From patients to the planet: A holistic approach to healthcare’s most wicked problems

Oct. 25, 2021

Hospital and healthcare system leaders face numerous challenges: workforce burnout, staffing and supply shortages, increasing health disparities, and a continuing trend toward lower reimbursement and higher costs, to name just a few. And now, the esteemed National Academies of Medicine (NAM) wants to add another wicked problem to the list: addressing climate change through decarbonization of the health sector. To some, this will just be one more thing to add to what they consider an already seemingly insurmountable list. But if you consider each of these issues from a systems perspective, it becomes clear that they are interrelated, and adding the health of the planet to the mix may create a galvanizing platform to help find solutions to multiple problems. And once again, supply chain is front and center as a contributor to both the problem and the potential solutions.

In late September, NAM held the public launch for the Action Collaborative on Decarbonizing the U.S. Health Sector, an initiative being led by leaders from the various parts of the healthcare ecosystem, including manufacturers, distributors, hospitals, physicians, nurses, payors and the federal government, among others. The goal of the initiative is to reduce the health sector’s negative environmental impacts while strengthening its sustainability and resilience. In other words, the action collaborative seeks to tackle several of healthcare’s biggest challenges simultaneously. As steering committee member and former Cardinal Health CEO George Barrett noted, “We must address these challenges concurrently; we don’t have time to do them sequentially.”

Globally, the health sector is responsible for 4.5 percent of the world’s total carbon emissions; but in the U.S, the percentage is nearly twice as high, with healthcare accounting for 8.5 percent of the nation’s total carbon footprint. Those carbon emissions contribute to global warming, which in turn creates more extreme weather and a disproportionate negative impact on our most vulnerable populations. When carbon in the form of carbon dioxide is released into the air, it traps the heat and warms the planet. Higher temperatures, in turn, contribute to longer wildfire seasons, more intense heat waves and higher concentrations of water vapor in the atmosphere that can result in heavier rain and snow storms. When moister and warmer air is located over the oceans, it can strengthen hurricanes and cause deadly flooding like we experienced with Hurricane Ida.

Individuals with chronic disease often suffer more from climate change compared to the population as a whole. As we saw firsthand with the pandemic, chronic disease is more prevalent in low-income populations and communities of color. This is often due to the lack of gainful employment, nutritious food, safe housing, and transportation, among other social determinants of health. During the pandemic, these underlying health conditions led to higher rates of hospitalization and death from Covid-19. Researchers expect the impact of climate change to have a similar if not more severe impact on those same populations. Climate change and carbonization also contribute to higher deaths from extreme heat, and increased prevalence of respiratory and infectious diseases from air pollution and unsanitary living conditions made worse by severe weather events, respectively. Those same at-risk populations are further challenged by their limited ability to take protective action when faced with extreme weather occurrences.

For these reasons, the Biden Administration recently opened the Office of Climate Change and Health Equity, which Assistant Health and Human Services Secretary Rachel L. Levine, MD (another steering committee member) says is the first of its kind to address the intersection between the health of the planet and the health of vulnerable populations. At the public launch, the collaborative’s leaders referenced the contribution of the healthcare supply chain to the sector’s overall environmental impact. More than 82 percent of the U.S. healthcare system’s total carbon footprint is tied to the production, transport, use and disposal of goods and services. The supply chain is the focus of one of four collaborative work groups (the others being Healthcare Delivery, Professional Education and Communication, and Policy, Financing and Metrics).

The Supply Chain and Infrastructure Working Group has an ambitious agenda, although it is primarily focused on the supply chain upstream from the delivery of care. The workgroup’s “opportunities for action” list currently includes developing and promoting lower carbon and more sustainable innovations in products and services and creating shared sustainability metrics for manufacturers and distributors. At the launch, working group co-lead Michelle McMurray-Heath, MD, with the Biotechnology Innovation Organization (BIO), referenced a number of exciting innovations, including the use of CRISPR to create synthetic alternatives to carbon and less carbon-intensive plastics.

While exciting, I believe there are more things the collaborative can do to reduce supply chain’s impact, including taking a lesson from the National Health Service in the U.K.  Through its effort to be carbon neutral by 2050, the UK determined that one of the largest contributors to its carbon footprint was the National Health Service (NHS) and two-thirds of the NHS’s carbon emissions could be traced to the supply chain. But rather than simply finding alternatives to current carbon-based products, the UK is considering how the delivery of unnecessary or duplicative care contributes to the overall carbon footprint. By using evidence to eliminate care that does not deliver value to patients, the NHS believes it can reduce the environmental impact associated with the delivery of that care, as well as the upstream impacts of manufacturing and transporting the products used in that care. Approaches such as this have the potential to reduce the total cost of healthcare delivery; in 2014, the Institute of Medicine estimated that unnecessary healthcare services contributed to about 10% of the nation’s total healthcare expenditures, or nearly $300 billion a year. Beyond reducing unnecessary expenditures, better data on what works and what doesn’t for specific patient populations can help us direct finite resources to the patient populations that need them most.

The supply chain can be a great source of data to support this real-world evidence generation. For example, supply chain can support the processes and back-end data management that enable accurate and complete documentation on what products were used in what kinds of care on which kinds of patients. By tying that data to the clinical outcomes achieved, we can build a robust repository of real-world data that guides evidence-based care redesign. As supply chain plays more of a role in the delivery of necessary social care interventions, it can also help document the effectiveness of various social care interventions, such as helping Type II Diabetes patients control their blood glucose levels with diet vs. just pharmaceuticals. In the end, it’s all about understanding what works for which patients, and helping them get the kind of care (social and clinical) they need to optimize their health, while minimizing the negative impacts on the planet.