Q&A: Cutting healthcare’s carbon footprint using technology

LOS ANGELES – At the recent Future of Health Annual Summit here, Dr. Ernst Kuipers, a gastroenterologist, vice president of research at Nanyang Technological University in Singapore, member of the HIMSS board of directors, and former Dutch minister of health, welfare and sport, spoke with MobiHealthNews about the healthcare industry's carbon footprint and how technology can help mitigate its impact on climate change.

MobiHealthNews: Can you tell me about your present work?

Dr. Ernst Kuipers: My current work is actually quite diverse. For one, I'm a member of the executive team of a technological university in Singapore. It's called NTU, and my responsibility in the executive team is that I'm responsible for the research and the whole research ecosystem, meaning I do not have to do the research myself, but I have to ensure that we have the international connections, that we get the right people in, and so on and so on. So that's one role.

But apart from that, I do many other things. I won't mention all, but one important one, which I'm very glad to be able to contribute to, is that I'm a member of the World Health Organization's Commission on Climate and Health.

Climate and health are extremely important. So, when we think about climate and climate change, the whole focus is only on sea level, glaciers and air pollution, and many things like that, but actually, the impact on our own human health is immense.

When I was a minister of health, I worked with my team and with an international colleague on drafting a resolution and getting support for that resolution, which stated that climate change is a major challenge to our human health. That resolution was accepted last year by the WHO at the World Health Assembly, but that is only the start. It's like a wake-up call. This is saying, "Houston, we have a problem."

So, then the follow-up commission I'm now a member of is actually looking at what healthcare systems need to do.

They need to do two things or two categories: One is to really prepare, in the broader sense, for all the changes that will arise from climate change, and people usually think, 'Oh, so, it means we need more air conditioning.' Well, no, not really. It's fine, but the challenges are so much broader than that, related to air pollution, migration, anti-microbial resistance, and so on and so on. It's an immense effect. It's like a whole cascade. If you affect one little thing, it has many other different effects. So, that's one thing healthcare systems need to be aware and need to be prepared for.

And the other aspect is that, healthcare systems, by the way we provide healthcare today, we also contribute to all the pollution. If you think about all our materials, many of these are disposable. Just waste. The wastewater that we produce, if you think of it, larger healthcare providers, larger hospitals, for instance, they may produce one to two complete Olympic swimming pools per day in wastewater. Per day! One to two swimming pools per day in wastewater!

MHN: That is just the water. That does not include the plastics or all the supplies they use.

Kuipers: Yes, and then all the travel personnel, the way we produce our drugs and many others.

So, the impacts, many people have calculated and tried to calculate it, but the one conclusion is that healthcare generally tends to have a larger ecological footprint than aviation.

So, we all talk about aviation; we don't talk about healthcare. And the interesting thing is that if you bring systems together, and you go very meticulously to every little step for every patient journey, like, what do we exactly do, and can we improve on it, then it turns out that we can markedly reduce our footprint by reducing waste, by cleaning our own wastewater, by doing remote care, by using drugs in a different way.

MHN: Even nitrous oxide molecules stay in the atmosphere for over 120 years, right? And a lot of it leaks when it is being transported and is wasted.

Kuipers: Correct. Correct.

So, we have this large international meeting. It's called the COP [Conference of the Parties] meeting. It is all about climate and climate change. It's an annual meeting. It will be held this year for, I think, the 30th time.

It was only two years ago, for the first time ever, that healthcare and healthcare ministers were invited. So, mind you, for 27 years, all the focus on climate change, nobody thought about healthcare, and only after 27 years, for the 28th year, I was the minister of health at the time, I was invited, and so were my colleagues.

I literally, in this case, from the Dutch press, got a question, "So, why are you here? Does it mean that all our nursing homes have to have air conditioning?" and I thought, "You're missing the point. That's the least of our problems." Of course, fine if they do so, but this is not the issue.

MHN: How can technology help improve healthcare's effects on climate change?

Kuipers: Healthcare has changed tremendously over the past 30 years.

But now, if we look where we are, we have aging populations, we have financial issues. Can we afford our healthcare? We have a workforce shortage and so on. It's very depressing if you hear all the stories.

But at the same time, we have all the solutions in a way, and the solutions have to come from technology, from AI, but also from logistics and from so many other expertise and bringing it all together, which actually means that instead of an era of change, we're now really changing an era. We're totally reinventing healthcare in the way we do it.

For example, what can you do with people being much more independent and autonomous? What can you do with remote care when people do need care? What can you do much more in the preventive?

The challenge will be that we can do all these individual things, but if you look at the past, many times we did things well but there were also many times we only created more work. And then at the end of the day, we would say, "Whoa, we innovated, but the wait list is even longer because we just added work."

Still, every situation is different, every payment model is different, every geography, every culture, and yet there is a lot that you can learn from each other and use these examples.