Le système de santé High-Tech est-ils durable ?

Le chirurgien, une peinture de David Teniers, vers 1670

L’empreinte environnementale du secteur des soins de santé

Points chauds, les équipements médicaux de haute puissance

Salle d’opération technologiquement avancée. iStock.
Un scanner IRM à Taipei, Taiwan (2006). Image : Kasuga Huang (CC BY-SA 3.0).

Utilisation des ressources le long de la chaîne d’approvisionnement

Laboratoire de fabrication de produits pharmaceutiques. Source : iStock.
Ligne de production de gants en caoutchouc. Source : iStock.
Face mask production line. Source: iStock.

Anesthésiques et vaccins

Empreinte carbone des procédures médicales

Salle d’opération en chirurgie cardiaque, 2020. Source : iStock.

Les limites du carbone et de l’efficacité énergétique

Médecin scientifique travaillant sur le traitement d’une tumeur cérébrale dans un centre de recherche. Source : iStock.

Des soins de santé suffisants ?

Chirurgien-barbier extrayant une dent, peinture d’Adriaen van Ostade, 1630.

La résistance aux maladies

Heure de pointe à São Paulo, Brésil, 2005. Domaine public.

La loi des rendements décroissants

Operating room nurse preparing instruments for surgery at the 3rd Station Hospital, Korea. 1951. Source: US National Library of Medicine.

La recherche du profit

Hôpital militaire King George, salle de traitement électrique et de radiographie. 1915. Source : Bibliothèque nationale de médecine des États-Unis.

Âge et durabilité

  1. Pichler, Peter-Paul, et al. “International comparison of health care carbon footprints.” Environmental Research Letters 14.6 (2019): 064004. https://iopscience.iop.org/article/10.1088/1748-9326/ab19e1/pdf
  2. National estimates of health care sector greenhouse gas emissions have been performed for the UK(2009), the USA (2009 & 2016), Sweden (2017), Australia (2018), Canada (2018), China (2019), Japan (2020) and Austria (2020). For an overview, see [15]. However, because each study has its own methodology, the results are not perfectly comparable. That’s why I quote this source, as it gives comparable estimates.
  3. Eckelman, Matthew J., and Jodi Sherman. “Environmental impacts of the US health care system and effects on public health.” PloS one 11.6 (2016): e0157014. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157014
  4. US National Health Expenditure Data. Centers for Medicare & Medicaid Services. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical
  5. Tainter, Joseph. The collapse of complex societies. Cambridge university press, 1988. Page 102 &103.
  6. Current healthcare expenditure, 2012–2017, Eurostat. Current health expenditure per capita (current US$) — European Union, World Bank. Current health expenditure per capita, PPP (current international $) — European Union, World Bank. Health spending, OECD.
  7. In what follows, I ignore the resource use and emissions caused by transportation to and from health care facilities, as well as the resource use and emissions caused by the building of the health care facilities themselves.
  8. Research in different countries has shown an electricity use of 130 to 280 kilowatt-hour per square metre per year, representing around 50% of total on-site building energy consumption. [11–12] For comparison, residential electricity use in European households is on average 70 kWh/m2/year, and total energy demand is dominated by heating, not electricity. According to a 2016 study, for which scientists collected power data over a period of 18 months in a German hospital, operating rooms have the highest electricity use (438 kWh/m2/year), followed by intensive care units (135 kWh/m2/yr). [9]
  9. Christiansen, Nils, Martin Kaltschmitt, and Frank Dzukowski. “Electrical energy consumption and utilization time analysis of hospital departments and large scale medical equipment.” Energy and Buildings 131 (2016): 172–183.
  10. Wu, Rui. “The carbon footprint of the Chinese health-care system: an environmentally extended input–output and structural path analysis study.” The Lancet Planetary Health 3.10 (2019): e413-e419. https://www.sciencedirect.com/science/article/pii/S2542519619301925
  11. Bawaneh, Khaled, et al. “Energy consumption analysis and characterization of healthcare facilities in the United States.” Energies 12.19 (2019): 3775. https://www.mdpi.com/1996-1073/12/19/3775/pdf
  12. Rohde, Tarald, and Robert Martinez. “Equipment and energy usage in a large teaching hospital in Norway.” Journal of healthcare engineering 6 (2015). http://downloads.hindawi.com/journals/jhe/2015/231507.pdf
  13. Black, Douglas R., et al. “Evaluation of miscellaneous and electronic device energy use in hospitals.” World Review of Science, Technology and Sustainable Development 10.1–2–3 (2013): 113–128. https://www.osti.gov/servlets/purl/1172701
  14. Picano, Eugenio. “Environmental sustainability of medical imaging.” Acta Cardiologica (2020): 1–5. https://www.tandfonline.com/doi/abs/10.1080/00015385.2020.1815985
  15. Sherman, Jodi D., et al. “The Green Print: Advancement of Environmental Sustainability in Healthcare.” Resources, Conservation and Recycling 161 (2020): 104882. https://www.researchgate.net/profile/Brett_Duane/publication/343137350_The_Green_Print_Advancement_of_Environmental_Sustainability_in_Healthcare/links/5f216962299bf134048f8960/The-Green-Print-Advancement-of-Environmental-Sustainability-in-Healthcare.pdf
  16. Martin, Marisa, et al. “Environmental impacts of abdominal imaging: a pilot investigation.” Journal of the American College of Radiology 15.10 (2018): 1385–1393. https://www.sciencedirect.com/science/article/abs/pii/S1546144018308639. The researchers write that “when production and use phases are combined, the total energy consumption of MRI (>309 MJ/examination, abdominal scan, 1.5 Tesla) is comparable with cooling a three-bedroom house with central air-conditioning for a day”.
  17. Weisz, Ulli, et al. “Carbon emission trends and sustainability options in Austrian health care.” Resources, Conservation and Recycling 160 (2020): 104862.
  18. Belkhir, Lotfi, and Ahmed Elmeligi. “Carbon footprint of the global pharmaceutical industry and relative impact of its major players.” Journal of Cleaner Production 214 (2019): 185–194. https://www.sciencedirect.com/science/article/abs/pii/S0959652618336084
  19. Laufman, Harold, Luther Riley, and Barry Badner. “Use of disposable products in surgical practice.” Archives of Surgery 111.1 (1976): 20–26. https://jamanetwork.com/journals/jamasurgery/article-abstract/581229
  20. Gilden, Daniel J., K. N. Scissors, and J. B. Reuler. “Disposable products in the hospital waste stream.” Western journal of medicine 156.3 (1992): 269. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1003232/pdf/westjmed00091-0045.pdf
  21. Sherman, Jodi D., and Harriet W. Hopf. “Balancing infection control and environmental protection as a matter of patient safety: the case of laryngoscope handles.” Anesthesia & Analgesia 127.2 (2018): 576–579. https://www.researchgate.net/profile/Jodi_Sherman/publication/322407715_Balancing_Infection_Control_and_Environmental_Protection_as_a_Matter_of_Patient_Safety_The_Case_of_Laryngoscope_Handles/links/5a82ba12a6fdcc6f3eadcfab/Balancing-Infection-Control-and-Environmental-Protection-as-a-Matter-of-Patient-Safety-The-Case-of-Laryngoscope-Handles.pdf
  22. Thiel, Cassandra Lee, et al. “Life cycle assessment of medical procedures: Vaginal and cesarean section births.” 2012 IEEE International Symposium on Sustainable Systems and Technology (ISSST). IEEE, 2012.
  23. Campion, Nicole, et al. “Sustainable healthcare and environmental life-cycle impacts of disposable supplies: a focus on disposable custom packs.” Journal of Cleaner Production 94 (2015): 46–55.
  24. “Reusables, Disposables each play a role in preventing cross-contamination”, Elizabeth Srejic, Infection Control Today, April 2016
  25. Sustainability roadmap for hospitals, American Association of Hospitals. http://www.sustainabilityroadmap.org/topics/waste.shtml#.YCsEOXyYXWc.
  26. Thiel, Cassandra L., et al. “Cataract surgery and environmental sustainability: waste and lifecycle assessment of phacoemulsification at a private healthcare facility.” Journal of Cataract & Refractive Surgery 43.11 (2017): 1391–1398. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5728421/
  27. Vollmer, Martin K., et al. “Modern inhalation anesthetics: potent greenhouse gases in the global atmosphere.” Geophysical Research Letters 42.5 (2015): 1606–1611. https://agupubs.onlinelibrary.wiley.com/doi/full/10.1002/2014GL062785
  28. Salas, Renee N., et al. “A pathway to net zero emissions for healthcare.” bmj 371 (2020).
  29. Brown, Lawrence H., et al. “Estimating the life cycle greenhouse gas emissions of Australian ambulance services.” Journal of Cleaner Production 37 (2012): 135–141.
  30. Connor, A., R. Lillywhite, and M. W. Cooke. “The carbon footprint of a renal service in the United Kingdom.” QJM: An International Journal of Medicine 103.12 (2010): 965–975. https://academic.oup.com/qjmed/article/103/12/965/1584174
  31. Herrmann, C., and A. Rock. “Magnetic resonance equipment (MRI)–Study on the potential for environmental improvement by the aspect of energy efficiency.” PE INTERNATIONAL AG, Report (2012).
  32. Shove, Elizabeth. “What is wrong with energy efficiency?.” Building Research & Information 46.7 (2018): 779–789. https://www.tandfonline.com/doi/pdf/10.1080/09613218.2017.1361746
  33. Heye, Tobias, et al. “The energy consumption of radiology: energy-and cost-saving opportunities for CT and MRI operation.” Radiology 295.3 (2020): 593–605. https://pubmed.ncbi.nlm.nih.gov/32208096/
  34. Blue, Stanley. “Reducing demand for energy in hospitals: opportunities for and limits to temporal coordination.” Demanding Energy. Palgrave Macmillan, Cham, 2018. 313–337.
  35. https://www.eia.gov/tools/faqs/faq.php?id=92&t=4
  36. Duffin, Jacalyn. History of medicine: a scandalously short introduction. University of Toronto Press, 2010.
  37. WHO compendium of innovative health technologies for low-resource settings, WHO; 2016–17. WHO, 2018. https://www.who.int/medical_devices/publications/compendium_2016_2017/en/
  38. Medical devices: managing the mismatch: an outcome of the priority medical devices project: methodology briefing paper, WHO, 2010. https://apps.who.int/iris/handle/10665/70491
  39. Global Atlas of Medical Devices, WHO, 2017. https://www.who.int/medical_devices/publications/global_atlas_meddev2017/en/
  40. Page, Brandi R., et al. “Cobalt, linac, or other: what is the best solution for radiation therapy in developing countries?.” International Journal of Radiation Oncology Biology Physics89.3 (2014): 476–480.
  41. In a survey of surgeons across 30 African nations, 48% reported at least weekly power failures, 29% had operated using only mobile phone lights, and 19% had experienced poor surgical outcomes as a result of it. [28]
  42. Parker, Steve. Medicine: The Definitive Illustrated History. DK Publishing, 2016.
  43. Hall, Peter A., and Michèle Lamont, eds. Successful societies: How institutions and culture affect health. Cambridge University Press, 2009.
  44. Borowy, Iris, and Jean-Louis Aillon. “Sustainable health and degrowth: Health, health care and society beyond the growth paradigm.” Social Theory & Health 15.3 (2017): 346–368.
  45. Sherman, Jodi D., and Harriet W. Hopf. “Balancing infection control and environmental protection as a matter of patient safety: the case of laryngoscope handles.” Anesthesia & Analgesia 127.2 (2018): 576–579.
  46. Steyn, A., et al. “Frugal innovation for global surgery: leveraging lessons from low-and middle-income countries to optimise resource use and promote value-based care.” The Bulletin of the Royal College of Surgeons of England 102.5 (2020): 198–200. https://publishing.rcseng.ac.uk/doi/pdf/10.1308/rcsbull.2020.150
  47. Haripriya, Aravind, David F. Chang, and Ravilla D. Ravindran. “Endophthalmitis reduction with intracameral moxifloxacin in eyes with and without surgical complications: Results from 2 million consecutive cataract surgeries.” Journal of Cataract & Refractive Surgery 45.9 (2019): 1226–1233. https://www.aurolab.com/images/JCRS%202%20million.pdf
  48. Venkatesh, Rengaraj, et al. “Carbon footprint and cost–effectiveness of cataract surgery.” Current opinion in ophthalmology 27.1 (2016): 82–88.
  49. Thiel, Cassandra L., et al. “Utilizing off-the-shelf LCA methods to develop a ‘triple bottom line’auditing tool for global cataract surgical services.” Resources, Conservation and Recycling 158 (2020): 104805.
  50. Relman, Arnold S. “The new medical-industrial complex.” New England Journal of Medicine 303.17 (1980): 963–970. https://www.nejm.org/doi/full/10.1056/NEJM198010233031703
  51. Smith, Richard. “Limits to medicine. Medical nemesis: the expropriation of health.” Journal of Epidemiology & Community Health 57.12 (2003): 928–928. https://jech.bmj.com/content/57/12/928
  52. In health care, there is a thin line between marketing and corruption, especially when the target audience is medical personnel that may gain benefits from using or prescribing a medical device or drug, or when regulators are influenced to facilitate practices that increase profits. Transparancy International ranks the procurement of drugs and medical equipment fourth on a list of seven processes that carry high risk of corruption, and calls the problem “widespread in all countries”. [37]
  53. Alemayehu, Berhanu, and Kenneth E. Warner. “The lifetime distribution of health care costs.” Health services research 39.3 (2004): 627–642. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361028/




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