have found ways to count their carbon calories, devised carbon reduction schemes, and figured out the various paths to becoming more sustainable operators. These are all things that consumers expect from organisations. While this environmentalist revolution has been brewing across industries, our healthcare sector has, for the most part, been immune from any real change. How bad is the sustainability of healthcare in the first place? Okay, first the bad news, then the good news. If the world’s healthcare sector was a single country, it would be the world’s fifth-largest biggest polluter by the amount of greenhouse gases it emits. Worldwide, the healthcare sector generates almost 5% of the world’s carbon emissions and is showing no signs of slowing down.
These energy-intensive processes are often conducted in parts of the world that do not use clean energy to power their factories - and this is often combined with low-cost labour. Not only is the total emissions footprint of a medical device a glaring issue, but the monumental amount of waste and pollution has become a widely accepted by-product of keeping our people healthy. Single use devices are a standard mode of operation, and hospitals are continuing to send masses of the stuff to the landfill on a daily basis. This is not a New Zealand specific issue. Even in the United States, data shows that the average patient is producing 10 kilograms of waste, even among top performing hospitals that earn environmental awards from Practice Greenhealth.
In fact, analysis in a Lancet Planet Health paper last year shows that the greenhouse gas emissions produced by the industry have not only shot up dramatically since the turn of the century, but are continually increasing to this day.
Much of this objectively bad practise can be attributed to a lack of consumer demand and understanding — how could a hospital patient know about the amount of waste, let alone demand change. Another part is the problem of NZ’s healthcare ‘monopsony’.
Zooming in on one problem in New Zealand, procurement, it is estimated that the importing of millions of dollars of devices, pharmaceuticals, and associated services - accounts for around 61 per cent of the sector’s emissions. This corresponds to around 6.6 million tonnes of CO2 equivalent emissions, per year. To give you a better idea, 1.1 billion tree seedlings are needed to grow for 10 years to sequester this amount of CO2 emissions (United States Environmental Protection Agency, 2021). Sadly, almost none of this is being captured by current reporting measurements.
Are we living in a healthcare ‘monopsony’, and what’s that got to do with sustainability?
The emissions profile of your medical devices Manufacturing, and processes leading up to it, is where most of a device‘s carbon footprint comes from. This comes from a combination of the processes used to extract and refine raw materials, manufacture plastics, and mine metals to make up these devices. One example of this would be in nylon, a common plastic that can be found in the majority of all medical devices. Manufacturing this stuff is an intensive process, requiring large amounts of energy and water. It also emits nitrous oxide, a greenhouse gas that is incredibly potent at nearly 300 times the equivalent impact of CO2.
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Once materials are sourced for manufacturing, energyintensive processes must then be used to shape them and finally clean the resulting device. Processes applied to raw materials to change their shape or join them include, thermoforming, molding, welding, and forging.
S U P P LY L I N E
In economic terms, a ‘monopsony’ is when there is a single (or outsized) buyer in a market. With a dominant public healthcare system and relatively small private counterpart, New Zealand’s healthcare is, in no uncertain terms, a monopsony. Because the public health system is the dominant buyer, they are able to set the terms for the market. Right now we’re seeing that monopsony play out on Queen Street as nurses strike to try and get more money from an employer that sets the rate, knowing full well the nurses have very few other places to go to get better pay. This can result in situations like we’re seeing, with nurses feeling underpaid and undervalued, but it also shows up from a sustainability perspective, too. As the chief purchaser of goods, the New Zealand healthcare system also has an outsized impact on the sustainability of the stuff they buy. In a world dictated by price, this often means that we’re buying container loads of cheaply made stuff from all around the world — things so poorly made that they can only be used once before they get sent to the bin. S U P P LY L I N E – J U N E 2 0 2 1
