Physicians working in hospitals see the mountains of medical waste generated each day. Meanwhile, the climate crisis challenges the medical system to reduce its contribution to greenhouse gas emissions. Globally, healthcare systems contribute as much carbon dioxide as the airline industry. In Canada, healthcare accounts for 4.6% of our total emissions. The problem is urgent, but potential solutions are both easier and more complex than many might think.
Guests on this episode are advocates in the climate and health space. Dr. Samantha Green is the co-author of the CMAJ article, Five Things to Know About Metered Dose Inhalers and their Impact on Climate Change. She's a family physician at Unity Health Toronto and the climate and health lead at the University of Toronto's Department of Family and Community Medicine.
In the article, she and her co-authors point out that pressurized metered-dose inhalers (pMDIs) are an important contributor to greenhouse gas emissions. Dr. Green says measurements done in the United Kingdom by the National Health Service found that MDIs contribute 3.1% of the entire health system's carbon emissions. One MDI contributes the equivalent of driving 290km by car.
Meanwhile, dry powdered inhalers (DPIs) and soft mist inhalers (SMIs) are effective available alternatives with lower environmental impact. Dr. Green encourages physicians to make the switch for eligible patients and explains how her clinic has created resources to facilitate the prescribing change.
Addressing such low-hanging fruit of climate action in the healthcare system is important but, according to Dr. Andrea MacNeill, reducing waste, changing prescriptions, and recycling are the tip of the iceberg. What’s really needed is profound systemic change. Dr. MacNeill argues that emissions are driven by a system focused on providing the most complex and carbon-intensive care.
“New healthcare funding seems to go into very complex resource-intensive treatments that modify very advanced disease processes. And I would suggest that we need to shift that focus upstream and start to think, okay, could we have prevented this from ever happening? And in many cases, the answer to that is yes,” says Dr. MacNeill.
Along with a focus on prevention, Dr. MacNeill argues healthcare systems need to put pressure on the supply chain, which accounts for the bulk of emissions. In England, the NHS is demanding that vendors match the NHS's climate target to decarbonize by 2030.
Links to resources discussed on the episode:
Inhaler Toolkit for Physicians
Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.
You can find Blair and Mojola on X @BlairBigham and @Drmojolaomole
X (in English): @CMAJ
X (en français): @JAMC
Facebook
Instagram: @CMAJ.ca
The CMAJ Podcast is produced by PodCraft Productions
Physicians working in hospitals see the mountains of medical waste generated each day. Meanwhile, the climate crisis challenges the medical system to reduce its contribution to greenhouse gas emissions. Globally, healthcare systems contribute as much carbon dioxide as the airline industry. In Canada, healthcare accounts for 4.6% of our total emissions. The problem is urgent, but potential solutions are both easier and more complex than many might think.
Guests on this episode are advocates in the climate and health space. Dr. Samantha Green is the co-author of the CMAJ article, Five Things to Know About Metered Dose Inhalers and their Impact on Climate Change. She's a family physician at Unity Health Toronto and the climate and health lead at the University of Toronto's Department of Family and Community Medicine.
In the article, she and her co-authors point out that pressurized metered-dose inhalers (pMDIs) are an important contributor to greenhouse gas emissions. Dr. Green says measurements done in the United Kingdom by the National Health Service found that MDIs contribute 3.1% of the entire health system's carbon emissions. One MDI contributes the equivalent of driving 290km by car.
Meanwhile, dry powdered inhalers (DPIs) and soft mist inhalers (SMIs) are effective available alternatives with lower environmental impact. Dr. Green encourages physicians to make the switch for eligible patients and explains how her clinic has created resources to facilitate the prescribing change.
Addressing such low-hanging fruit of climate action in the healthcare system is important but, according to Dr. Andrea MacNeill, reducing waste, changing prescriptions, and recycling are the tip of the iceberg. What’s really needed is profound systemic change. Dr. MacNeill argues that emissions are driven by a system focused on providing the most complex and carbon-intensive care.
“New healthcare funding seems to go into very complex resource-intensive treatments that modify very advanced disease processes. And I would suggest that we need to shift that focus upstream and start to think, okay, could we have prevented this from ever happening? And in many cases, the answer to that is yes,” says Dr. MacNeill.
Along with a focus on prevention, Dr. MacNeill argues healthcare systems need to put pressure on the supply chain, which accounts for the bulk of emissions. In England, the NHS is demanding that vendors match the NHS's climate target to decarbonize by 2030.
Links to resources discussed on the episode:
Inhaler Toolkit for Physicians
Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.
You can find Blair and Mojola on X @BlairBigham and @Drmojolaomole
X (in English): @CMAJ
X (en français): @JAMC
Facebook
Instagram: @CMAJ.ca
The CMAJ Podcast is produced by PodCraft Productions
Dr. Mojola Omole:
Hi, I'm Mojola Omole.
Dr. Blair Bigham:
And I'm Blair Bigham. And this is a CMAJ podcast.
Dr. Mojola Omole:
So today's episode is inspired by the article in CMAJ called, The Five Things to Know About Metered Dose Inhalers and their Impact on Climate Change. Or as we should be calling it, the climate emergency. We're going to speak with one of the authors of the article, but then we're going to go a bit broader and talk about the challenges in climate emissions from healthcare. So what are you interested in looking at, Blair?
Dr. Blair Bigham:
So I never thought about metered dose inhalers as being a big culprit for emissions. When I think about waste and healthcare, I just think about the amount of garbage that we produce, like all the packaging, all the disposable gowns, everything that just fills up garbage bins so quickly in the operating room and the emergency department in the ICU. I just think, man, this is nuts, the amount of things that we just throw away.
Dr. Mojola Omole:
Yes, that definitely was the same thing. It never occurred to me that inhalers... Well, I don't really prescribe inhalers, but it never occurred to me that this has such a big impact.
Dr. Blair Bigham:
Yeah. I'm totally curious to hear if this is as easy as it sounds.
Dr. Mojola Omole:
Yes. And also if there's any cost changes to the patients, like if we're talking about equity with our patients, is this going to change that? And also is it something that's, and this is part of my ignorance, is this something that's widely available throughout Canada for our patients also? So we're not further marginalizing the patients who are already marginalized?
Dr. Blair Bigham:
Absolutely.
Dr. Mojola Omole:
And then going a bit broader and having that conversation with our other guest about, what are the system changes that need to be made in healthcare for us to actively be participating in reversing the climate emergency that we currently have?
Dr. Blair Bigham:
I was on the bus from the train station to work the other day, or this is probably going back a few months now, but I was sitting beside this lady and her name tag said, Director of Waste Management for the hospital I work at. And I said, "Oh, hi." And we just started chatting. And she told me that we produce 18,000 pounds of garbage a day. I was like, "What?" She's like, "Yep. Every day."
Dr. Mojola Omole:
But you're in America, so that makes sense.
Dr. Blair Bigham:
Yeah, down here, we don't reuse anything. Everything goes in the garbage, nothing gets reprocessed. It's really sad.
Dr. Mojola Omole:
Yeah. And so our second guest is also a surgeon. That's something that would be interesting to talk about, is if we're reprocessing what is the energy cost to reprocessing versus single waste, right? So for me, it was like when I was trying to decide between cloth and whatever, disposable diapers. I'm like, but how much water... And first it's gross, but how much water am I going to be using to be cleaning these diapers? And then how much waste am I going to be producing into the landfill with disposable diapers? So I'm always interested in looking at it from both angles of the actual garbage, but also in terms of energy.
Dr. Blair Bigham:
You want to make sure you're not just swapping out one bad thing for the environment for another, be it packaging or transport or production emissions.
Dr. Mojola Omole:
Exactly.
Dr. Blair Bigham:
Let's jump into it.
Dr. Blair Bigham:
Dr. Samantha Green is the co-author of the CMAJ article, Five Things to Know About Metered Dose Inhalers and their Impact on Climate Change. She's a family physician at Unity Health Toronto. She's also the climate and health lead at the University of Toronto's Department of Family and Community Medicine. Hi, Samantha.
Dr. Samantha Green:
Hi.
Dr. Blair Bigham:
Thank you so much for joining us today.
Dr. Samantha Green:
Thanks for having me.
Dr. Blair Bigham:
Why did you decide to focus on puffers?
Dr. Samantha Green:
Great question. First of all, we know that climate change is the biggest health threat of this century. And we also know that the healthcare system contributes 4.6% of Canada's carbon emissions. So there's a lot of room for us to improve the way that we deliver care to make it more sustainable. A lot of work has been done elsewhere to measure where those emissions come from. So we know from measurements done in the United Kingdom at the National Health Service there that metered dose inhalers contribute about 3.1% of the entire health system's carbon emissions. One metered dose inhaler is the equivalent of driving 290 kilometers by car.
Dr. Blair Bigham:
Oh, wow.
Dr. Mojola Omole:
Wow.
Dr. Samantha Green:
So it's a huge hot spot, and a great place for us to make some change.
Dr. Blair Bigham:
And what is it about a puffer that makes it so bad for the environment?
Dr. Samantha Green:
Metered dose inhalers contain a propellant, HFC, that is about a thousand times as potent as carbon dioxide as a greenhouse gas.
Dr. Blair Bigham:
Oh, why are they made with that gas instead of something else?
Dr. Samantha Green:
Yeah. Great question. They actually used to contain a different kind of propellant back in the 1990s, but that chemical actually contributed to ozone depletion. And so under the Montreal Protocol at the time, there was a global agreement to switch away from ozone depleting chemicals, and so there was a switch made to HFCs. And unfortunately although HFCs do not deplete the ozone, they are this very powerful greenhouse gas.
Dr. Blair Bigham:
Oh, so they've swapped one bad option for another bad option.
Dr. Samantha Green:
Pretty much, yes.
Dr. Blair Bigham:
And so as an emergency doctor, I use a ton of puffers. Tell me about some of the alternatives to metered dose inhalers. What are the other options for people who have asthma or COPD at home?
Dr. Samantha Green:
Sure, absolutely. So dry powder inhalers and soft mist inhalers are the alternatives. They do not contain powerful HFC propellants. And instead the medication of course is inhaled into the lungs using the patient's breath. They are actually more effective, and patients tend to find them easier to use. For the vast majority of our patients, and actually in other countries, they are the default inhaler that's used in many countries, for example, across Europe.
Dr. Blair Bigham:
So they're equally effective, just environmentally friendly. Is that a good way to sum it up?
Dr. Samantha Green:
Yeah, equally effective for the majority of our patients. There are some patients who do better with metered dose inhalers, and so we're not advocating that we switch every single patient to DPIs.
Dr. Mojola Omole:
Is there a difference in terms of technically being able to use it?
Dr. Samantha Green:
Yeah. So dry powder inhalers are actually much easier to use. And so there are studies that show patients may actually require fewer doses because the medication is actually reaching the lungs and patients tend to use them more appropriately. They also contain dose counters, so patients know how much medication is left in them. So they're actually recommended over metered dose inhalers in school-aged children, and they're equivalent in adult patients.
Dr. Blair Bigham:
And so who don't they work for? Who should still stick with an MDI?
Dr. Samantha Green:
So we should be prescribing an MDI with a spacer to preschoolers, to anyone with end stage disease who can't muster enough breath to use a DPI, and anyone with dementia who might have trouble coordinating the use of a DPI.
Dr. Blair Bigham:
So the DPI really depends on your ability to inspire deeply and quickly?
Dr. Samantha Green:
Yeah, that's right.
Dr. Blair Bigham:
Okay. And then I guess we have to ask about cost. Is there a cost difference between the different inhaler modes?
Dr. Samantha Green:
There is. In primary care what we've been recommending is that most patients who are prescribed, for example, salbutamol could be switched to terbutaline as an equivalent short acting beta agonist. It is slightly more expensive than salbutamol, but it's on the same order of magnitude. And then of course there are new asthma guidelines, the updated Canadian Thoracic Society guidelines and the new GINA guidelines, which suggests that even patients with very mild asthma could be prescribed a combination inhaler for as needed use. So for example, budesonide formoterol, and that is much more expensive, like an order of magnitude more expensive. But as the SYGMA studies have shown that using a combination inhaler is more effective to prevent asthma exacerbations.
Dr. Blair Bigham:
And can you basically get anything that comes in an MDI in dry powder form instead, or are there only certain brands or only certain drugs that come in that format?
Dr. Samantha Green:
Most of the inhalers come in dry powder inhaler form. Salbutamol even comes as a discus, but it's on brand so it's very expensive and difficult to find. But on our website, which we mention in the article, there are a number of reference charts that people can look at to see what a reasonable switch might be for their patient from an MDI to a DPI.
Dr. Mojola Omole:
So are DPIs widely available in Canada? Like even in more remote areas? Like do patients have access to those?
Dr. Samantha Green:
Yeah. Yeah, definitely. They are widely available.
Dr. Blair Bigham:
So this sounds like a no brainer, like low hanging fruit. What's the catch here? Why hasn't this become more popular in Canada if it's so much better for the environment than the traditional MDIs?
Dr. Samantha Green:
I just think like anything, it's a practice change. And so there's a bit of inertia. We all need to switch what we prescribe to our patients, and that can be quite a challenge, especially for example, myself in family medicine, I might receive through my EMR a faxed prescription renewal request for salbutamol, and it's very easy to just click renew than to change that patient to a DPI. That requires a conversation. It requires a discussion of risks and benefits and why I'm suggesting we make that switch. And so it takes some effort. I will say though, that when I've discussed this with my patients, they're more than happy to make the switch. And most patients are actually quite disturbed when they find out the impact of a single metered dose inhaler on the environment. And they're very happy to switch to a less impactful DPI.
Dr. Blair Bigham:
So often, Samantha, in our podcast, we hear that family doctors need to take the burden on for change, that there's more to do. How do you overcome that? We're now asking one more thing of family doctors who are already overwhelmed and overworked.
Dr. Samantha Green:
I think that this intervention is actually an antidote to burnout. People actually feel really good about making a difference, and it's one little thing, but to see how much of an impact you can make by making this one practice change, I think can actually be quite fulfilling and help people, providers, doctors, feel good about doing at least something about the climate crisis.
Dr. Blair Bigham:
Samantha, you make a really strong case here for the switch. What other things might be done to make it easier for physicians or their patients to see the value in switching over, to overcoming that inertia you spoke about?
Dr. Samantha Green:
Yeah, what we've done at my clinic is we have in our EMR prescription favorites to make it easier for providers to prescribe DPIs over MDIs. And when we type in hashtag inhaler, the DPI prescriptions come up pre-populated to make it much easier to prescribe. And there are resources on our website so people can download these prescription favorites to use themselves. There's also waiting room posters that can be used, and a form letter that can be sent to patients when you've received a faxed renewal request for say, a salbutamol inhaler, there's a letter you can send to your patients. But I think it requires local system change within each primary care clinic, within each specialty clinic. I think it does require engaging in a QI process.
Dr. Blair Bigham:
I'm going to give this a try on my next shift, and try to switch away from MDI prescribing. And I'm sure I'm going to get all sorts of weird looks and phone calls, but I'm going to give it a go.
Dr. Samantha Green:
All right. Amazing.
Dr. Blair Bigham:
Samantha, thank you so much for your time. This is great information.
Dr. Samantha Green:
Thank you so much for having me.
Dr. Blair Bigham:
Dr. Samantha Green is co-author of the CMAJ article, Five Things to Know About Metered Dose Inhalers and their Impact on Climate Change.
Dr. Mojola Omole:
Dr. Andrea MacNeill is a surgical oncologist at Vancouver General Hospital and BC Cancer. She's the founder of UBC's Planetary Healthcare Lab. Thanks for joining us today, Dr. MacNeill.
Dr. Andrea MacNeill:
Thanks for having me, Dr. Omole.
Dr. Mojola Omole:
Can you describe to us what waste you see in your practice?
Dr. Andrea MacNeill:
Yeah, I expect it's very similar to yours, Jola, being a surgeon as well. That for me, this began when I was a resident, and I was quite stricken by the mountains of waste that we generate with every operation. And that prompted me to do a Masters of Environmental Change and Management to look into this. But I discovered through the course of that that the visible waste is not really the problem. That's the tip of the iceberg. That in terms of greenhouse gas emissions from healthcare consumables, up to 90% of a products emissions happen before we ever use them. So whether we throw them into a black bag or a recycling bin is really only modifying that last 10%. So that's why we can never recycle our way out of this. That's why that question makes my head explode. But the mountains of waste, like I say, are really the tip of the iceberg here.
Dr. Mojola Omole:
So is there any low hanging fruit, or is that not even possible when we're talking about institutional healthcare waste?
Dr. Andrea MacNeill:
No, I think there is low hanging fruit. And one of the things I would encourage people to do really is think about reduction, as you can appreciate in the OR we routinely open a lot of things that we don't use. There are sources of systematic waste. That sort of thing can be easily eliminated without in any way compromising care. There are other known sources of greenhouse gas emissions, like certain types of inhalers, like certain inhaled anesthetics that can be easily substituted for an environmentally preferable one. So there are low hanging fruits like that, but I actually think that we are in a place where we should be thinking about systemic transformation, not the low hanging fruit. Let's get away from the easy wins, the green washing, and let's go for the money.
Dr. Mojola Omole:
So how would we do that in the healthcare system?
Dr. Andrea MacNeill:
Well, I would suggest that we, like I said, need systemic transformation. And we have published a framework for what I call planetary healthcare, meaning environmentally sustainable healthcare. And it is predicated on three key principles, beginning way upstream of ever being in the OR and using those consumables in the first place. We need to focus on prevention. We need to shift our goal from being a factory for the treatment of disease to a source of health and wellness. To focus on having healthy populations, health promotion, disease prevention, and good chronic disease management, so that fewer people need the healthcare system
, or that we in general keep people's interactions with the system at their lowest level of resource intensity, which is going to their family doctor, having their cancer screening, all of those things that prevent them from developing an advanced disease that then necessitates resource intensive treatment.
Dr. Andrea MacNeil
We're really bad at that. All new healthcare funding seems to go into very complex resource intensive treatments that are modifying very advanced disease processes. And I would suggest that we need to shift that focus upstream and start to think, okay, could we have prevented this from ever happening? And, in many cases, the answer to that is yes.
Dr. Mojola Omole:
What are the other two?
Dr. Andrea MacNeill:
So the second operating principle is what we call matching supply to demand. And this gets back in a way to that primary care and prevention piece, in that we want to match our health services to the problem at hand. So when you have people using the emergency department because they don't have a family doctor, or you have patients waiting in hospital for months for long term care placement, that's a supply and demand mismatch. So what that means is that we need to avoid both underuse of necessary health services, and overuse of unnecessary services. So underuse of vaccines, for example, leads to people being in the ICU on ECMO. And you can appreciate that, from a resource consumption standpoint, there's a vast difference there. Whereas, within the acute care system, we actually do a lot of overuse, as I'm sure you can appreciate. There's a lot of built-in inefficiencies, redundancies, ways that we drive consumption of healthcare resources that doesn't in any way add value to patients' care.
Dr. Mojola Omole:
Okay. And so then what is the final principle?
Dr. Andrea MacNeill:
Yeah. So once we have prevented as much disease as we can, and then appropriately constructed and funded our system to address that, then we can really focus on decarbonizing health services so that in the appropriate treatment of people's disease, we do that in a low carbon, low material use way.
Dr. Blair Bigham:
I feel like all I ever hear about at work is this phase, the third phase here, the de-carbonization. People are always talking about making sure that your waste goes in the right bin and talking about if they should incinerate or if they should do other things with the waste. How did we get so far off track where that focus is just on this mountain of garbage? How do we get people to think more upstream, the way you've described?
Dr. Andrea MacNeill:
I wish I had an answer to that. In a way, our undue focus at the end of the line in terms of environmental impacts simply mirrors our undue focus on end of the line treatments in terms of how we construct and fund our system. So I think this is some innate part of human nature in thinking, to only want to deal with the problem that is immediately in front of us, which is this cancer that I have to treat right now, and not to think about all the other people who have cancer now or who will develop it in future and how can I modify any of the steps in that process so that those patients don't end up in front of me?
Dr. Blair Bigham:
Andrea, I don't want to have people feel like they're no longer empowered because these other interventions, the day to day stuff, is less valuable. I mean, there's hundreds of people employed in hospitals whose job it is just to make sure that we manage our waste a little bit better. But how can we inspire those people to take it that next step?
Dr. Andrea MacNeill:
Yes, I in no way want to suggest that we must solely focus on prevention, by any stretch. I guess what I want to suggest is that there's an opportunity to rethink how we deliver healthcare in a way that's better for patients and for the planet. And I can give some examples of that to your previous question Blair, but what does that de carbonization piece look like? Things like regional anesthesia, for example, which means not putting people to sleep for their surgery or, in addition to putting people to sleep, blocking the nerves that supply the area you're going to operate on. There has been an uptake in regional anesthesia throughout the pandemic because it avoids the generation of aerosols, so COVID was the motivation for this in many cases. But it provides better analgesia, minimizes things like postoperative nausea and vomiting, accelerates people's recovery. Patient satisfaction scores are through the roof with regional. Patients love it, their experience is improved, and it dramatically decreases the emissions associated with the administration of anesthesia, because in many cases, it avoids the need for inhaled agents altogether.
Dr. Andrea MacNeill:
So that is one simple example of the way something we can do very much within existing resources and existing systems can not only minimize our carbon footprint and decarbonize the administration of anesthesia and surgery, but also improve the value and experience of that surgery for patients.
Dr. Mojola Omole:
So just to pivot a bit, the NHS in England, they have a very ambitious approach to tackling emissions. What are they doing, and could something like that be replicated here in Canada?
Dr. Andrea MacNeill:
It absolutely could. And we certainly look to them for leadership in this, and want to leverage their success for similar initiatives here. The NHS has committed to decarbonizing by 2045 with some intermediate targets and timelines along the way. They have an ambitious supply chain strategy, recognizing that that is the source of most emissions. They're essentially demanding that their vendors match the NHS's ambition of their climate targets. So by 2030, in order for a vendor to sell something to the NHS, they have to have committed to decarbonizing as well within that same timeframe. So we will all benefit from that. I mean, the medical device industry is a global industry. These are the same vendors that we are purchasing from. So the NHS's leadership in this is going to really shift the dial for all of us.
Dr. Mojola Omole:
Awesome. And it sounds like all of these things will not just be better for the environment, but it'll be better for our patients, which is our ultimate goal as healthcare providers. What are the obstacles that are stopping us from being able to do that?
Dr. Andrea MacNeill:
People are strangely wed to the status quo, and I think that stems from a belief that the way we have always done things is because it was somehow better. Like that we did rigorous studies that showed that general anesthesia is the best way to deliver surgery, and we should not deviate from that. It has actually astonished me to see some of the innovations that have come out of the pandemic that have defined a better way forward for patients, for the system, for the planet. And, now that one could argue the pandemic is waning, there is a conversation around, great, we get to go back to the way things were. It just blows my mind, like. hold the phone, we know how to do this better now. But there is this strange, like I say, affinity for the status quo that I think is from a belief that that was carefully crafted according to some master plan. And it was not.
Dr. Andrea MacNeill:
And I think the other major barrier has to do with our training as scientists. So that reductionist thinking that goes into isolating a single variable, controlling for it and studying it, which is reinforced in our quality improvement training with things like PSA cycles, leads us to believe that these issues exist in isolation, and therefore in competition. So I frequently hear, well, we can't focus on sustainability because somehow that would detract from patient care, or it's at odds with whatever else we want to do at the same time. And I think it is absolutely imperative that people recognize that these are not competing priorities. They're actually quite synergistic, that we can define a path forward that offers better patient care, better experience, typically lower costs, a greatly reduced environmental impact, better equity access, the list goes on. The escalating levels of social value creation that can come from an intentionally designed system.
Dr. Mojola Omole:
So as I'm listening to this, I'm inspired. So if there are other physicians who are inspired, and maybe they work in the hospital setting, what can they do if they want to go to the organization and say, "Okay, you know what? I just listened to a great podcast and I want to institute some changes." What can they do?
Dr. Andrea MacNeill:
Well, first of all, I would suggest that they get connected to Cascades, which is an emerging pan-Canadian network that's meant to be a knowledge mobilization network to accelerate the uptake of best practices within sustainable healthcare, and to facilitate clinicians or institutions implementing these things at scale. So we have constructed this network to help people do that. So go to Cascades, get plugged in. There's an entire community of people who want to do this and who can help you do it.
Dr. Andrea MacNeill:
The second thing I would suggest is really to go to the top, to understand the leadership and governance of your organization, and to start by trying to embed planetary health or environmental sustainability as an institutional priority, rather than starting with a grassroots volunteer green team, as they're often called, or committee where your remit will be limited. The state of the climate and ecological crisis is such that health leaders need to be stepping up and taking a leadership role. And by engaging your senior leadership, that will facilitate action throughout the organization and really amplify and accelerate your impact.
Dr. Blair Bigham:
That's a great call to action.
Dr. Mojola Omole:
Andrea, are there more people like you? You're the first person I ever heard of that's a surgeon who has a Masters in environmental something. Are there more people like you?
Dr. Andrea MacNeill:
Yeah, there's a lot of people like me. The healthcare community is crying out for this kind of change. Which I think you totally get, that we've been asked to live differently at work than we do at home. And to be incredibly wasteful and just throw things out that are unused, where you can see there's retained value and we just discard that. There's a lot of moral distress over the broader climate and ecological crisis, and over the way that we are forced to practice as clinicians. And people are starting to say, “Not okay anymore. Do better.”
Dr. Mojola Omole:
Thank you so much, Andrea. This was awesome.
Dr. Andrea MacNeill:
Thank you so much. Jola and Blair.
Dr. Mojola Omole:
Dr. Andrea McNeil is a surgical oncologist at Vancouver General Hospital and BC Cancer. She's the founder of UBC's Planetary Healthcare Lab.
Dr. Blair Bigham:
Well, apparently the 18,000 pounds of garbage a day isn't the issue.
Dr. Mojola Omole:
No, but it does matter, right?
Dr. Blair Bigham:
Right, right.
Dr. Mojola Omole:
But it does matter, because it's not about recycling that much waste, it's about how do we stop generating?
Dr. Blair Bigham:
It's about going upstream.
Dr. Mojola Omole:
Yeah. It's like, how do we stop generating that much waste?
Dr. Blair Bigham:
Yeah. And I just feel like all the focus is always on what do we do with all this waste, and that nobody ever said, "Well, wait a minute, how did we get all this waste to begin with?"
Dr. Mojola Omole:
This has been such an eye opening episode.
Dr. Blair Bigham:
Mind blowing.
Dr. Mojola Omole:
What are you thinking?
Dr. Blair Bigham:
I'm thinking that I've been wrong for years and years and years about my approach to planetary health and the environment. This idea that dealing with all of our carbon production is just the end of the road is really eye opening for me. But I think Andrea is totally right. We have all of this waste in healthcare that is being produced because we have to deliver healthcare. And why do we have to deliver healthcare? Because we didn't prevent the disease to begin with. That's really eye opening for me.
Dr. Mojola Omole:
Me too. I think I'm left with the more episodes we do on the podcast, even the ones that are very textbook medicine, that at the end of the day if we are not addressing social determinants of health, we're not... That should be the main pillar of healthcare, is to actually…
Dr. Blair Bigham:
Absolutely, going upstream.
Dr. Mojola Omole:
Yeah. And like preventative health. And we don't spend enough time learning about that in medical school. And I chose surgery so I don't spend a lot of time preventing health issues, but it really is eye opening that a lot of our problems in society, and also when we talk about the planet, could be solved if we prevent disease.
Dr. Blair Bigham:
Absolutely. I only worry about coming up with that conclusion because it seems so pie-in-the-sky, and what do we do about that as an ER doc and a surgeon? What do we do to actually address all of these upstream issues? And it sounds like Andrea has dedicated a huge amount of time to figuring out how individuals can contribute to the collective, and help organizations slowly shift that culture.
Dr. Mojola Omole:
Well, I think investing more in people having family doctors is a huge part of it. Family doctors are the bedrock of our healthcare system. And we don't pay them well, we don't treat them well. And if we actually make it a career that they feel that they're rewarded, that's going to benefit our patients. And that's also going to benefit our planet, because if we can prevent disease, a lot of our downstream problems would be solved.
Dr. Blair Bigham:
Absolutely. And I feel like the pandemic has shown firsthand how much value family doctors add to the system. Because, when so many clinics had trouble seeing patients because of the pandemic, we really saw that over reliance on more expensive parts of the healthcare system, like having more advanced disease, like needing emergency departments, like needing to go to the ICU because you didn't have information about the vaccine that you needed. That a lot of the time family doctors, because they have that longitudinal relationship with people, they’re really effective at getting behavioural changes. Whereas when I talk to someone in the emergency department about quitting smoking, they don't know me. I don't know them, I'm not going to be effective. But it's the family doctors who really hold that key, that trust that patients have with that longitudinal relationship, to stay healthy and not end up requiring expensive and highly carbon-producing healthcare.
Dr. Mojola Omole:
I left actually feeling very invigorated in terms of what actionable change I can make when she mentioned the one about regional anesthesia. I never thought of it from the perspective of the planet. And so that has really left me thinking, okay, this is something that I would like to bring to my hospital organization. I think it is cost saving, and at the same time, it is good for the planet and it's good for our patients. So it's a win-win all around
Dr. Blair Bigham:
And even simple things like switching to a dry powder inhaler instead of our current puffers, it's those small actions that can make you feel like you're at least part of the solution and not part of the problem.
Dr. Mojola Omole:
100%.
Dr. Blair Bigham:
Feel free to check out the show notes for a link to some of the things that we talked about out today with our fabulous guests. And please do share the podcast. It's the best way to get information out there so that we can spread the word. I'm Blair Bigham.
Dr. Mojola Omole:
I'm Dr. Mojola Omole. Until next time, be well.