Health Care Without Harm Asia Focuses on Procurement, Plastic Pollution, Air Pollution

Photo: A rooftop garden at Khoo Teck Puat Hospital in Singapore.

by Sandra Curtis

The international gathering of members of Healthcare Without Harm Asia (HCWHA) convened at the Khoo Teck Puat Hospital in Singapore October 8-10.  HCWHA is committed to alignment with the Paris accords by moving to net zero by 2050. This fifth HCWHA gathering focused on three specific areas:

• Procurement

• Plastic Pollution

• Air Pollution

Following welcoming remarks, the first day took deep dives into each area. The first segment on procurement featured an introduction the Sustainable Health in Procurement Project (SHiPP).  SHiPP’s goal is to catalyze broad change in the health care sector in key markets to help transform the global economy. Specifically, SHiPP is looking to help hospitals use their purchasing power to transform the supply chain by reducing their environmental footprint.  Their goal is to reduce toxicity, reduce GHGs, and conserve resources. Noting that if the global health care sector were a country, it would be the fifth largest GHG emitter on the planet. This sector accounts for 4.4% of global carbon footprint, 70-80% of which comes from their supply change, making procurement an important area to support UN SDG12. 

Initially, SHiPP participants are creating a sustainable public global baseline across sectors – bringing suppliers together to focus on reusables not disposables. They’ve identified the top 30 carbon hotspots which will be prioritized for greatest impact. They are developing an index with the UN to identify more sustainable products and for suppliers, as well as identifying gaps in the marketplace. 

Six hospitals initially launched SHiPP. Their biggest challenge is how to influence suppliers and purchasers to shift away from chemicals of concern. Cross collaborations offer great learning since some teams know about energy but not chemicals. One hospital in the Philippines is seeking a replacement for plastic bottles for fluids. In India, they are looking at more energy efficient medical devices. In Colombia, they are supporting everything from refillable shampoo bottles to using recycled paper. 

The challenges faced by SHiPP are embedded in a system focused on profit, not on environmental health.  The goal is to inform doctors, who may be resistant to change, on the costs of goods, availability of supplies and information/knowledge on environmental health to doctors.  It takes planning in several stages:

• Pre-purchasing: Planning, Requirement definition, sourcing

• Purchasing: Solicitation; Bid receipt and Opening, evaluation, Review and award

• Post-purchasing

SHiPP is producing fact sheets, tool kits, among other resources with a major focus on reusable products.   

The first afternoon session focused on global plastics and the effects on health followed by air pollution. Von Hernandez, Global Coordinator for Break Free from Plastic gave a broad overview of the environmental plastic crisis.  PPC’s Sandra Curtis, Director of Innovative Projects, discussed the background, framework, findings and ongoing efforts of the ReThink Plastics intervention study.  Rob Chase of New Gen Surgical described the need for non-plastic alternative medical products for operating rooms which account for 35% of hospital waste.   

SHiPP’s plastic audit toolkit was piloted at Mary Johnston Hospital, Philippines, successfully reducing their plastic use from 47 to 28% in a year by segregation of waste at source, using personal mugs, providing water station on every floor among other purchasing and policy measures. One Indonesian hospital took plastic completely out of in-hospital meals.

The final afternoon session of the Deep Dive on Air Pollution offered a case study from Chennai highlighting the importance of helping the public understand the air pollution problem by making the invisible “visible.”  Toxics in the air have no boundaries in a city.  Once they began monitoring, they also generated data for trends, developed posters and website for the public to get more information, provided updates given on the radio, like traffic updates and offered recommendations for what individuals can do to protect themselves and what municipalities can provide for safe/healthy environments for people to be outdoors during safe air times of the day.  what to do – good to maximize and how to protect yourself during bad air quality days.

Day 2 got underway with an opening address that featured statistics on health care’s  contribution to global carbon emissions and the need for health care systems to respond to the growing climate crisis.  HCWH Asia’s aims is to align global climate goals with global health goals, meeting the Paris accords to achieve net zero by 2050.

The actions needed to support of Climate-Smart Health Care include:

·      Reduce health care’s climate footprint now

·      Support a societal transition to clean renewable energy

·      Chart the course for zero emissions health care by 2050

·      Make development assistance for health climate-smart

·      Establish and implement government action plans

·      Deepen research on health care and climate change

Themes repeated throughout the day’s presentations included:

·      Climate change is a health issue;

·      Renewable energy as a prescription for a healthy planet;

·      Increasing health equity and health access;

·      Building climate resilience in health care,

·      Moving the Hippocratic oath of “Do No Harm” outside the hospital walls;

·      Health care workers are the climate messengers

Challenges for the Health Care community are focused on:

·      Responding to health emergencies resulting from the climate crisis;

·      Changing consumption patterns contribute to non-communicable diseases (NCDs)

·      Rapid urbanization

·      Traditional health threats including infectious diseases (Polio epidemic declared last week in the Philippines; heat stress, waterborne and foodborne disease, malnutrition from food insecurity)

·      High rates of maternal and infant mortality.

·      Air pollution – causes a million deaths a year in Asia

There was a major effort to promote vegetarianism, including at the final evening’s gala banquet which was a 8 course meal of all vegetarian dishes. EAT published in the Lancet 2019 reinforces the message that food is the single strongest lever to optimize human health and environmental sustainability on Earth. 

During the plenary on waste management, Ruth Springer emphasized segregating waste for streams for recycling and the use of autoclave for sterilization, which is cheaper than incineration.  Such methods are working in Nepal and Zimbabwe with a motivating mantra of “Waste to energy or waste of energy?”  She also promoted biodigestion as a low carbon emission waste treatment which is being used in Tanzania and Madagascar.  She also emphasized the importance of Resilience/Disaster preparedness to be ready for climate disasters when health care workers may be coping with three times the amount of waste.  As an example, when the Gorkha earthquake occurred in 2015 in Nepal, the medical community had already been trained.  If not, predictions are that they would have been dealing with had an epidemic.   

A variety of programs in effect in Singapore were highlighted which reinforce the waste hierarchy of Refuse, Reduce, Reuse, Repair, and lastly Recycle.  They practice an ecofriendly lifecycle which, if reduced at the source, leaves not much to recycle.  One program, BYO Singapore has 881 outlets in which companies offer a variety of incentives to push a zero waste (ZW) government agenda. However, despite their ZW focus, incineration remains one of their waste management strategies and they are resistant to banning Styrofoam.

Another focus of energy reduction is on building design. Principles include maximizing natural light; water efficiency, including biodiversity and ecosystems, material efficiency, waste reduction; and indoor air quality.  The Khoo Teck Puat Hospital is a model example of the implementation of these principles.  Not only are plants, trees and running water incorporated into the design, an extensive rooftop garden provides food for the hospital patients and an opportunity for community volunteers to work in the garden.   

Under the dynamic leadership of Ms. Yen Tan, the COO at Khoo Teck Puat Hospital, “A Vison of a Healthropolis” was launched.  The hospital building process, design principles were integrated into operational work.  They reinforce the 4Rs with Recycle as the last element, , not the first one.  Other practices they’ve instituted are: refusing plastic bags and receipts, encouraging use of multi-use containers for which employees get 20 cents off, a No Straw policy, all plastic bottle stopped in 2001, upcycling all cloth – creating mittens, kimono jackets, even clothes for teddy bears.  Their story is told in the newly released Seeking Sustainability. 

The next HCWH Asia will be held in 2021 in India.  Progress on the SHiPP program or other HCWH initiatives or access to the Plastic Audit Toolkit can be found at https://noharm-asia.org/.