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The greening of health systems, a question of consistency

This is just my annual check-up, imagine the waste produced by a hospital that doesn’t ring a bell. Added to this assessment are the greenhouse gas (GHG) emissions produced by these establishments. In fact, according to several studies, health systems in Canada are responsible for 5 to 10% of the country’s GHGs.

The CHUM goes green

Dr. Stephan Williams and his colleagues from the anesthesiology department of the Center hospitalier de l’Université de Montréal (CHUM) have long wondered about the pollution and GHG emissions generated by hospitals, especially anesthetic gases.

For some years now, they have been calculating their emissions and trying to reduce them. By making a few changes, within their own department, they have already started a transition.

Dr. Stephan Williams explains that there are different technologies available to reduce the amount of gas that ends up in the atmosphere. The CHUM has installed new anesthetic stations that minimize gas leaks. They also use anesthetic agents that emit fewer GHGs.

Anesthetic gases are what is called a carbon hotspotthey can be very polluting. »

A quote from Stephan Williams, anesthesiologist

Anesthesiologist Stephan Williams

Photo: Radio-Canada / Elisa P. Serret

There are even other options to gas anesthesia, he points out. It is possible, according to the doctor, to use intravenous products with precision pumps which have an equivalent or better anesthetic effect. What’s more, patients would have less nausea upon waking.

The CHUM is also equipped with a module that captures the anesthetic gas before it escapes through the hospital chimney.

He and his team also gave scientific presentations to educate their colleagues and help them make this transition to carbon neutrality.

Gestures paying off on all fronts

With these changes, the anesthesia department expects to reduce its greenhouse gas emissions from 3,500 tonnes in 2017 to 150 tonnes by 2023. Already the bill is getting lighter: the costs of anesthetic gases for the CHUM have gone down from $532,000 in 2017 to $106,000 in 2022.

To offset 3,500 tonnes of GHGs from the anesthesia department, the CHUM should plant trees over an area equal to 10 Mount Royal parks.

The members of the CHUM’s senior management were challenged by these positive results. They commissioned Dr. Stephan Williams and his team to draw up a plan that will make it possible to achieve carbon neutrality for the establishment.

We became aware of the importance of this subject and we mobilized ourselves, we will mobilize even more in the years to come to make everyone understand the importance of this attitude. »

A quote from Fabrice Brunet, President and CEO of the CHUM

Following an initial assessment, Dr. Williams and his team proposed a series of measures, including the following: moving away from fossil fuels for heating and transport, reducing the use of disposable objects and tools and, when it is possible, trade them for reusable instruments, and develop the recovery of residual materials (reduce, recycle and compost).

We know that the climate crisis is the number one threat to health in the 21st century. And we know that the solution to the climate crisis is to stop emitting greenhouse gases. This is what we are trying to do at the CHUM. »

A quote from Stephan Williams, anesthesiologist

To achieve this, all departments will have to provide their share of effort, specifies the doctor. Governments will also need to be responsive. Because, according to Stephan Williams, the Ministry of Health and Social Services (MSSS) has a strike force through its purchasing power. Thus, all decisions regarding supply must be reviewed. The ministry must choose suppliers and products that respect the environment.

Health Canada must also review its ways of doing things, thinks Dr. Stephan Williams, among other things for the approval of drugs and anesthetic gases.

[Les employés de] Health Canada, too, have not been trained to consider the greenhouse gas emissions of drugs. There really is a culture change to be made on that side. »

A quote from Stephan Williams, anesthesiologist

Health Canada is aware that certain types of gases used for anesthesia are more polluting than others. The federal ministry says it is studying this question as part of the review of the approach to reducing GHG emissions within the health system.

Non-existent frameworks

Claudel Pétrin-Desrosiers is a family doctor, president of the Quebec Association of Physicians for the Environment, helped launch the Quebec Sustainable Health Action Network and is completing a master’s degree in the environment.

She too has been interested in the importance of greening health systems for a long time. She affirms that there are more and more initiatives in various establishments in Quebec, but that there is not yet a national strategy at the MSSS. According to her, the absence of a clear framework is sorely lacking and makes the objective of carbon neutrality very difficult to achieve.

Portrait of Claudel Petrin-Desrosiers

Claudel Pétrin-Desrosiers, family physician at CLSC Hochelaga-Maisonneuve

Photo: Radio-Canada / Patrick André Perron

In several establishments, currently, all that is there is paper recycling, exclaims the young doctor. Quebec health networks are required to have sustainable development committees, but since there is no clear framework, according to Ms. Pétrin-Desrosiers, there is a bit of everything and anything.

Since the implementation of the Sustainable Development Act in Quebec, each department is required to have certain objectives, but Claudel Pétrin-Desrosiers affirms that there is no plan for updating or exercising evaluation of the situation at the MSSS.

Claudel Pétrin-Desrosiers feels that ministers and senior officials misunderstand the urgency of the climate situation.

Emergency panel

What are the sustainable development approaches of hospitals?

Photo: Radio-Canada / Jean-Claude Taliana

We requested an interview with Quebec Health Minister Christian Dubé, but he declined our request. The Ministry of Health specifies, however, that the health and social services network is not subject to the Sustainable Development Act, but that it has nevertheless adopted a voluntary approach vis-à-vis that -this.

In 2015, the government set itself the goal that by 2020, 25% of establishments in the health network would have adopted a sustainable development approach.

As of March 31, 2020, among the public establishments monitored, 30% had undertaken a formal sustainable development approach and 100% of public establishments had made at least a formal commitment to sustainable development.

In Ottawa, Health Canada says it recognizes the urgency of greening the country’s health systems. And the department recalls the creation of a Carbon Neutrality Advisory Group in February 2021. This group of independent experts has the mandate to dialogue with Canadians and advise the Minister of Environment and Climate Change on ways to achieve carbon neutrality by 2050.

Canada supported the health agenda priorities of the 26th Conference of the Parties to the United Nations Framework Convention on Climate Change (COP26), including those on climate-resilient health systems and sustainable health systems and low carbon. Health Canada recalls that health is a jurisdiction shared with the provinces and must therefore work with its counterparts.

For Drs. Claudel Pétrin-Desrosiers and Stephan Williams, the health system has a duty of consistency.

If I treat people every day, I know how much the climate crisis will affect their health. For me, there is a duty of consistency that the system in which I welcome them should also be alert to these issues, then do its part and lead by example. »

A quote from Claudel Pétrin-Desrosiers, family physician

The UK model

Dr. Claudel Pétrin-Desrosiers considers the United Kingdom to be the model student in terms of eco-responsible practices. The country has established a national strategy for its health system to achieve carbon neutrality by 2040 and aims for 2046 for the entire supply chain.

Every year they hit their targets. What is all the more interesting, believes the doctor, is that their system is also a public system that resembles that of Quebec. Who experiences the same challenges of understaffing and waiting lists. But the UK government still decided to make carbon neutrality a priority for its healthcare system.

According to the two doctors, the greening of the health network is possible and it is really a question of political will.

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