Environmental and Sustainability Network
The Environmental and Sustainability Network aims to reduce the carbon footprint of healthcare and other activities to mitigate climate change.
Origins and role of the network
We established the network to harness the knowledge and leadership of anaesthetists who are committed to environmental sustainability, including in their own hospitals and DHBs. Since its formation the Network has contributed to NZSA submissions relating to the environment including the Zero Carbon Bill, and also writes a regular column for the NZSA magazine providing advice on progressing sustainability. You can read some of these articles below or by accessing back issues of our magazine.
Chair of the Network: Dr Rob Burrell
Northern Region – David Heather, Felicity Pugh, Martin Minehan, Ian Chapman & Ann-Marie Stevenson (ADHB), Rob Burrell & Tristan Bennett (CMDHB), Michael Booth (West Auckland), James Houghton (Epsom Anaesthesia)
Midlands – Cambell Bennett (Lakes DHB), Sallie Malpas (Waikato DHB)
Central Region – Adam Hollingworth (CCDHB)
Southern Region – Matthew Jenks and Katherine Wills (Southern DHB)
Articles by the E&S Network
The NZSA Environmental and Sustainability Network writes a regular Q & A on environmental issues. Network member Dr Campbell Bennett, from Lakes DHB, writes about carbon offsetting.
What is carbon offsetting?
Carbon offsetting is a means of compensating for the inevitable carbon dioxide and other greenhouse gases (GHGs) emitted into the atmosphere by our daily activities. Everyday fossil fuels are burned to transport, power and feed us. Food production and wastage generate additional GHGs. Collectively, these are measured or quantified as carbon dioxide equivalents (CO2e) and are the drivers of climate change.
Reducing individual and collective emissions needs to be at the forefront of our goals, however carbon offsetting enables us to compensate for the GHG emissions we cannot avoid. The principle is to invest in projects that represent a sufficient reduction in emissions to balance out the emissions we’re creating. Simply, we pay some cash which is used to either increase uptake of or reduce the production of atmospheric carbon. Examples of offsetting include;
- Planting new, or preserving existing forestry
- Investing in renewable energy alternatives to fossil fuels
- Energy efficiency projects aimed at reducing overall energy use and therefore carbon emissions.
For offsetting to be legitimate, projects must be permanent (the lifespan of some GHGs is 100 years!) and additional i.e. created by the offsetting investment which would otherwise not have happened.
Why should I do it?
As individuals we are typically high emission producers – but we do have the means to measure, reduce and offset. Our work-related emissions from nitrous oxide, desflurane and air travel are visible on the top 10 list for all DHBs undertaking the Toitū Envirocare carbon emissions measurement and reduction scheme. Long haul business air travel is the second highest operational GHG for Auckland DHB and approximately 20% of their total emissions. Most other DHBs that measure their carbon footprint are similar. Many DHBs are now trying to measure, mitigate and in some cases offset their operational carbon emissions (see Toitū table below) so it makes sense for us to do the same.
The stance of the Association of Salaried Medical Specialists (ASMS) is that carbon offsetting is a legitimate travel claim for CME related travel. As this is not explicitly written into the MECA though, variable interpretations exist. Given the Health Minister’s letter of expectation to DHBs to minimise and mitigate GHG emissions, it seems very reasonable for SMOs to offset and claim for CME related travel.
How do I do it?
There are various accredited online voluntary carbon offsetting schemes. Accreditation of the schemes ensures the validity and legitimacy of projects. It’s quick and easy to calculate your emissions estimate and cost to offset – all you need are a few of your household bills and knowledge of your lifestyle and eating habits. For air travel it’s important to include radiative forcing in your offset as this accounts for all the Greenhouse Gas Emissions (GHGe) from the jet engines rather than just CO2.
Toitū Envirocare (formerly Enviro-Mark Solutions): provides offset calculators and programs for individuals and businesses, as well as certification programs for businesses (including DHBs) wanting to go carbon neutral. It’s a subsidiary of a government-owned crown research institute with a background in the science of carbon accounting. Toitū Envirocare has the highest level of accreditation for their carbon offsetting schemes and allows you to choose the scheme you want from a range of options. Examples include: reforestation projects such as the Hinewai project on Banks peninsula; renewable energy projects such as a wind farm in China; a solar plant in Mexico; and energy efficiency projects in China where traditional coal cooking stoves are being replaced with solar cookers. The Toitū projects have an additional improvement focus added to the carbon science. Examples of this include biodiversity improvements in Hinewai and a reduction in air pollution with the energy efficiency project.
Ekos: provides carbon offsetting for individuals and businesses. It’s a New Zealand based non-profit enterprise which develops, pilots, and then scales up self-sustaining forest carbon projects. Their projects are locally owned, collaboratively developed and as much as possible locally delivered. They have a very user-friendly website and their offsets are accredited to a high standard. Ora Taiao (the New Zealand Health and Climate Council) has partnered with Ekos for their carbon offsetting (my family also uses Ekos for our carbon offsetting). All their projects are forest conservation projects in New Zealand and the South Pacific. Many mountain bikers and frequenters of the Tasman area will be familiar with Project Rameka, which is reforesting marginal farmland with native bush in the Rameka track area of Golden Bay. Other Ekos projects protect mature rainforest from logging, which include the Rarakau rainforest conservation project in South Westland and areas in the Solomon Islands, Fiji and Vanuatu. To offset the emissions for my family of four last year, which included an overseas holiday, cost around $400.
Air New Zealand carbon offsets: the calculator they use is backed by Toitū. Offsets purchased are half from permanent forest sink initiative projects (run by the Ministry for Primary Industries) which promote replanting new forests on private land in New Zealand, such as Mangarara Station in Hawkes Bay. The other half are offshore biodiversity and sustainable energy accredited projects.
Take home messages
If you want to minimise climate change the best thing you can do is reduce your GHGe’s. Attending a videoconference will always be better than flying to the other side of the world from an environmental perspective. I would encourage everyone to consider carbon offsetting and explore your options. It’s a positive environmental opportunity to compensate for the GHGe’s you can’t avoid and the process of identifying your GHGe’s will show you where your opportunities to reduce lie. It’s great to see some of the positive work being undertaken by offsetting organisations. Why not begin by checking carbon calculators on the links below:
Disposing of drugs
Chair of the Environmental and Sustainability Network Dr Rob Burrell writes about how to dispose of drugs in a way that is best for the environment.
Ampoules and contents should go into sharps bins. Syringe contents (+/- syringes) should go into a yellow bag, or a sharps bin (if there are sharps, or if you are concerned about diversion).
The best place to put drugs is into the patient. Not only is this what we do well, it enables drug metabolism, reducing environmental exposure.
New Zealand has not been particularly good at keeping pharmaceuticals out of our water and ground. Whilst large amounts of drugs pass through patients’ livers and kidneys, and metabolites go to municipal sewage schemes, there has been little pressure to deal well with waste drugs. In fact, (hospital) pharmacies have been putting waste drugs, expired medicines, and recalled pharmaceuticals into kitchen blenders, and pouring them down the sink in enormous quantities. With little regulation, hospitals and individuals have been free to do what they wish.
The problem arises when the drugs get to the sewage plants. Without data about what is entering the system, those plants are not monitoring what leaves and enters the ocean or treated water outflow. And many medicines are poorly broken down by sewage plants. Sewage plants do not want our unused drugs and are making efforts to keep them out.
An alternative place to put unused drugs might be domestic landfill, (white bags). It is cheap (~$80/tonne). Municipal landfills are lined with plastic, to prevent the contents escaping. But the disaster at Fox River should make us very cautious.
The liquid that sinks to the bottom of an intact landfill (the leachate) is removed. After limited processing, it is usually put down the nearest municipal sewer. So, the white bag solution may only delay drugs from entering the environment.
There is no incineration in New Zealand. The only drugs incinerated are cytotoxics, which go into purple bags and bins, and are exported at considerable expense.
Yellow bags (~$1000/tonne) and the contents of sharps bins (~$35 for a large one) share a common fate: sterilised by steam in a pressurised rotating vessel (rotaclaved), shredded, and “sealed” into a higher standard of landfill. Again, leachate can ultimately make its way to municipal sewers, and the sea.
Unfortunately, we don’t know enough about the fate of pharmaceuticals under these conditions, and some may remain biologically active. The drugs of most concern include antibiotics, local anaesthetics, sympathomimetics, and propofol (said to be very thermally stable) . And then there are the legislative requirements of opioid disposal to consider.
Sadly, pressurised steam sterilization is our current best option.
There are two types of sharps bins in common use: the (Daniels) hard plastic, reusable ones, and softer (BD make one) versions, destroyed with their contents. The hard shell versions get washed out before being returned to users. It is not always clear where the water goes after washing out sharps bins, however preventing intact drugs from hitting the sewers or ground water would be a worthy aim, possibly not able to be universally achieved.
Talk to your waste contractor for specifics on how they treat hospital waste.
With the above information in mind, a reasonable conclusion is that all unused drugs should go down the pathway most likely to result in destruction, and least likely to leak into the environment. That means yellow bags or sharps bins, perhaps with absorbent to rather optimistically prevent loss, diversion, and rapid leaching, and that empty syringes might be okay in domestic waste.