Over the past few months, I have faced a seemingly classic question of whether to support the economy or the environment (although I hope this column will demonstrate how this does not have to be a zero sum game). My current predicament is: I want to support a local family-owned restaurant, but every time I place a “to go” order, I cringe at the amount of plastic and Styrofoam used to deliver the food safely and how plastic use has grown exponentially in the wake of the pandemic. A recent LA Times article1 documented “a dramatic increase in the use of plastic,” from hand sanitizer bottles to takeout containers. Even Starbucks temporarily stopped allowing customers to bring reusable mugs for fear that they contribute to the spread of the virus (despite assurances from medical experts that they can safely and routinely be sanitized).
COVID-19 has increased the use of plastics-based products in healthcare, with cities around the world facing dramatic increases in infectious medical waste, including disposable masks, gloves and gowns. Even before the pandemic, healthcare was one of the biggest consumers of plastic.
But there are signs that the pandemic has reinvigorated interest in more sustainable medical products. Faced with shortages of disposable isolation gowns, many hospitals are considering purchasing more reusable gowns. A 2018 peer-reviewed study2 looked at the environmental impact of reusable isolation gowns across their lifecycle compared to disposable alternatives. The researchers found that conversion to reusable gowns had significant environmental benefits:
28 percent lower natural resource energy consumption
30 percent lower greenhouse gas emissions
41 percent less total (blue) water consumed
93-99 percent lower solid waste generation
Even with such evidence, product conversions are not easy. The director of linen services at the Carilion Clinic recently republished a two-part article3 on how he managed the switch during similar supply shortages caused by the H1N1 pandemic. Eric Frederick gained buy-in from multiple stakeholders, from infection control to nursing, by solving packaging concerns and developing laundry protocols that improved versus reduced repellency of the gowns. UCLA Health also reports saving more than $1 million dollars and nearly 300 tons of waste since converting to reusable products in November 2015.4
As these stories demonstrate, moving to more environmentally sustainable products can also make economic sense. This becomes increasingly significant as we consider how COVID-19 has disproportionately impacted low-income populations and communities of color, which suffer from higher rates of obesity, diabetes and hypertension that can increase the severity of COVID-19 infections.
The critical supply shortages driven in part by a paucity of domestic production combined with the impact of COVID-19 on disadvantaged neighborhoods present some interesting opportunities for community reinvestment. Economists have long spoken about a multiplier effect when jobs, especially in manufacturing, are created, spurring additional economic benefits for the community where those jobs are located. The 45 plus health systems participating in the Healthcare Anchor Network (HAN) are working with the Democracy Collaborative and Practice Greenhealth to promote more local hospital purchasing from minority- and women-owned local businesses.
Westside United in Chicago did something similar years ago, bringing together unaffiliated health systems to create a shared laundry service staffed by individuals hired from the local community. Such initiatives take on added significance if you consider the potential for increased demand for laundry services with the switch to more reusable personal protective equipment (PPE).
Now, consider how a similar effort might address the need for more domestically produced PPE. What if regional hospitals were to create long-term purchasing commitments that would provide a local manufacturer with the business case necessary to invest in not only production capacity but also take the steps necessary to get U.S. Food and Drug Administration first (FDA) clearance for its products.
During a recent workshop as part of the Association for Healthcare Resource and Materials Management (AHRMM) virtual conference, 40 percent of attendees said they partnered with local businesses to address pandemic-related shortages, with nearly 50 percent planning to work with these companies in the future. The ability of those businesses to continue to supply to hospitals after the FDA’s emergency use authorizations expire will require navigating the ins and outs of FDA clearance. Long-term purchasing agreements can provide those businesses with the assurance that demand for locally produced, quality products will continue beyond the pandemic. Yes, it takes a village to make this level of change happen, but it can also solve multiple problems – from supply continuity to economic development that generates jobs with insurance coverage and the ability for disadvantaged populations to have access to not only healthcare services, but also the social resources, such as good food, housing and transportation, that contribute to better health overall.
As for the challenge of food delivery, I am encouraged by a Singapore start-up that is piloting food delivery using bamboo boxes that can be returned, washed and sanitized before re-use. Of course, to do that in the U.S. would likely require some regulatory changes, but after all, that’s how villages create new standards for economic and environmental health.
References
1 https://www.latimes.com/world-nation/story/2020-06-13/coronavirus-pandemic-plastic-waste-recycling
2 Vozzola E, Overcash M, Griffing E. Environmental considerations in the selection of isolation gowns: A life cycle assessment of reusable and disposable alternatives. American Journal of Infection Control. 2018; 46:881-6.
