​Introduction
Climate change is a health emergency that has a direct and immediate impact on the public, patients, and the NHS. The effects of climate change, such as intense heatwaves, storms, flooding, and the spread of infectious diseases, are getting worse, and urgent action is necessary to prevent further harm. Although the NHS has taken steps to reduce its carbon footprint, it still has a responsibility to cut its emissions and build resilience to climate change into its care provision.
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The "For a Greener NHS" campaign was launched to set an evidence-based plan for the NHS to reach net zero emissions by 2040 for the care provided and by 2045 across its entire scope. (NHS, 2020).
The NHS is still the largest public sector emitter of greenhouse gases, despite making progress in reducing its relative carbon footprint. Clinical waste produced by the NHS is equivalent to over 400 loaded jumbo jets and has a major impact on the environment, leading to high running costs and carbon emissions (NHS, 2018).
This health impact assessment aims to assess the potential health effects of Zero Medical Waste Management. It aims to reduce medical waste generated by healthcare facilities to zero and promote environmentally sustainable practices.The Zero Medical Waste Management scheme is a promising initiative that can contribute to reducing the healthcare sector's environmental footprint and improve public health outcomes. This HIA will assess the potential health impacts of the project and provide recommendations for safe and effective implementation.
900 People killed from heatwaves and England in 2019
156,000 tonnes of clinical waste/year
5000 jobs opportunities
NHS accounts 4% of England total carbon footprint
30,000 t of carbon dioxide / year
800,000 space shuttle of greenhouse gases
Saving NHS £11 million and 30% of carbon emissions=2 million road miles/ years
50% felt sad, anxious, angry, powerless,helpless,guilty
Determinants of Health
Physical environment
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Lower air pollution
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Improve air quality
Social environment​
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Social ties
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Better mental health
Economic environment​
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Job opportunities
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Reduce costs
Indirect Health Impacts
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Improved air and water quality
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Lower greenhouse gas emissions
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Better working conditions
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Increased community involvement
Direct Health Impacts
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Reduced exposure to hazardous waste
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Reduced risk of infections
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Health equity
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Reduce respiratory & cardiac illnesses
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Promote sustainable practices
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Protect environment
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Vulnerable Society
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Reduce access to reusable items
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Less accessibility to healthcare
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Stress or anxiety
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High level of pollution areas
Time frame: 3 weeks
Geographic
Boundaries: NHS entities in UK
Financial and Human Resources: 6 people and time
Type of HIA:rapid retrospective studies and prospective studies for the future
Stakeholders: NHS stuff, patients, waste disposal workers...
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Waste Management Impact
1
+ Impact
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Reduce risk of infections(NHS Sustainable Development Unit, 2016)
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Improve air quality (NHS England & NHS Improvement, 2019).
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Reduce exposure to hazardous materials
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Reduce greenhouse emissions
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Reduce waste in incinerators
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Conservation of natural resources
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Improving Sustainability
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Reduce Healthcare Cost(Yin et al., 2019)
2
- Impact
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Increased risk of infection from reused equipments
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Increased workload for healthcare workers
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Increased energy consumption
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Increased use of chemicals
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Resistance to change
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Stakeholders
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NHS facilities
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Companies involved in waste management
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Patients
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Regulators
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Shareholders and investors
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Environmental organizations
4
Laws & Regulation
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The Hazardous Waste Regulations 2005
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The Controlled Waste Regulations 2012
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The Environmental Protection Act 1990
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The Waste (England and Wales) Regulations 2011
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The Duty of Care Regulations 1991
Assessment
Medical waste is proven by research to produce both direct and indirect impacts such as gastrointestinal and respiratory cancer, worsen vital capacity, congenital malformations, psychological distress, eco-anxiety, and damage to buildings and also the ecosystem.
Cost-benefit analysis justified that a circular economy saves billions of pound sterling of healthcare expenditure for premature death and illness by reducing air pollution.
However, zero medical waste will be beneficial if the zero waste hierarchy is applied as starting from preventing, reducing, reusing, and disposal (incinerator) becomes the last choice due to its high cost.
Saves £150 million by reusing medical devices
Saves £2.74 billion from air pollution exposure’s premature death and illness;
£1.94 billion in the value of healthy years of life gained (WHO, 2018)
