What happens when a pandemic meets a heat wave? It’s a question that many jurisdictions are asking themselves this summer, weighing the need for emergency cooling centres against the continued need for physical distancing. This intersection between COVID-19 and climate change shows in microcosm the interconnections between health systems and natural systems.
We know that climate change affects a wide range of human activities, but we don’t always think of its impacts on health care. Yet climate change is a risk factor for worse health outcomes, whether through direct impacts such as heat-related illness, or indirectly through factors like poor air quality.
In turn, the health care system has significant effects on the environment. If the global health system were a nation, it would be the fifth largest emitter of CO2. While the bulk of these emissions arise from the procurement of medications and equipment, the energy needs of infrastructure and health-related travel comprise a substantial portion as well.
In our recent webinar, researcher Nicole Simms noted that as the health system’s purpose is to improve health outcomes, it must also take steps to mitigate the environmental effects that compromise them.
To that end, the increasing use of virtual care holds promise for reducing carbon emissions. According to Infoway’s 2019 Access Digital Health Survey, Canadians in rural areas travelled an average of 23.6 km to their regular place of care, while their urban counterparts travelled an average of 13.1 km, both significantly larger distances than the approximately 4-7 km travel break-even point (depending on vehicle fuel efficiency) needed to offset the relatively minor carbon emissions of virtual care.
The virtual delivery of care has particular implications for carbon savings in Canada. While Canadians’ cars are among the world’s least fuel efficient, our energy grid is comprised largely of non-carbon-emitting sources. The virtual delivery of care thus allows us to replace fuel-inefficient cars with technology run on relatively clean energy. If half of in-person visits were replaced by virtual visits, carbon emissions would be reduced by 325,000 metric tons. These savings are equivalent to taking more than 70,000 passenger vehicles off the road for a year.
A 50 per cent adoption rate might sound high, but we’re already there. Since the beginning of the COVID-19 pandemic, approximately 60 per cent of visits have been conducted virtually, either by video, telephone or text/email.
There are potential environmental savings on a systemic level, as well. From past studies, we know that patients with access to their personal health information are more confident in managing their care, particularly with respect to chronic conditions. Virtual care can provide a means to improve continuity of care and help manage conditions before they worsen. Better health outcomes mean patients are likely to require fewer hospital admissions and/or emergency department visits, thus reducing care-associated emissions further.
Reducing emissions also decreases the health risks associated with climate change. And as we’ve seen, better health outcomes reduce health system usage— and therefore, emissions. Simms describes this as a “positive feedback loop,” with increasingly significant benefits to patients and the environment.
The COVID-19 crisis has opened space in which to reassess how we deliver care. By incorporating environmental sustainability into our health system post-COVID, we can protect the health of patients and the planet. Working together, we can avoid making our next health crisis an environmental one.
Interested in continuing the conversation? Watch our webinar “How the Rise of Virtual Care is Contributing to Sustainable Healthcare,” and tune into the Digital Health InfoCast on August 4 to hear Nicole Simms in conversation with Bobby Gheorghiu and Waldo Beauséjour.
Holmner A, Ebi KL, Lazuardi L, & Nilsson M. (2014). Carbon Footprint of Telemedicine Solutions--Unexplored Opportunity for Reducing Carbon Emissions in the Health Sector. PLoS One. 2014;9(9):e105040.
 International Energy Agency (IEA), 2019, (Fuel Economy in Major Car Markets: Technology and Policy Drivers 2005-2017).
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Bobby works with stakeholders in academia, private and public sectors to develop and monitor performance targets for initiatives such as PrescribeIT®, Canada’s national e-prescribing service, to ensure widespread adoption of technology and to demonstrate tangible benefits of investments in digital health. He holds an MHSc in Health Policy, Management, and Evaluation from the University of Toronto.
Waldo holds a master’s degree in Applied Economics. He currently serves as Analyst, Performance Analytics at Canada Health Infoway. He has experience in applied social research and quantitative research methods for over 10 years. He has led and contributed to several quantitative surveys, research and impact evaluations aiming at investigating the impact of government-led or funded interventions on health outcomes.
Nicole Simms, PhD
Nicole is the Managing Director of the Centre for Sustainable Health Systems, which works in collaboration with health partners to shift healthcare practice and policy toward comprehensive (environmental, social, and financial) sustainability, from the ground up and the top down. She holds a PhD from the Department of Geography, Environment & Society at the University of Minnesota, and an MA in Geography/Environmental Studies from the University of Toronto.