Deathly healthcare

A syringe and vials, pills scattered on a table.

The effects of health care waste

Health care institutions (this includes hospitals, doctors offices, labs and research centers, blood banks, nursing homes etc.) protect and restore health and save lives? This is a very common and widespread belief, but is this really the case? When looking at it superficially it seems as if this is actually true but when taking a closer look we have to acknowledge that the health care system is not the altruistic angel that it seems to be and there are many problems linked to it that actually even diminish the general advantages that the advancements in the health sector have created.

At the moment I am working in a hospital and therefore have the opportunity to gain some interesting insights about the management of health care which one would never get as a normal patient. I was shocked the most about all the waste that was produced in the daily routines: food, one-way material, packaging of instruments and medication, syringes etc. In the past hundred years, the health sector has grown at an unsustainable rate which has increased the waste generation and resources used and has caused difficulties in waste management and disposal. This is a very big problem as there is a direct relationship between a healthy society and a healthy environment.

Health care waste covers a wide range of materials including:

• Infectious waste (containing body fluids and blood)

• Pathological waste (body parts, organs, human tissues)

• Sharps

• Chemicals

• Pharmaceuticals

• Genotoxic waste (particularly cytotoxic drugs used in cancer treatment and their metabolites)

• Radioactive waste

• General waste

The effects of health care waste:

From the waste generated by health care activities, 85% is general non-hazardous waste. The rest 15% is hazardous material meaning that it is infectious, toxic or radioactive. These materials are dangerous and pose a potential threat to both the environment and human health. In high-income countries, an average of 0.5kg of hazardous waste are produced per bed per day in hospitals. In low-income countries it is 0.2kg. However due to a lack of waste separation in low-income countries the real quantity of hazardous waste is much higher. Possible health risks for humans include radioactive burns, sharps inflicted injuries (in 2010 unsafe injections were responsible for 33800 HIV infections, 1.7 million hepatitis B and 315000 hepatitis C infections ) and antibiotic resistance development. In addition to that landfill sites where waste is disposed contaminates ground and drinking water which can lead to other illnesses as for example cholera. Furthermore, the incineration of waste releases air pollutants and particulates which have a direct relationship with respiratory diseases such as asthma. In addition to that, the burning of chlorine-containing materials is a great concern as it generates dioxins which are human carcinogens.

What can we do:

The process of waste management should begin at the sight of generation and then the efficient and standard meeting transport, storage and disposal of it. Health care institutions should monitor the type and weight of waste produced so that future decisions (e.g. when making orders) can be made using the data. The waste potential of products including potential harmful effects should also always be kept in mind. Decisions should be made consciously throughout the lifecycle of goods including their extraction, manufacturing, distribution and usage. The demand for materials has to be reduced and packaging should be kept at a minimum. Where possible recyclable and compostable products should be used.

The reasons of health care waste:

The failure of health care waste management can be attributed to several reasons including inadequate training of personnel, the absence of disposal systems, insufficient financial and human resources and a lack of awareness about health hazards related to health care waste. In addition to that corruption in the sector plays a considerable role in the creation of waste. The traditional model of healthcare where a patient feels well, then sick, then better and finally is treated has become outdated mainly through demographic and social changes as more and more people live with multiple degenerative and/or chronic conditions (sometimes very questionable!) and are therefore send from institution to institution- we have to keep in mind that every treatment is also directly a source of money. Unnecessary waste is mainly created by:

• Failure of care delivery- not the best and suitable practices are adopted in the treatment of the patient means that other treatments will be necessary

• medical error- for example some operations and medications can lead to other problems including kidney failure which requires further treatment

• Failure of care coordination- when care is segmented or disjointed meaning that some treatments and tests have to be repeated

• Over-treatment and defensive medicine- this includes unnecessary tests and diagnostic procedures, overdiagnosis (treating a symptom at a very early stage where the existence and progress of the illness is not even sure), the excessive use of antibiotics and intensive care at the end of life when alternative, palliative care would have been more suitable

So do we have to decide for and against treatment or for and against environmental protection? No, I am not saying that we have to restrict health care activities but I firmly believe that it is the time for the health care sector to find ways in which it reduces waste and used resources without diminishing the quality of the outcomes and indirectly endangering the health of the society. Already now the Dartmouth Institute of Health Policy and Clinical Practice estimates that 30% of clinic care could be avoided without worsening the health outcomes. The health care system has to strive to become sustainable; the illness should be treated not only the symptoms. Patients should be supported to be able to understand and control their own health and chronic and degenerative diseases. As attacking waste means attacking someones income rewarding outcomes rather than activity could be a more creative and ethical solution. This transition (which includes technological, social, cultural, political and economic aspects!) will only be possible through collaboration, honesty, public involvement, innovative uses of business modes and technology to create a safer and fairer future. It would require a cultural change of the whole society away from profit-making approaches to ethical approaches. The health sector is the best sector to set an example of collective responsibility because its aim is to serve the human in the most suitable way (Hippocratic oath).