Environmental Emissions Reporting and Life Cycle Assessment

Sustainability should be an important part of product design, procurement, management, and end-user decision-making. To inform environmentally preferable choices, emissions that are embedded in products (from manufacturing, packaging, and transportation) and processes (including cleaning and waste management) must be understood. Embedded emissions in medical products ideally should be disclosed by manufacturers, e.g., through internationally standardized Environmental Product Declarations (EPDs). EPDs provide credible, third-party verifiable, transparent environmental data. Such EPDs do not yet exist for medical products, however, and environmental information is largely either absent or claims are unverifiable, leaving decision-makers vulnerable to greenwashing, i.e. false claims of environmental benefits.^13-15 In the absence of such information, decision-makers can work with existing peer-reviewed publications and experts who perform environmental emissions assessments.

Life Cycle Assessment

Life cycle assessment (LCA) is an internationally standardized scientific method (ISO 14040 and 14044) of quantifying emissions from the material and energy inputs associated with natural resource extraction, manufacturing, packaging, transportation, use/reuse, and eventual waste management — the so-called cradle-to-grave emissions. LCA applications range in complexity and scale, from basic materials to whole products, entire organizations, infrastructures, and sectors of the economy (including health care). Understanding the relative environmental impacts of each life cycle phase (e.g., manufacturing, waste disposal), as well as total life cycle emissions, guides mitigation strategies (e.g., reusable vs. disposable medical devices).

While global warming potential (carbon dioxide equivalents [CO₂e]) is the most well-known type of emission studied and reported, there are several standard categories of environmental impacts that are routinely evaluated. Other environmental impacts include: toxic air emissions (particulate matter [PM2.5], stratospheric ozone depletion, and photochemical smog formation); ecosystem disruption (eutrophication, or promotion of algae growth); and human health harms (carcinogenesis and respiratory disease).¹⁶ Results across multiple endpoints may indicate relative advantages for some outcomes over others, and prioritization of risks and benefits must be considered to avoid simply shifting burdens from one problem area to another. Importantly, some emissions may be specific to geographic regions as energy sources (e.g. for manufacturing and reprocessing) and shipping distances will vary or be updated over time. For instance, whether electricity comes from coal or a cleaner source, such as wind or solar power, can tilt LCA results toward a different conclusion for a specific region.^10,13,16,17 Thus, care must be taken to appropriately extrapolate findings.

LCA applications to health care¹⁴ include diverse areas such as: surgical approaches to hysterectomy,¹⁸ phacoemulsification,^19-21 prostate biopsy,²² orthopedic surgery,²³ surgical vs. non-surgical management of disease (e.g., gastroesophageal reflux disease), ²⁴ alternative approaches to dialysis, ^25-27 radiographic diagnostic testing,^28-30 blood work,³¹ reusable vs. disposable devices (e.g., anesthesia airway equipment,^15,17 and blood pressure cuffs³²), alternative anesthetic drugs,^33-35 and entire health care systems. ^4-6,16,36-43

LCA is frequently coupled with life cycle costing (LCC), to combine both environmental and financial cost considerations and aid decision-making. For medical devices, LCCs expand the narrow focus on up-front purchasing costs to include considerations of the device’s lifetime, and costs of cleaning, maintenance and refurbishment, and waste disposal, to determine the total cost of ownership to aid fair comparisons.^13-15 LCAs and LCCs are becoming more available for a variety of health care applications and can be utilized to guide administrative and clinical decision-making. Importantly, assessments must consider local contexts including costs, management protocols (cleaning and waste disposal), energy grids, and water scarcity. Industry environmental and cost savings claims, and peer reviewed literature should never be accepted without scrutiny.

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