By Emily Gvino
According to the Environmental Protection Agency, Americans produce 25% more trash than usual between Thanksgiving and New Year’s Day, generating 1 million tons more waste every week during this time frame[1]. However, the life cycle of this country’s waste poses a critical issue throughout the year. Urban planners, public works departments, and local officials are already dealing with the downstream impacts of our trash generation problems; land use decisions must handle a community’s needs for housing and economic development but also balance the increasing amount of land required to create landfills and resources to facilitate trash management. The upstream causes of waste management should also be the concern of major businesses and employers, such as healthcare organizations. Hospitals – which have relied on single-use plastic items since the 1970s – could step up in an environmental stewardship role for their communities by tackling their plastic waste generation.
The Issue: The Unending Waste Problem
In 2017, representatives from China notified the World Trade Organization of their intent to ban solid waste imports from the United States, Canada, Australia, and other countries at the Committee on Import Licensing[2]. China’s decision marks a monumental shift in global waste management that has sent municipalities and businesses across the United States into a panic. China has long been the main recipient of our garbage, and now manufacturing companies and public works departments alike must scramble to find waste management solutions[3]. Pictures of dump trucks moving debris have been splashed across the news since then, juxtaposed with impoverished workers whose daily job includes sifting through mounds of trash by hand for items that can be recycled. These images dig at our moral sensibilities, as no individual is guilt-free from contributing to this system of unnecessary accumulation. Attention to this issue is framed in the media as a problem for the greedy consumer that gets their coffee to go, orders pizza for dinner in that large cardboard box, and requires multiple plastic bags for every grocery trip.
For decades, the environmental movement has emphasized these individual choices as the essential mechanisms for preventing impending environmental crises: Don’t buy single-use plastics. Recycle your bottles, cardboard, and paper. Accumulate reusable tote bags and use them whenever you go shopping. The maxim of “reduce, reuse, recycle” has become so ingrained that it stands as a cliché, a slogan for an indifferent public. On a community level, we can do better: a Pew Research Center survey from 2016 found that one in five Americans lives in a community that does not encourage recycling, while half live in a community that encourages “but doesn’t seem overly concerned with” recycling efforts, mirroring this sentiment of apathy[4].
While our garbage accumulation crisis may seem to be a concern only for environmental advocates, we also face more public health threats due to waste. The World Health Organization reports that mercury poisoning can occur through contact or through waterway contamination by chemicals that leach into water systems from landfills[5]. Without China and other countries to process our waste, more plastic products will end up in landfills and incinerators, which can release toxic chemicals harmful to our health. In Chapel Hill, North Carolina, the Roger Eubanks neighborhood faced the public health and environmental justice consequences of a waste disaster[6]. The community, whose residents are a majority African American, was the site of a landfill and waste transfer station. Meanwhile, the neighborhood was denied sewage service until 2017[7]. The Roger Eubanks neighborhood stands as a lesson for all municipal planners and public works directors of the potential environmental justice issues ahead as we will continue to grapple with our waste problem.
Hospitals: Grounds for Impactful Change
We cannot place the sole blame for our trash crisis on the individual who insists on using plastic straws. Large corporations and business entities have manufactured products with cheap plastics for decades without concern for the consequences down the line[8]. The hospital sector has remained unjustifiably free from the line of fire in the environmental movement. A study published by the American Chemical Society in 2015 found that one hysterectomy, the most common surgical procedure on women in the United States, can produce at a minimum 20 pounds of plastic waste. With 500,000 hysterectomies performed in the US each year, that quickly adds up to 10 to 16.5 million pounds of trash annually from hysterectomies alone[9]. According to the Healthcare Plastics Recycling Council, all U.S. healthcare facilities generate 14,000 tons of waste per day[10], equivalent to the weight of almost 115 blue whales[11]. That level of waste generation presents a terrible dichotomy of hospitals working hard to save patients’ lives while simultaneously polluting the air, contaminating the ground, and massively contributing to landfills in the communities they are aiming to heal.
Understandably, perceived barriers to sustainability abound when discussing the options for hospital systems: concerns about sterile environments and patient safety, cost effectiveness of materials, and the efficiency of hospital operations, from surgery in the operating room to outpatient procedures. Given the evidence that single-use plastics were made for convenience rather than medical hygiene, healthcare systems should not remain exempt from our nation’s larger conversation about how we contribute to landfills.[12]
The snag here is convincing a healthcare system to become a champion of environmental stewardship. However, it’s not a far-fetched plan: for example, the Cleveland Clinic launched a pilot of reducing plastic waste in their operating rooms in 2011 by tackling operating room surgery products that were opened during surgery but unused. Their single-use plastic program diverted these unused products from the regulated medical waste incineration path, recycled and reprocessed the items, and sold products to other healthcare providers at a lower cost. The reprocessed products were created under stricter regulations than the original devices and were resold with a higher safety standard[13]. In 2017 alone, Cleveland Clinic reprocessed 66 tons of plastic that would have otherwise ended up in a landfill. Their secondary program to recycle medical plastics also created 50 jobs in 5 years for those with developmental disabilities. A follow-up study by the Government Accountability Office echoed the idea that reprocessing medical products emphasized the reliability and safety of these products, supporting adoption nationwide[14].
In fact, healthcare systems are the ideal place to implement innovative changes for a few key reasons: First, they are centers of innovation by nature of their sector. A leading healthcare system can create its own standard for plastic waste reduction and roll it out to all of their hospital locations and facilities. Competitor hospitals will see the cost-savings of other sustainability campaigns—and surrounding media attention – and will want to follow suit both in the service of their community and to help their bottom line.[15] Healthcare systems are major employers for many communities and often tied closely with university and research institutions. Voluntary policy adoption in a healthcare system doesn’t require the same amount of lobbying and leadership buy-in as passing mandatory legislation forcing commercial businesses to adjust their practices. These characteristics create the perfect combination of an organization willing to make systemic change with the resources to accomplish this.
Looking Ahead: Future of Plastic Reduction
Practice Greenhealth, which focuses on environmental initiatives for hospitals, has 1,100 member hospitals, and finds that hospital leadership is interested in making changes but lacks the technical knowledge and support to take steps in the right direction[16]. Stories of hope continue to emerge: Dr. Ravi Gupta, a physician at Inova Fairfax Hospital, advocated for reducing plastic waste and campaigned the hospital administration for a better waste management program. As a result, Inova Fairfax reduced its waste by 1 million pounds in one year while also saving $200,000, and can now market itself as a true sustainable healthcare leader[17]. Inova Fairfax and UNC Healthcare have similar surgical procedure volumes but are on opposite ends of the sustainability leadership spectrum. Inova Fairfax completed 19,402 inpatient surgeries in 2010, while UNC Healthcare completed 20,598[18]. In comparison, UNC Healthcare –despite its connection to the University of North Carolina at Chapel Hill and the Three Zeros Environmental Initiative –still lacks a sustainability plan or concrete actions regarding the reduction their environmental footprint.
A multifaceted campaign with accompanying policies to decrease plastic waste in hospitals could make a dramatic impact. The Cleveland Clinic was able to record substantial improvements with a simple, two-pronged approach for reprocessing single use plastics for resale and recycling other medical plastics. Change doesn’t have to come in sweeping steps; 90% of IV bags do not need to be processed as regulated medical waste and redirecting IV bags alone could reduce hospital plastic waste by 10%[19]. Practice Greenhealth reports that recycling the blue wrap, which wraps surgical instruments for sterilization, could divert over 255 million pounds of waste per year[20]. Better yet, blue wraps are made with #5 plastic, one of the easiest plastic types to reuse or reprocess. Case studies across the United States have found that plastic waste reduction programs can carry significant cost savings, an added bonus.[21]
Hospital leadership should invest planning efforts and resources into medical waste reduction programs, for the sake of their patients, communities, and bottom line. By starting small with plastic waste reprocessing programs – even for a single product – they can create a huge impact.
Featured image: Plastic tubes, test strips and insertion devices that have accumulated after many months before they are discarded as medical waste. Laura Forlano.
About the author: Emily Gvino is a second-year master’s student seeking dual degrees from the Department of City and Regional Planning and the Gillings School of Global Public Health. Her research interests involve how the built environment can address social justice issues and the impact of climate change and the environment on health. Prior to attending UNC, Emily earned her bachelor’s degree in urban & environmental planning and Spanish at the University of Virginia.
[1] Doran, G., & Kidwell, J. (2016, December). Creative Ways to Cut Your Holiday Waste. The EPA Blog. Retrieved from https://blog.epa.gov/2016/12/21/creative-ways-to-cut-your-holiday-waste/
[2] WTO. (2017). China’s import ban on solid waste queried at import licensing meeting. World Trade Organization, (October 2017), 2017–2019. Retrieved from https://www.wto.org/english/news_e/news17_e/impl_03oct17_e.htm
[3] Semuels, A. (2019, March 5). What Happens Now That China Won’t Take U.S. Recycling – The Atlantic. The Atlantic. Retrieved from https://www.theatlantic.com/technology/archive/2019/03/china-has-stopped-accepting-our-trash/584131/
[4] Pew Research Center. (2016, October 7). Recycling perceptions, realities vary widely in U.S. Retrieved November 23, 2019, from FactTank website: https://www.pewresearch.org/fact-tank/2016/10/07/perceptions-and-realities-of-recycling-vary-widely-from-place-to-place/
[5] Health care solid waste. (n.d.). Retrieved November 23, 2019, from World Health Organization (WHO) website: https://www.who.int/sustainable-development/health-sector/health-risks/solid-waste/en/
[6] UNC Center for Civil Rights. (2017). The State of Exclusion: Orange County, N.C. – An In-depth Analysis of the Legacy of Segregated Communities. 1–10. Retrieved from www.uncinclusionproject.org
[7] Friend, E. (2016, December 27). Sewer lines approved for Rogers Road as ‘reparations’ for housing Orange County landfill. The News and Observer. Retrieved from https://www.newsobserver.com/news/local/community/chapel-hill-news/article122983359.html
[8] Hodges, S. (2017). Hospitals as factories of medical garbage. Anthropology and Medicine, 24(3), 319–333. https://doi.org/10.1080/13648470.2017.1389165
[9] Thiel, C. L., Eckelman, M., Guido, R., Huddleston, M., Landis, A. E., Sherman, J., … Bilec, M. M. (2015). Environmental impacts of surgical procedures: Life cycle assessment of hysterectomy in the United States. Environmental Science and Technology, 49(3), 1779–1786. https://doi.org/10.1021/es504719g
[10] Healthcare Plastics Recycling Solutions for Hospitals. (2019). Retrieved November 23, 2019, from Healthcare Plastics Recycling Council website: https://www.hprc.org/hospitals
[11] Mallos, N. (2013, May 14). What Does 10 Million Pounds of Trash Look Like? Ocean Conservancy. Retrieved from https://oceanconservancy.org/blog/2013/05/14/what-does-10-million-pounds-of-trash-look-like
[12] Hodges, Sarah. (2017) Hospitals as factories of medical garbage, Anthropology & Medicine, 24:3, 319-333, DOI: 10.1080/13648470.2017.1389165
[13] Additionally: I’m trying to find a header photo for her. Does it need to be open source if I cite it at the bottom? And either way, is there a special way to cite the header photo?
[14] Williamson, R. (2008). REPROCESSED SINGLE-USE MEDICAL DEVICES: FDA Oversight Has Increased, and Available Information Does Not Indicate That Use Presents an Elevated Health Risk. (January), 38. Retrieved from https://www.gao.gov/new.items/d08147.pdf
[15] Health Research & Educational Trust. (2014, May). Environmental sustainability in hospitals: The value of efficiency. Chicago, IL: Health Research & Educational Trust. Accessed at www.hpoe.org
[16] Chen, I. (2010, July 5). In World of Throwaways, Making a Dent in Medical Waste. The New York. Retrieved from https://www.nytimes.com/2010/07/06/health/06waste.html
[17] Nix, M. (2011). Case Study: Inova Fairfax Hospital: Regulated Medical Waste Reduction and Minimization Demographic. Retrieved from www.GreeningTheOR.org
[18] Nix, M. (2011). Case Study: Inova Fairfax Hospital: Regulated Medical Waste Reduction and Minimization Demographic. Retrieved from www.GreeningTheOR.org
Embracing Excellence: The University of North Carolina Health Care System 2010 Annual Report. (2010).
[19] Gibbens, S. (2019, October 4). Can medical care exist without plastic? The National Geographic. Retrieved from https://www.nationalgeographic.com/science/2019/10/can-medical-care-exist-without-plastic
[20] Bodkin, C. (2018, November 1). Blue Wrap and the Circular Economy. Practice Greenhealth. Retrieved from https://practicegreenhealth.org/about/news/blue-wrap-and-circular-economy
[21] Kaplan, S., Sadler, B., Little, K., Franz, C., & Orris, P. (2012). Can Sustainable Hospitals Help Bend the Health Care Cost Curve? The Commonwealth Fund, 29(1641). Retrieved from www.hpoe.orgcontact:hpoe@aha.orgor