Sustainable healthcare during a pandemic

... because you can’t have healthy people on a sick planet

At Health Care Without Harm Europe, our mission is to transform the European healthcare sector so that it reduces its environmental footprint, becomes a community anchor for sustainability, and a leader in the global movement for environmental health and justice. To achieve this, we work with our members and partners across five closely connected programme areas of sustainable healthcare - Safer Chemicals, Sustainable Food, Climate-smart Healthcare, Safer Pharma, and Sustainable Procurement.

We recognise the extraordinary burden placed on our community by the recent COVID-19 outbreak in Europe. Many of you are on the front lines of this unfolding crisis, caring for the most vulnerable in your communities. The team at HCWH Europe wishes to extend its thanks for your tireless work during this unprecedented time. We have heard countless stories of hope, community, and compassion from across the healthcare sector in Europe. We are all humbled and inspired by you.

Whilst working from home during the COVID-19 outbreak, our team shares some of their thoughts on lessons we might learn from this pandemic, and how we can respond to COVID-19 without abandoning a sustainable approach to providing healthcare.

 Safer Chemicals – Dorota Napierska

In the course of providing care, the healthcare sector uses a large variety of chemicals. Some of these substances can be hazardous to human health, and a growing number of hospitals are already substituting them with safer alternatives - safeguarding human health without sacrificing quality of patient care. The COVID-19 pandemic has re-centred healthcare’s priorities and highlighted challenges around not only disinfection, but also the decontamination and reuse of personal protection equipment (PPE) during shortages that are affecting the care of patients and safety of healthcare workers. We need to rethink our dependency on single-use items and work towards more sustainable solutions to reduce environmental impacts from manufacturing and waste – as well as improved resilience to such shortages.

During a pandemic, it is essential for healthcare professionals and citizens to have access to more disinfectants; to increase manufacture and supply of disinfectants in Europe, the European Chemicals Agency (ECHA) is supporting EU/EEA authorities to apply derogations from the normal authorisation requirement for biocidal products.

We still need to understand the implications of such exemptions for the healthcare sector in terms of availability, quality, safety, and efficacy of disinfectants, as well the implication for the environment in terms of amounts used. Whilst the chemicals used to clean healthcare facilities play an important role in infection prevention and control they are also, ironically, a source of health and environmental hazards. Cleaning and disinfecting products has been identified as the most frequent cause of work-related asthma, allergies, and skin problems in healthcare workers.

There is increasing concern about the amount of waste arising from healthcare’s response to this outbreak; Health Care Without Harm's experts have prepared a comprehensive document with the latest information and recommendations on how to address waste management in a pandemic. Let us ensure sound medical waste management - proper segregation, collection, and disposal of all COVID-19 related waste must be properly practiced.

 Climate-smart Healthcare – Scott Brady & Mireia Figueras Alsius

One could say that the COVID19 outbreak has caught the global community off guard - consequently responding to this crisis in a rather reactive way. Looking at this pandemic’s impact on Europe’s health systems, and with parallels being drawn between COVID-19 and the climate crisis now is an important time to take action on healthcare resilience in a meaningful way. It is time to be proactive in planning future responses to climate emergencies and health emergencies which are inextricably connected; we must guarantee that hospitals are the last buildings standing during times of crisis.

It is not enough that hospitals alone weather this storm, however, resilience means that served communities are equally prepared. We need to build strong communities and recognise them as central actors in health systems - not simply the recipients of healthcare. Engaging communities and building a common, collective response can eventually minimise social and economic disruption in times of crisis. In other words, having a strong community means that people are ready to take responsibility and the vulnerable are protected.

Another prerequisite for resilient health systems is to move towards low-carbon healthcare - decarbonising the health sector and integrating climate as a transversal element into the way we deliver care will contribute to maintaining core functions during crises. Moving to onsite renewables or purchasing energy-efficient medical devices, for example, will not only reduce emissions but also improve energy security in times of disaster.

A sentence resonates loud these days: we can’t go back to “normal” - while trying to be resilient ourselves, we are convinced that being proactive today and building resilient health systems for tomorrow, is a smart beginning for a new (and better) normality.

 Safer Pharma – Jean-Yves Stenuick

The COVID-19 pandemic is reshaping the world as we know it - thousands of lives have been lost, millions of people around the globe are under lockdowns, and stock markets have plunged to record low levels. Discussions in the healthcare sector have focused on related threats such as shortages of medicines, personal protective equipment, and ventilators. Another looming threat, however, has received much less attention: antibacterial resistance.

Though antibiotics do not work on viruses, they are nevertheless crucial against secondary bacterial infections - more common when cells are badly damaged by viral infections; bacterial pneumonia, for instance, is quite common in influenza patients. It has already been reported that secondary bacterial infections have a significant impact on COVID-19 patients, particularly those under extended hospital stays.

This pandemic should highlight, once again, that it is crucial to ensure that our antibiotics continue working to form a second line of defence - they are the cornerstone of our modern medicine. Yet antibiotics are still largely mismanaged - they are routinely used in intensive farming, overprescribed in the healthcare sector, and escape from manufacturing facilities into the environment. Such factors drive the development of antibiotic resistance, one of the top ten global health threats. 

The healthcare sector has an important role to play to tackle antibiotic resistance and reduce its development in the environment. This includes using the sector’s huge procurement power to incentivise pharmaceutical companies to green their production methods, informing patients about safe disposal methods for unused or expired antibiotics, and tackling inappropriate and oversubscription practices of antibiotics.

 Sustainable Food – Paola Hernández Olivan

Food services in healthcare have their own complexities, but during this exceptional time, new measures must be quickly implemented to avoid contagion and contamination between service professionals and patients.

Critical focus points for food services in healthcare during the COVID-19 pandemic are the removal of waste, the management of isolated patients, and staff training.

Cleaning food areas and utensils has been intensified to reduce contact contamination, open salad bars have been removed, and fruit is now offered whole, instead of cut pieces. In some cases, single-use items are offered as a precaution or at the request of the client. Hospital cafeteria layouts have also been rearranged to respect the two metre spacing guidelines, with many now offering a take-away option to reduce potential crowding.

Finally, let us not forget the importance that diet and nutrition plays in boosting our immune system and supporting recovery from the virus – particularly for those who are already at risk with existing conditions including diet-related ones such as cardiovascular disease or diabetes. The Food and Agriculture Organization of the United Nations (FAO) has published a list of recommendations to maintain healthy diets and create more sustainable food systems. These two aspects should be a top priority for our health now and in the future.

 Sustainable Procurement – Arianna Gamba

European Member States have struggled to adopt a coordinated response to the current COVID-19 pandemic and the dependency of the healthcare sector on global supply chains for single-use PPE and other medical equipment has put a spotlight on the vulnerability of our health systems.

With increased demand for products and national governments initially limiting exports of essential supplies, procurement teams have been facing enormous pressure to ensure both workers’ safety and delivery of care for patients. This may result in purchasing whatever is available on the market, neglecting the organisations' sustainable procurement principles - but it has also prompted healthcare professionals to find ways to safely reuse protective equipment, and encouraged businesses to create new solutions.

Some businesses are adapting their production to address the supply shortages and we are experiencing many other inspiring stories of solidarity across the globe.

What could have prevented us to get to this point? There are many political answers to this question and surely there is no one-size fits all solution, but from a procurement perspective, there are a few actions that could contribute to building resilient health systems.

By creating shorter, transparent, and more sustainable supply chains we could spur the local production and support SMEs. The coordination of joint procurement programmes for cross-border health emergencies can prevent speculations and price spikes resulting in public authorities competing against one another. By harmonising sustainable procurement criteria and merging their purchasing power, healthcare organisations can increase demand for sustainable products and boost innovation in the field of circular economy, producing safe and reusable medical products and preventing supply shortages and hazardous waste. 

Our members are using innovation, ingenuity, and investment to transform the health sector and create a healthy future for people and the planet. Find out more about membership here.

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