Is a modest health care system possible?

• Author: Jameton, Andrew
• Position: 80% Less Energy - Critical essay

The health care system in the US is generally regarded by economists and activists as over-scaled and inefficient. Health care consumes nearly 15% of the US GDP (high as compared to most industrialized nations) while providing insured access only to about 85% of the population. Moreover, the provision of health care services has a relatively small effect on public health as compared to what people generally expect of it.

Substantial reductions in the overall scale of health care thus at first appear to be an excellent idea. However, health care also provides services key to the health and happiness of many individuals and vulnerable groups. So, reductions in energy consumption must be balanced against the struggle to maintain highly valued services. Moreover, whether energy consumption in health care can be reduced substantially depends on whether the 80% reductions in other economic sectors are likely to improve or reduce the health of the public.

Energy in health care

Some of health care's problems with energy consumption can doubtless be solved by efficiencies in other economic sectors, such as in more efficient production of electric power, but not all problems can be so easily fixed. Health care in the US (and to a lesser degree, in developed nations generally) has many features that reflect high levels of energy consumption. Indeed, the modern acute care hospital--spanking clean, brightly lit, packed with imaging machinery, complex medications, and highly trained personnel--is symbolic of the humane achievements of high-energy societies. We envision health care as though we believe that high levels of energy consumption are good for health. Some of the specific high-energy features of hospitals are: [1]

* Twenty-four/seven, hospitals maintain bright lights, intensive air filtration, sealed windows, and controlled temperature levels, which involve intensive use of heating, air conditioning, and fans. Hospitals are like hotels and restaurants; they clean and process tons of food and laundry.

* Large imaging machines such as x-rays and MRIs, computers, diagnostic devices, operating rooms, intensive care units, and emergency departments use lots of electricity. Our own medical campus has three power generating facilities.

* Health care uses energy in storing and transporting a wide range of materials and supplies, as well as disposing of them and cleaning up after their use. Many hospital tools and materials are manufactured globally, and so the production network is wide and complex. Since so many therapies involve exotic materials, it is difficult to save energy by localizing the sources of materials. Indeed, the pharmaceutical industry, at the end of the 19th century, was one of the pioneering global industries.

* Pharmaceuticals are often synthesized through long chemical paths and highly purified, requiring substantial energy inputs. Cleaning up the toxic wastes of such processes requires energy all the way from manufacture to use and disposal. Chemotherapeutic agents, for instance, are often sufficiently toxic that the waste after their use needs to be transported long distances for incineration.

* Re-use of tools and materials requires more processing than normal, since tools and materials must be very clean. Clean-up via incinerators or autoclave is a high-energy process.

* Hospitals are often large regional facilities requiring extensive parking lots to accommodate traveling patients. Helicopters ply the airways between traffic accidents and trauma centers. Better-paid clinicians often live in large homes in the suburbs, far from inner-city hospitals and academic medical centers, thereby increasing the energy costs of providing health care.

Because health care involves high energy consumption in so many of its functions, it is impossible to reduce its energy levels without also reducing materials consumption, together with services provided. So, in the balance of the article, I will treat the problem of reducing energy...