Empowering health-care learners to take action towards embedding environmental sustainability into health-care systems
Authors: Owen Dan Luo, Jacob Joel Kirsh Carson, Victoria Sanderson, Kelan Wu, Rosemarie Vincent
Journal: The Lancet Planetary Health (2021)

Health care is one of the most important sectors in addressing the growing health impacts of climate change, but it has also been identified as a significant contributor to the climate crisis, being responsible for 4·6% of global greenhouse gas emissions in 2017.1Watts N Amann M Arnell N et al.The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises.Lancet. 2021; 397: 129-170Summary Full Text Full Text PDF PubMed Scopus (477) Google Scholar The negative environmental effects of health care are growing, with greenhouse gases and particulate matter emissions from health-care systems increasing by 29% and 9%, respectively, between 2000 and 2015.2Lenzen M Malik A Li M et al.The environmental footprint of health care: a global assessment.Lancet Planet Health. 2020; 4: e271-e279Summary Full Text Full Text PDF PubMed Scopus (69) Google Scholar There is thus a tremendous impetus to reduce the environmental impact of health-care delivery and achieve net-zero health-care services. Intersectoral collaboration is required to realise the transformative changes required for health-care systems to align with the sustainable development goals. However, health-care learners are often not included in the planning and delivery of climate change adaptation and mitigation efforts in the health-care service. This is despite the fact that these trainees have considerable interest in driving a healthy societal response to the impending ecological crisis,3Hackett F Got T Kitching GT MacQueen K Cohen A Training Canadian doctors for the health challenges of climate change.Lancet Planet Health. 2020; 4: e2-e3Summary Full Text Full Text PDF PubMed Scopus (16) Google Scholar and will soon be caring for patients and communities whose health will be impacted by the ongoing and compounding effects of climate change. To bridge this gap between health-care students and health sector leaders, we launched Project Green Healthcare (PGH), or Projet Vert la Santé, the first national community of practice empowering medical students to lead green change within the Canadian health-care system. The inaugural PGH cohort shows the strong interest of medical trainees in sustainable health-care delivery, as seven teams of 34 medical students distributed over five Canadian provinces are leading green quality improvement projects at ten health-care institutions. These teams have partnered with 18 physicians, eight interdisciplinary experts, five green teams, and six health-care administrators to launch a spectrum of projects that align with MacNeill and colleagues' framework for constructing environmentally sustainable health systems.4MacNeill AJ McGain F Sherman JD Planetary health care: a framework for sustainable health systems.Lancet Planet Health. 2021; 5: e66-e68Summary Full Text Full Text PDF PubMed Scopus (22) Google Scholar Specifically, these projects aim to reduce the use of heavily polluting desflurane and nitric oxide anaesthetic gases,5Sherman J Le C Lamers V Eckelman M Life cycle greenhouse gas emissions of anesthetic drugs.Anesth Analg. 2012; 114: 1086-1090Crossref PubMed Scopus (158) Google Scholar improve ward waste streaming and recycling in hospitals, launch interdisciplinary green team networks, promote active transportation to and from health-care facilities, increase the representation of planetary health content in medical education, implement more sustainable methods of managing health-care food waste, and inform primary care providers to reduce their ordering of carbon-intensive and low-value investigations and treatments.6Cassel CK Guest JA Choosing wisely: helping physicians and patients make smart decisions about their care.JAMA. 2012; 307: 1801-1802Crossref PubMed Scopus (665) Google Scholar 3 months after launching PGH, each of our medical student teams completed forms to reflect on their experiences, revealing common barriers and facilitators to student-driven health-care sustainability quality improvement projects (figure). In regard to enabling factors, the teams cited the motivating nature of their collective passion for sustainable health care and their inspiring interactions with other medical student climate action champions and health-care change-makers enabled by the PGH programme. Common barriers cited by the medical student leaders included the complexity of the Canadian health-care system and the many bureaucratic hurdles that delay and limit the realisation of meaningful change. In addition, medical student teams identified that the ongoing COVID-19 pandemic is posing unique challenges in their engagement with health-care leadership, who have little time to engage in non-pandemic related projects. Taken together, it is clear that the interactions between trainees and health-care system representatives can either elicit encouraging or discouraging influences on their capacity to build sustainable health care. It is thus important for health sector leaders to meaningfully engage with trainees and their ideas, passions, and commitments to build a long-lasting culture of environmental sustainability at their institutions. This can take the form of removing bureaucratic hurdles by launching interdisciplinary green teams that coordinate and initiate green initiatives at their hospital, incentivising health-care professionals to practise with smaller ecological footprints, and measuring the institution's environmental performance to enhance accountability and benchmark continuous quality improvement with tools such as the Green Hospital Scorecard. Health-care students are concerned about the impending climate crisis and are passionate about driving meaningful climate action—most particularly, within the health-care systems that they will soon be practising in. The urgency to realise transformational change to build a net-zero health-care service has never been greater, and health-care students are eager to lead, partner, and advocate for sustainable health-care services. By tapping into this strong learner-driven movement for green change through effective empowerment of emerging health-care leaders, our health-care systems can simultaneously nurture career-long sustainability advocates and advance their delivery of care that protects both communities and the planet. The PGH programme has the potential to serve as a model for meaningfully engaging health-care learners to build sustainable health services that can be replicated in other health systems internationally. The Project Green Healthcare (Projet Vert la Santé) programme is funded by a Strategic Innovation Fund administered by the Canadian Federation of Medical Students. Our funding source had no involvement in the administration of the programme or the writing of this Comment. We declare no competing interests.