Today’s medical practitioners are expected to perform more than clinical roles.  They are expected to act as resource managers, clinical standards arbitrators, educators, researchers, and patient advocates. If all these weren’t enough, now tack on the additional role of green advocate.

Little is known about the processing of less toxic waste once it leaves health care environs.

Environmental pollution is an area where both clinicians and administrators can make a difference. The World Health Organization has recognized that healthcare is a major contributor to pollution because of pathological, pharmaceutical, chemical, radioactive, health risk and other wastes.

In the United Kingdom, the National Health Service produces approximately four percent of the country’s total carbon dioxide emissions. In the United States this figure exceeds eight percent.

More than half the emissions derive from activities unique to the health environment, such as pharmaceutical and medical equipment production and destruction.

There is a growing body of knowledge around sustainability within hospital environments. Some of the research has instigated effective change, especially in areas of major pollution such as haemodialysis units. Research into reusable medical instruments, water conservation and wastewater treatments also has resulted in major improvements in carbon dioxide emissions and water management.

It is a small step to address a growing problem. Little is known about key areas of sustainability change, such as the final processing of less toxic waste once it leaves the health care environs. Despite almost regular reports of hospital syringes being washed up on beaches, it is difficult to find substantive research on the biosecurity of long term disposal sites. Similarly, the disposal of both toxic and non toxic wastes in homecare is a looming problem.

While necessary, expanding physicians’ roles to include environmental protection can cause divided loyalties for doctors who are trained in clinical decision making, which is patient focussed and bottom up. Sustainability in the long term requires the capacity to engage more big-picture, out-of-the-box thinking, whilst still maintaining the ability to address each individual patient’s problems.  One can easily imagine circumstances where a needed medication or procedure produces medical waste not safely disposed of.

Ultimately, the green challenge is to develop effective strategies that use both governance structures and support the integration of green options in all decision‐making processes, while maintaining positive patient outcomes.