Abstract
The U.S. health care sector is highly interconnected with industrial activities that emit much of the nation’s pollution to air, water, and soils. We estimate emissions directly and indirectly attributable to the health care sector, and potential harmful effects on public health. Negative environmental and public health outcomes were estimated through economic input-output life cycle assessment (EIOLCA) modeling using National Health Expenditures (NHE) for the decade 2003–2013 and compared to national totals. In 2013, the health care sector was also responsible for significant fractions of national air pollution emissions and impacts, including acid rain (12%), greenhouse gas emissions (10%), smog formation (10%) criteria air pollutants (9%), stratospheric ozone depletion (1%), and carcinogenic and non-carcinogenic air toxics (1–2%). The largest contributors to impacts are discussed from both the supply side (EIOLCA economic sectors) and demand side (NHE categories), as are trends over the study period. Health damages from these pollutants are estimated at 470,000 DALYs lost from pollution-related disease, or 405,000 DALYs when adjusted for recent shifts in power generation sector emissions. These indirect health burdens are commensurate with the 44,000–98,000 people who die in hospitals each year in the U.S. as a result of preventable medical errors, but are currently not attributed to our health system. Concerted efforts to improve environmental performance of health care could reduce expenditures directly through waste reduction and energy savings, and indirectly through reducing pollution burden on public health, and ought to be included in efforts to improve health care quality and safety.
Highlights
The Institute of Medicine 2013 Workshop Summary Public Health Linkages with Sustainability suggests that “the health sector should lead by example by greening itself and reducing its ecological footprint. . ..to improve global health and the health of the planet [1].” Quantification of pollution and disease burden stemming from health care is critical to improve the quality and safety of practice, to inform mitigation strategies and leverage health care leadership in sustainable development.PLOS ONE | DOI:10.1371/journal.pone.0157014 June 9, 2016Environmental and Health Impacts of U.S Health CareThe United States spends the most of any nation by far on its health care system, nearly one-fifth of GDP, or approximately $3 trillion dollars in 2013 [2]
As the U.S is the second-largest emitter of greenhouse gases (GHGs) globally, it follows that the health care sector is an important target for emissions reductions as well
Negative environmental and public health outcomes attributable to the health care sector were estimated for the U.S using economic input-output life cycle assessment (EIOLCA)
Summary
Hospitals are the second-most energy-intensive commercial buildings in the country, after food service facilities [3]. Hospitals are typically large buildings, open 24 hours a day, seven days a week, and contain several energy-intensive activities, including sophisticated heating, cooling, and ventilation systems, computing, medical and laboratory equipment use, sterilization, refrigeration, laundry, as well as food service [3]. In addition to energy used on site in the form of heating fuels and electricity, the health care system uses vast quantities of energy-intensive goods and services, such as pharmaceuticals and medical devices, which require significant energy inputs for their manufacturing. As the U.S is the second-largest emitter of greenhouse gases (GHGs) globally, it follows that the health care sector is an important target for emissions reductions as well. Despite its size and status, there has been little work to quantify or probe consumption-based emissions from the U.S health care sector, how these emissions are trending over time, or how these emissions might affect public health overall
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