Why hospitals need to jump on board the sustainability bandwagon

By Rachel Teng

GovInsider speaks to Ramon San Pascual, Director of Health Care Without Harm Asia, to understand why a One Health approach to green up hospitals is a win for all – and how hospitals can start taking little green steps.

Singapore's Khoo Teck Puat Hospital integrates greenery throughout its premises. Image: KTPH/Wikimedia Commons

Author and historian Niall Ferguson once said, "The law of unintended consequences is the only real law of history,” – a poignant reminder that even the best of intentions can result in unforeseen and often adverse outcomes. 


The healthcare industry, arguably the most altruistic sector, is no exception. While it has saved billions of lives, it has also inadvertently generated a significant amount of waste and pollution that is harmful to both environmental and human health. 


In 1996, for example, the US Environmental Protection Agency identified medical waste incineration as the leading source of one of the most potent carcinogens: dioxins, which can also cause hormonal, reproductive, and autoimmune diorders. This kickstarted a coalition of 28 healthcare organisations to form Health Care Without Harm


The not-for-profit organisation aims to transform healthcare worldwide by developing best practices for ecologically sustainable healthcare practices, without compromising patient safety or quality of care. 


“Hospitals are unique in that they produce a different set of waste. These include toxic waste, chemical waste, pharmaceutical wastes, and even highly infectious biochemical waste,” Director of Health Care Without Harm - Asia, Ramon San Pascual, tells GovInsider.


GovInsider sits down with San Pascual to discuss how hospitals can and should align global health goals with global climate goals in order to achieve total healing for both people and the planet. 


What is One Health? 


Hospitals, for a long time, have treated themselves as isolated systems – highly focused on the treatment of patients, San Pascual points out. 


“It has resulted in an almost reckless attitude on the matter of what is disposed of. This was even more visible during Covid times because everything was treated as infectious, and therefore everything became single-use,” he adds. 


One might argue, however, that these are inevitable side effects for a “still-net-positive” population health outcome. After all, what can healthcare professionals do when they are fighting to save lives everyday? To consider the disposal of medical waste when lives are at stake seems like a trivial matter in comparison. 


But San Pascual highlights that if we care for people in a way that harms the environment, we are setting the stage for them to fall sick again, and bringing them back to hospitals anyway. 


“Healthcare does not – and should not – only refer to people’s health. There should be a more holistic understanding of both people’s health and environmental health, rather than viewing them as segregated from one another,” he says. 


The World Health Organization has dedicated the One Health Initiative to encourage this paradigm shift. The One Health approach seeks to redefine public health, no longer seeing it in purely human terms. Instead, One Health is the idea that public health encompasses human health, animal health, and environmental health. 


This could mean, for instance, acknowledging that the rise of zoonotic diseases like the swine flu, or Covid-19 are directly related to climate change and rising temperatures. and addressing this at the systemic level. Or recognising that nearly a quarter of all premature human diseases and death are caused by environmental factors, such as air and water pollution. 

Image: IS Global. 

“Healthcare does not only happen in hospitals. Whether it is ensuring that air we breathe is clean, or caring for the welfare of other living species, everything amounts to good health. So let us not think that healthcare is isolated from the problems we are facing with the environment,” says San Pascual. 


Beyond the bedside 


With many hospitals undergoing digital transformation worldwide, healthcare professionals are now able to track the healing of their patients with their patient databases. San Pascual argues that hospitals should begin to utilise the same technologies to track their carbon and waste footprints. 


“I have realised that basic awareness of the environmental impact of hospitals is not there, even among the most committed, brightest, and well entrenched healthcare officers and doctors today. Perhaps it is because there is no programme in the government that pushes them to understand healthcare in the larger context,” he says. 


In partnership with the United Nations Development Programme, IT consultants, and other healthcare stakeholders, Health Care Without Harm is working to digitalise healthcare waste management data. The project aims to provide hospitals with the essential template with which data can be stored, generated, and analysed. 


This is part of a larger blueprint for the reduction of healthcare emissions, recommending hospitals to take seven high-impact actions that will reduce their carbon and waste footprints significantly. They are:

  1. Power healthcare with 100 per cent clean, renewable electricity 
  2. Invest in zero emissions building and infrastructure 
  3. Transit to net-zero emissions through sustainable patient travel and transport 
  4. Provide healthy, sustainably grown food and support climate-resilient agriculture when sourcing for patient and staff meals 
  5. Incentivise and produce low carbon pharmaceuticals 
  6. Implement circular healthcare and sustainable healthcare waste management 
  7. Establish greater health system effectiveness 

While this may seem out of reach to some, many hospitals across Asia and the world have tried and tested these steps in recent years. Singapore’s Khoo Teck Puat hospital, for example, has reduced its energy usage by 36 per cent through building a rainwater harvesting system and a green roof. 

Green roof at Khoo Teck Puat Hospital. Image: WorldArchitectureNews.com

“It’s not complex, someone just has to initiate and make those changes in the hospital setting. We are trying to guide them towards low hanging fruits that can bring about positive results,” says San Pascual.

Also read: The prescription for a greener healthcare sector: Preventive care and data