Student Literature Review Newsletter
Issue 7: Managing Medical Waste
If health care were a country, it would
be the world’s 5th largest emitter.
The world must achieve net zero emissions before 2050, yet the carbon footprint of the health care sector remains substantial, accounting for 4-5% of global net greenhouse gas emissions – more than aviation or shipping.  
Figure: Top 10 health care emitters as percentage of global total 
(Source: Health Care Without Harm and Arup, Health Care’s Climate Footprint, September 2019)

The healthcare sector in the U.S. is the leading contributor to total global health care emissions (and is responsible for 8% of the U.S.’s total emissions). The production, distributions, use, and disposal of health care services and goods, especially single-use devices, drive nearly three quarters of health care sector emissions. 
(Data from: Health Care Without Harm and Arup,
While U.S. hospitals generate over 29 pounds of waste per patient per day and a whopping 5 million tons of trash each year, health care emissions drastically outweigh the impact of material waste. Emissions are classified into scopes 1-3, outlined below, to define emission sources. The majority of health care’s high emissions arise indirectly from it’s supply chain (Scope 3), and through the production, transport, and disposal of materials including pharmaceuticals, chemicals, food, equipment, and related electricity needs. Additional emissions come directly from health care facilities and their vehicles (Scope 1), as well as indirect emissions from purchased energy sources, such as electricity (Scope 2).
Scope 1-3 language, practice greenhealth


The COVID-19 pandemic has only added to emissions, with the rush for PPE creating a boon for production in the plastic industry; according to one estimate, as many as 3.4 billion single-use masks were discarded globally each day in 2020. In response to COVID, the WHO and UNICEF released the Water and Sanitation for Health Facility Improvement Tool (WASH FIT) which provides step-by-step guidance and tools for assessing and improving waste management infrastructure and services.
Addressing waste streams is vital to building 
sustainable and climate-smart health systems.
NGOs, governments, and private companies alike recognize the need for solutions to health care waste.  

Utilizing a more circular economy is key to decreasing health care waste. This framework focuses on reusing, repairing, sharing, and refurbishing existing materials or products in order to decrease consumption and waste.

For example, a San Francisco-based biotechnology company, Polycarbin, is implementing a wastebasket design to improve waste segregation among researchers and health care professionals, which will aid downstream processing and recycling of plastic waste. 

Multiple third-party companies are also contracting with hospitals to reprocess personal protective equipment (PPE) and “single-use” devices (such as surgical instruments and accessories to endoscopes) after sterilization, allowing for reuse of materials instead of landfill disposal or incineration. 

In parallel, the international advocacy coalition Health Care Without Harm achieved the closure of 4,500 medical waste incinerators in the US in favor of safer non-burn waste treatments. While incineration is a rapid waste removal option that can offer heat as an energy source, it can lead to the emission of toxic compounds such as dioxin gas and heavy metal ash, and many incinerators in nations of the global south are rudimentary without safety measures or techniques that might help reduce toxic emissions. Health Care Without Harm thus proposes alternatives to incineration, including low-heat thermal processes such as autoclaving and microwaving, chemical processes like alkaline hydrolysis, irradiation, and biological processes that utilize enzymes to breakdown organic materials. 

Finally, the World Health Organization (WHO) recommends provider education on proper waste segregation to ensure that healthcare facilities do not produce more regulated medical waste, or biohazardous waste, than necessary.
The health care sector is emerging as
an important climate steward.
In October 2020, the World Health Organization (WHO) published a framework that guides health care facilities through steps to implement more environmentally sustainable waste management strategies. 

The medical NGO Practice Greenhealth works to incentivize systemic shifts towards sustainable healthcare. They partnered with Health Care Without Harm to develop an accounting tool for health systems and hospitals to use to calculate their greenhouse gas emissions. The Climate Impact Checkup evaluates Scope 1 and 2 emissions (direct emissions from health care facilities and indirect emissions from purchased energy sources). Practice Greenhealth also provides a Scope 3 emissions tool to calculate all other emissions, which comprise the bulk of health care emissions and primarily stem from the supply chain and investments.  

Students at UCSF developed the Planetary Health Report Card that provides feedback-based incentive to medical schools to develop sustainable practices and education.

The American Society of Anesthesiologists (ASA) is advancing efforts to shift away from from the use of gaseous anesthetic agents, powerful greenhouse gasses responsible for over half of operating room emissions. One hour’s use of desflurane, an especially potent greenhouse gas, generates emissions equal to a car driving 200 to 400 miles. UCSF anesthesiologist Seema Gandhi has worked toward implementing more sustainable alternatives, helping UCSF to reduce emissions from inhaled anesthetics between 2018 and 2020 at a level comparable to removing 159 cars from the streets of San Francisco.

Alongside these efforts for the U.S. health care system and it’s global partners to increase climate stewardship, pandemic-related waste has renewed attention to the need for safe and sustainable medical waste disposal in low-and middle-income countries. A recent meta-analysis found that medical and healthcare waste management practices in 78 countries often lacked standard regulations, particularly in countries with transitioning economies. Progress for these countries will require financial investment in adaptive technologies, improved training, and a shift towards greater sustainability and a more circular economy.
Learn More

  • My Green Doctor offers peer-to-peer guidance on reducing medical waste and making sustainable environmental choices for your clinic. 

  • Treatment and disposal of medical waste is restricted by state and federal policies. Check with your state to see what hazardous waste disposal programs are available to you. 

  • Practice Greenhealth provides data and experience-driven resources for medical facilities to engage in sustainable purchases through the “Impact Purchasing Commitment”. 

  • Learn about and lead a discussion on healthcare waste treatment and disposal processes as well as new technologies available for use with this learning module from the United Nations Development Program, WHO, Health Care Without Harm, and institutional partners.

Do you have other resources you use to learn about climate change and solutions, action items that you’d like us to share, feedback or ideas for our newsletter? Please share them here!
This newsletter was created by Alia Badawi, Matthew White, and Briana Kulisch and edited by Karly Hampshire for the UC Center for Climate, Health, and Equity.