2023-08-27 09:01:22
by Anna Fregonara
The emissions attributable to the biomedical sector are between 1 and 10% of the total national emissions, depending on the State considered. But much can be done to reduce them
If it were a country, healthcare would be the fifth largest producer of carbon dioxide emissions on the planet. Those in the health sector vary between 1 and 10 percent of total national emissions, depending on the state considered.
Now for the first time a group of researchers, we read in the European Journal of Internal Medicine, has calculated the environmental impact in terms of avoidable CO2 of unjustified clinical variations, i.e. inappropriate use or use of little value for patients, of resonance magnetic (MRI) and computed tomography (CT).
From the Earth to the Moon
We evaluated the different rate of use of these radiographic examinations per thousand inhabitants among seven G20 countries (Australia, Canada, France, Germany, Italy, South Korea and the United States) with similar demographic, economic, health system quality characteristics, of life expectancy and disease distribution explains Ludovico Furlan, first author of the survey, researcher at the University of Milan and internist at the Milan Polyclinic.
For energy consumption alone, and we are talking about downward estimates, if Italy carried out the same number of Rmn and Tc for every thousand inhabitants of Australia, the most prudent country among those chosen, it would save the emission of 40 thousand tons of CO2. This environmental impact can be compared to driving a car for 15 million km, which is equivalent to 20 round trips from the Earth to the Moon.
United States and Germany
For some States with a higher rate of use of imaging surveys and which resort to a massive use of fossil fuels, things are worse: among these there is the United States, whose potentially avoidable emissions for Tc and Rmn exams are equivalent to driving a cars for about 700 million km, and Germany. If the latter behaved like Australia, every year it would save the emission of 35,000 tonnes of CO2. To compensate for these emissions, it would take one and a half times the largest German forest. According to analyzes by the British National Health System, which aims to become carbon free by 2040, around 70 per cent of emissions come from the supply chain and from the energy needed to produce, ship and dispose of pharmaceutical products and medical equipment.
Clinical practices with heavy environmental impact
But not all. On the other hand, 20 percent depend on patient care, where inappropriateness is only one of the contributing factors. Examples of clinical practices with a heavy environmental impact are slowly emerging, such as the use of anesthetic gases or propellants for asthma and bronchitis inhalers, potentially replaceable with others with a lower impact, with the same efficacy and safety for the patient. In addition, some anesthesia societies, such as the World Federation of Societies of Anaesthesiologists, have published guidelines with practical examples to reduce waste in the operating room, encouraging the use of environmentally friendly anesthesia with clinically equivalent anesthetic gases and indicating the use of reusable devices.
Prevention
One might think that greening is the last thing the health system could do right now, after years of underfunding, with skyrocketing waiting lists, shortages of doctors and nurses. There are actions that healthcare can begin to take to reduce its emissions without compromising the quality of therapies or patient safety: waiting lists are growing due to the increase in the need for care of citizens and chronically ill patients and due to inappropriate prescriptions , says Nicola Montano, co-author of the study, professor of Internal Medicine at the State University of Milan and director of the division of the same name at the Irccs Policlinico hospital in the Lombard capital.
Every time we ask for an unnecessary test, there is a risk for the patient (think of exposure to the rays of a radiological test) and for the environment. Clinical inappropriateness increases for various reasons: the absence of an effective basic medicine filter; the excess of defensive medicine which leads to prescribing one more test instead of one less, pressure and economic interests. If a test or exam does not answer a precise clinical question, it probably should not be prescribed, especially in the absence of evidence on its real benefit in that clinical context. It is based on this
l’approccio Choosing Wisely
a medical cultural movement that is increasingly gaining ground around the world. Primary prevention is not done by undergoing an extra exam just to do it, but by following a correct lifestyle, participating in screening programs that include specific diagnostic tests, for a certain type of population at risk in a certain period of life.
Reconnect health and planning
Sustainability should not be understood only in energy-environmental terms. The new discipline of the psychology of sustainability and sustainable development has as its main objective that of promoting well-being through the creation of physical spaces that are attentive to man in his entirety, therefore also to the psychological aspect, says Giovanni Santi, professor of Technical Architecture at the Department of Energy Engineering of Territorial Systems and Buildings of the University of Pisa. Developing awareness of this need for a reconnection between health, psychology, urban planning and architectural design contributes to improving the quality of life and to so-called primary prevention. Transforming the environment to better respect man’s needs and functions means responding to the new paradigm of sustainability also in terms of health and well-being and not just in a purely economic key.
Hospitals are energy intensive
Computers, machinery and lighting work 24 hours a day, 7 days a week, says Giacomo Salvadori, professor of environmental technical physics at the University of Pisa and in the supervisory committee for eco interventions underway in 13 hospitals of the North Tuscany Local Health Authority West. There are constraints that limit eco-interventions. Operating theatres, for example, need air changes and temperature and relative humidity control; in certain laboratories the lighting must have specific characteristics; machines for Rnm must be cooled. The energy management of the building stock is responsible for one third of all energy consumption worldwide. In Italy hospitals are often old and full of leaks: the possible main interventions, considering the cost-benefit, are low consumption lighting, thermal insulation, heat pumps, condensing boilers, solar thermal and photovoltaic systems. Finally, remote management systems to intervene in real time if there are energy-intensive anomalies.
August 27, 2023 (change August 27, 2023 | 09:00)
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