New report calls on policy integration of sustainability in medical device and pharmaceutical registrations and funding

ESG: Increasing pressures from diverse stakeholder groups, spanning policymakers, investors, customers, and employees, have elevated Environmental, Social, and Governance (ESG) considerations to a strategic focus. Staggering statistics underscore the significant carbon footprint of the healthcare industry, responsible for a noteworthy 4.4% of global greenhouse gas emissions and a substantial 7% in Australia, surpassing the emissions of the aviation industry by more than double.

The Royal Australasian College of Surgeons (RACS) partnered with the UK Health Alliance that brought together the surgical colleges from England, Scotland, Ireland, Canada, Australia and the US in developing the Green Surgery Report.

Dr Ben Dunne, Thoracic Surgeon representing RACS as a co-badging organisation on the report, expressed immense satisfaction with the collaborative effort.

“The report provides vital information and a blueprint for surgical organisations and teams internationally to take an evidence-based approach to reducing the environmental impact of surgery while maintaining the highest standards of patient care,” Dr Dunne stated.

Highlighting RACS’ commitment to environmental sustainability, Dr Dunne said “We recently became the first medical college in Australia to sign up to the newly released Green College Guidelines developed by Doctors for the Environment Australia (DEA) in collaboration with the Australian Medical Association (AMA). The guidelines provide guidance to medical colleges on how they can reduce the carbon emissions from their organisation by incorporating practical changes to the way they operate. The guidelines also support colleges to develop resources for their fellows/members and embed understanding of how to practice in an environmentally sustainable way.”

Compelling shift from public and private hospitals to elevate sustainability agenda for medtech sector

A critical aspect of reducing the carbon footprint lies in minimising the environmental impact of surgical products utilised in operating theatres. The manufacturing and distribution of medical devices and pharmaceuticals contribute to 71% of healthcare’s global ‘scope 3’ emissions. This includes items like single-use surgical instruments, gloves, caps, drapes, tubing, and drains.

The largest decrease in environmental impact may be seen through reducing consumption of unnecessary surgical items and medical devices where this does not negatively impact on patient care. Circular economy principles may be used to mitigate the carbon footprint of products used for surgery, including reduction (e.g. streamlining single-use pre-prepared sets through removing unused items, and appropriate use of personal protective equipment) and switching from single use to reusable equipment. Where “reduce and reuse” are not possible, the lifespan of items can be extended through repair and remanufacture, and the recycling of waste.

The report calls upon policymakers and regulators to integrate sustainability into medical device and pharmaceutical product registration, funding approval processes, and product placement rules to facilitate innovation in healthcare research, manufacturing and supply chains.

Recent collaborative efforts by RACS, the Australian College of Perioperative Nurses (ACORN), and the Australasian College of Infection Prevention and Control (ACIPC) advocate for the environmental advantages of reusable sterile surgical gowns over single-use ones, stressing equivalent infection prevention outcomes for both.

Dr Dunne also applauded actions taken to mitigate the environmental impact of anaesthesia, such as the removal of Desflurane, a potent greenhouse gas, from public formularies in Western Australia.

Speaking about the overarching goal, Dr Dunne reiterated, “Surgeons must continue to work to reduce the environmental impact of the care we provide while ensuring we maintain excellence in surgical outcomes. RACS calls on surgeons and hospitals to consider the principles of effective sustainable healthcare and take suitable steps to reduce the impact of surgery on the environment, underpinned by the five Rs: reduce; reuse; recycle; rethink; and research.”

The Green Surgery Report is relevant to surgical teams worldwide. To bring about change in behaviours to enable more sustainable models of surgical care, surgical teams and personnel within supporting services need appropriate knowledge about environmentally preferable models of care, alongside a shift in attitudes. One of the main perceived barriers to sustainability in surgery is a lack of leadership. Effective, efficient, visionary and responsive leadership will be central to delivering the service provision changes necessary for sustainable healthcare.

Dr Richard Smith, Chair of the UK Health Alliance on Climate Change, stressed the urgent need for systemic changes, highlighting the critical role of research and innovation in achieving net-zero emissions in surgical practices.

Dr Chantelle Rizan, the academic chair of the report, urged the transition to sustainable models of care.

“Now it is time to translate that research into real-world action and drive the transition to sustainable models of high-quality patient care. We must build on win-wins, where there are co-benefits for patients, the environment, and the public purse,” Dr Rizan remarked.

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