Health system and pollution
According to the Lancet Countdown (2023), the global healthcare system accounts for 5.2% of greenhouse gas (GHG) emissions, almost twice as much as air traffic! If the healthcare system were a country, it would be the 5th largest polluter in the world! In Switzerland, the healthcare system is responsible for 6.7% of GHG emissions, mainly through the hospital sector. The vast majority of these emissions are indirect, meaning that they are not produced on the territory but upstream or downstream of the analysis cycle.
What is causing this pollution?
According to the Shift Project, a study carried out in France on the energy transition in 2023, medicines represent the largest share of GHG emissions, which includes their production, packaging, transport, use and recycling. The second most polluting sector is medical devices, including for example equipment, imaging tests, biological analyses, etc. Then come more conventional sectors such as feeding patients and staff, transport, heating, etc. These emissions are mainly due to the hospital system.
And what about Switzerland ?
The graph below, taken from a 2023 article published in the Lancet Planetary Health, is very interesting because it shows that the Swiss health system, although extremely efficient, is also much more emitting than those of other countries with comparable efficiency. This also highlights the inequalities in terms of emissions and access to care: the least polluting countries are those where access to care is the most difficult. Thus, questions of distributive justice, one of the four major principles of medical ethics, are put into tension.
Towards transformation
In this sense, the Swiss Academy of Medical Sciences (SAMS) published in 2022 a roadmap dedicated to the transformation of Swiss health services to make them more sustainable and within planetary boundaries. Three major action strategies have thus been identified at several scales according to the following diagram:
Thus, a transformation of the health system is necessary, not only to reduce its environmental footprint but also to become more resilient in the face of health problems caused by environmental degradation, while ensuring access to care for all with controlled costs.
What can I do ?
1/ Learn about and discuss these issues: read this brochure developed by H4F students and published in the Revue Médicale Suisse in 2024!
2/ Get involved in hospitals: in Switzerland, many hospitals have a group for eco-responsible care. Ask your institution or organize a meeting with colleagues interested in these topics.
3/ Get involved in the office: the FMH offers a toolbox to assess the carbon footprint of your office for free. For solutions, this article from the Revue Médicale Suisse proposes and compares various daily interventions.
4/ Get involved in associations: Health For Future is not alone in its commitment to planetary health. To join other structures active in different fields, here are some useful links:
- Doctors for XR : a group of health professionals supporting the demands of Extinction Rebellion (www.facebook.com/doctors4xr.ch).
- Médecins en faveur de l’environnement : association of doctors concerned about environmental degradation and its effects on health (www.aefu.ch)
- Engagés pour la santé : association committed to proposals for reform of the health system(https://engagespourlasante.com)
While individual actions are beneficial, a profound transformation of the health system is necessary: rather than investing in acute hospital care, it is urgent to revalue prevention and health promotion. As a reminder, currently, Switzerland invests less than 2% of its health expenditure in prevention: here is another health/environment co-benefit!