Greening healthcare delivery: Environmental and human health impacts of medical practice

Healthcare institutions are becoming increasingly aware of the impacts their facilities have on the environment and human health (eco-health). We present findings from a multi-sited ethnographic study that suggests the delivery of patient care also has eco-health impacts of concern. Our study question asked: what are the eco-health outcomes of medical care delivery, and why do these outcomes—which worsen the health of some while supporting the health of others—occur? We collected data through participant observations (255 hours, 73 participants), semi-structured interviews (33 hours), and institutional records for medical supply use, pharmaceutical administration, and waste generation between May 2008 and June 2009 on three end-of-life medical inpatient units for cancer patients (conventional cancer, palliative care, and hospice). We selected end-of-life care as our focus because it offers an extreme example of a high cost, materially intensive medical setting that serves a large number of patients each year. Results indicate that medical supply use intensity was lowest in the hospice setting and highest on the conventional unit and that supply-related eco-health impacts occur upstream within the ecosystems and communities involved in harvesting and manufacturing processes. Waste generation was highest within the conventional unit and lowest in the hospice unit, and occupational exposures to infectious waste was a major concern for workers downstream. Pharmaceutical administration impacts were related to occupational exposures from chemotherapy drugs, with the largest impacts in the conventional setting. Pharmaceutical disposal impacts resulted from hazardous waste incineration (conventional and palliative care) and “down-the-drain” disposal (hospice). Resource use at each of these three medical models has potential eco-health impacts particularly through staff exposures to improperly disposed waste and public health exposures from waste incineration and pharmaceutical disposal. Key determinants of resource use include political economy, institutional policies, and clinical training.