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Op-ed: Justin Billard and Lauren Law

Prescribing green: integrating environmental responsibility into medical practice

By Justin Billard and Lauren Law

A cornerstone of medicine is to do no harm, yet Canada’s health-care system is among one of the most harmful sectors to the environment in terms of carbon emissions, waste production and pollution.

As the nexus between planetary health and human health becomes more evident, there is growing apprehension about the potential consequences of unsustainable health-care practices on the future well-being of patients.

To improve patient outcomes, health-care professionals should seek innovative approaches that extend beyond medical and technological advancements and recognize the role of the environment as an important social determinant of health.

At Memorial University, a small cohort of medical students belonging to the Planetary Health Interest Group is doing just that.

Intersection of planetary and human health

Humans are inextricably linked to biodiversity, climate stability and the overall integrity of our natural systems. When these systems are compromised or depleted, it can result in negative health effects.

For instance, the World Health Organization found that almost 25 per cent of all deaths worldwide are attributed to environmental factors, including air pollution, harmful exposure to chemicals and increasing severe weather events.

Last summer in Newfoundland and Labrador, Environment Canada issued heat warnings as temperatures reached a tropical 30 C, leading to heat-related deaths and wildfires that put people at risk for smoke inhalation and respiratory distress.

Air pollution stemming from human-made sources such as vehicle emissions, residential natural gas usage and industrial manufacturing is responsible for more than 6.5 million deaths each year.

Food inflation, exacerbated by global drought conditions, is resulting in poorer food crops that are intensifying food insecurity and making it increasingly challenging for vulnerable populations to access affordable and sufficient food.

Overall, these environmental issues place communities at greater risk for adverse health outcomes.

Health-care’s ecological footprint

 The health-care sector consumes significant amounts of energy, heavily relies on transportation and global supply chains and generates substantial waste, which all contribute to climate change and environmental degradation.

In Canada alone, 110 hospitals were found to produce 87,000 tonnes of waste annually — more than what circulates in the Great Pacific Garbage Patch.

The COVID-19 pandemic exponentially increased the use of medical masks and gloves, resulting in the disposal of three million face masks every minute globally.

It is estimated that 20-50 per cent of all routine and repetitive laboratory tests are inappropriately ordered, contributing to negative patient outcomes and increased waste.

Health conditions, such as chronic kidney disease, are increasing globally, and treatments like hemodialysis necessitate the consumption of approximately 265 trillion litres of water annually and produce up to 3.8 tonnes of carbon dioxide emissions per patient each year.

From stethoscopes to sustainability

Health-care professionals have the capacity to contribute to the essential change required to protect the well-being of patients, communities and the environment.

To work towards this change, health-care providers can begin by educating themselves on the intersection of planetary health and human health.

There are numerous resources that guide health systems in making greener health-care decisions, while ensuring patients receive the care they need.

For example, Choosing Wisely Canada developed several recommendations to support prudent decision-making around routine laboratory testing to reduce waste and improve patient outcomes.

At a broader level, the latest Lancet policy brief on health and climate encourages the health sector to advocate for climate-related policy changes that align with Canada’s National Climate Adaptation Strategy to reduce fossil fuel reliance and emissions.

Physicians and medical students play a crucial role in educating patients and communities about the impacts of health care on the environment.

Our Planetary Health Interest Group aims to foster a greener health-care culture in Newfoundland and Labrador by working with community partners to advance sustainable and innovative initiatives.

One such initiative includes our annual Car Free Week.

This event encourages individuals to adopt active modes of transportation for their daily commute and promotes active lifestyles, a reduction in carbon emissions and raises awareness of planetary health.

Going forward, we encourage more individuals in the medical community to pursue their own initiatives in promoting sustainable health-care practices for healing both patients and the planet.

Medical students at Memorial University formed the Planetary Health Interest Group, a group that advocates for more sustainable health-care practices in Canada and strives to increase awareness of the intersection between planetary and human health.

 Annually in June, the students host a Car Free Week event to promote active transportation among health-care professionals and the wider community. For more information about this event and to participate, visit the Planetary Health Interest Group on Facebook or @MUNCodeCycle on Instagram and Twitter.

We would like to thank our team, Robyn Woodrow, Richard Smith, Emma Jacobs and Alexandra Janes, for their tireless efforts in preparing for Car Free Week.

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