Why Oxford's new Sustainable Health Care short course is vital to mainstreaming sustainability in health care delivery.

Too wasteful, too polluting, too harmful to the environment

It was 10am in the morning. I had just completed a 26-hour COVID shift. I peeled off my plastic gloves, gown, boots, face shield, mask, and disposed of them. In my slightly dazed state of exhaustion, I experienced a twinge of guilt at how much waste I had produced that night. Over the next few weeks, every time I donned plastics gloves and used a plastic syringe to fill plastic test tubes of patients’ blood or stood in the operating theatre looking at all the plastic drapes, surgical gowns, caps, visors, and anaesthetic equipment that ended up filling bags and bags of waste, the guilt grew. Something was not right in the way we were delivering health care. It was too wasteful, too polluting, too harmful to the environment.

With this realisation, I began researching the impact of health care on the environment, certain that I was not the first person to experience such a revelation. During my lunchbreaks, I immersed myself in the literature and was, ultimately, struck by two thoughts. Firstly, the impact of health care on the environment was far worse than I thought; and secondly, the research and literature on the topic was incredibly sparse. There were innumerable gaps to be explored and I wanted to be part of this burgeoning field.

Health care contributes between 4-5% of global greenhouse gas

I made the decision to leave clinical medicine and embark on doctorate research at the University of Oxford, on how to deliver environmentally sustainable health care. I was grateful to find a willing supervisor in Professor Sara Shaw, a senior researcher in the Nuffield Department of Primary Care Health Sciences and co-lead of the Masters in Translational Health Sciences programme, a new Master’s programme which aimed to apply an interdisciplinary approach to the challenges of implementing innovations and research discoveries in the health care setting. I joined the Department in 2021, as part of the first cohort of students to undertake a Doctor of Philosophy (DPhil) in Translational Health Sciences.

In the first few months of my DPhil, I expanded my understanding of the broad impact of health care on the environment. I learnt that health care contributes between 4-5% of global greenhouse gas emissions; I learnt that we generate between 0.2-0.5kg of health care waste per hospital bed per day; I learnt that chemicals and pharmaceuticals leak into our environment contributing to anti-microbial resistance, ecotoxicity, and a range of other harmful effects. Health care provision is highly energy intensive, uses large amounts of water, produces tonnes of waste, and contributes to the climate crisis, environmental damage, and ultimately (and ironically), affects human health.

I became particularly interested in the impact of pharmaceuticals on the climate crisis. I was struck by the estimate that medicines contribute a massive 20% of the NHS’s carbon footprint, with an additional 5% of the carbon footprint attributable to anaesthetic gases and metred-dose inhalers (MDIs) used to treat conditions like asthma (MDIs contain hydrofluorocarbon propellants, that depending on the type, can be up to 3800 times more damaging than carbon dioxide!). I was also struck by the lack of information on the environmental impact of the bulk of medication that we prescribe, coupled with the realisation that the data to determine this impact lies primarily with the pharmaceutical industry that manufactures the medication. This ultimately led me to focus my DPhil on exploring how the upstream pharmaceutical industry is engaging with its climate impact and reducing its greenhouse gas emissions.

A growing interest in sustainable health care, a huge gap in knowledge in this area

Concurrently with my DPhil journey, I was surprised to find myself becoming, in the words of a colleague in the Department, the “token sustainability person”. And as ‘sustainability’ became more and more of a buzzword, whenever anyone wanted more information about environmentally sustainable health care or wanted to add a sustainability lens to a research paper or needed someone to present a lecture on these ‘novel’ ideas, I was called upon. Together with my supervisor, Professor Shaw, we realised that there was a growing interest in sustainable health care, that there was a huge gap in knowledge in this area, and that it was a vitally important topic to begin mainstreaming in health care delivery, especially with the increasingly concerning impact that the climate crisis is having globally.

And so, to fill this need, we set about developing an accredited short course on Sustainable Health Care, hosted by the University of Oxford Department for Continuing Education, set to kick off in March 2024. The course will explore the intersection between health care and climate change and introduce students to the impact of health care provision on the environment, discussing some of the topics introduced above, such as carbon modelling, energy use, waste management, health system supply chains, the role of technology in sustainability, and issues of global climate justice within health care. We hope that this module will bridge the gap in knowledge on this topic, making everyone into a “sustainability person”, and lead to transformative change in the way health care is delivered to the best possible standards within planetary boundaries.

Ultimately, there is no healthy patient without a healthy planet!