As with any business or public service, the health sector both depends upon and impacts upon a range of ecosystem goods and services. In terms of sustainable health care systems, there is a wide range of environmental issues facing the health sector, issues which affect not only the overall impact which the sector has on the global and local environment, but which may also ultimately affect the health status of the communities that health systems aim to protect. The table below outlines some of the key impacts which health care systems can have upon the environment. Globally, the healthcare community has begun to take its environmental responsibilities seriously. The concept of “healthcare without harm” recognises the links between environmental quality and human well-being, and is becoming widely adopted by public and private health service providers.
Some of the impacts of health care activities on ecosystems | ||
Issue | Example | Potential impacts |
Energy use | Energy demand for health care facilities is often significant, with 24-hour requirements for medical equipment, lighting, heating and air conditioning. | Energy demand associated with consumption of fossil fuels, with emissions of greenhouse gases and other pollutants |
Water use | Hospitals and other healthcare facilities can use large quantities of water, particularly for patient hygiene, surface cleaning, food preparation and general sanitation. | Adds significantly to community demand for water resources, potentially impacting on aquatic ecosystems or water-dependent habitats. |
Water pollution | Healthcare facilities use significant amounts of a wide variety of pharmaceuticals and personal care products, as well as sanitisers and other chemicals such as X-ray contrast media. Many of these are not fully degraded by modern wastewater treatment systems. | Release of active ingredients to the soil or aquatic environments, including some which act as endocrine-disrupting compounds, is implicated in a range of impacts upon ecosystems and upon animal health and behaviour. |
Waste production | As well as large quantities of general paper and plastic waste, health care facilities produce large quantities of food waste and hazardous waste materials, including biohazardous and radioactive waste. | Waste disposal poses challenges for environmental and public health authorities. Inappropriate waste management and disposal infrastructure can impact quality of waters, soil, and air, and affect human, plant and animal health. |
Air pollution | Many hospitals have incinerators to deal with hazardous and / or biological waste, which may release contaminants into the local atmosphere. | Potential for local impacts on human or ecological health, as well as wider release of greenhouse gases. |
Medical research and drug discovery | Much modern and traditional health care depends on animal studies, and on medicines derived from nature, from modern drugs to herbal remedies and complimentary therapies. | Unsustainable exploitation of biodiversity for research can endanger species, ecosystems and communities. |
The issue of pharmaceuticals in the environment has gained particular attention in the media. Research has demonstrated the presence of a wide range of pharmaceutical compounds in the aquatic and terrestrial environments worldwide, affecting surface and ground water, drinking water, soils and food resources. For many human and veterinary drug compounds, a large portion of the administered dose is not fully metabolised by the patient, and the active compound is excreted either whole or only partially metabolised. Drug molecules and their metabolites are often not broken down in sewage treatment plants, and so are discharged in sewage plant effluent to surface waters, or with sewage sludge which is spread onto fields as fertiliser or disposed of in landfills, where they may affect wildlife. In areas with little or no sewage treatment or resources for collecting waste pharmaceuticals, routes of entry to the environment are more direct. Veterinary medicines are also a concern, entering the environment by excretion or from animal carcasses.
Some pharmaceuticals and other health and personal care products are known to negatively impact on wildlife health. Through impacts on biodiversity, these may subsequently impact on ecosystem services. The worst recorded example is the Asian vulture crisis, which has seen over 95% of the population of vultures in India and Pakistan die from secondary toxicity due to a veterinary drug. Other issues are related to sub-lethal effects such as endocrine disruption or behavioural changes, with impacts recorded in species of amphibians, reptiles and mammals. The measurement of drug compounds in the environment and drinking water, albeit at low concentrations, also raises concerns for human health effects.
These issues represent challenges for primary healthcare facilities, and for organisations involved in emergency management who may have to deal with disposal of large quantities of left-over or out-of-date drugs stockpiled for emergencies.
The harvesting of wild species for community use, medical research or for commercial purposes (e.g. natural therapies or herbal remedies) can also pose a threat to biodiversity. Unsustainable approaches to bioprospecting also threaten important species and their habitats. Addressing these issues requires partnerships with organisations and individuals involved in promoting, funding or conducting medical and pharmacological research, and those involved in harvesting of biodiversity for commercial therapies or remedies; and co-operation between government agencies involved in conservation, development, trade regulation, foreign affairs and public health.