Tuesday, December 14, 2010

Harming nature and creating trash in the name of medicine and health

Health is a concept I think about frequently: What does it mean to be healthy? What does it take to be healthy? How do other people influence one's health? How do nature and the environment influence health?

It is easy to look up the standard definition of health, written by say, the World Health Organisation (WHO): "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." What is striking about this definition is its anthropocentrism. What this definition implies is that health is contained within a human or a group of humans, and one is well when all is in sync within oneself and within a social group. When you ask someone what it means to be healthy, more likely than not they will reply that health ends with her. As long as she eat wells, mind absent of stress, and are surrounded by good people she can have a beer with, she is healthy. Unfortunately, we live in a continuous world (at least macroscopically). Air and water and nature begin where the human body ends, contained in its skin. Health includes our surroundings. It is not only that our environments influence our health, but we influence its "health," too, and consequently are influenced in return by it. Yet, because of how medicine is practiced in many places around the world, our conceptions of what it means to be healthy, and what it takes to be healthy, are firmly at odds with the natural world. Consequently, we cannot define health that ends merely in a healthful mind and healthful body.

According to the Environmental Protection Agency, medical waste (and trash) includes bandages, gloves, syringes, surgical instruments, culture dishes and glassware, etc. This list also includes "highly hazardous, mutagenic, teratogenic and carcinogenic chemicals, such as cytotoxic drugs used in cancer treatment and their metabolites," as well as nuclear wastes, and chemicals that aren't metabolised in our bodies.

The common perception of the problem of medical waste is not that waste itself is a problem, but how this waste can spread disease and harm other humans; indeed medical waste is thought of as a public health problem. Here's what the WHO says: "Health-care waste is a reservoir of potentially harmful micro-organisms which can infect hospital patients, health-care workers and the general public. Other potential infectious risks include the spread of, sometimes resistant, micro-organisms from health-care establishments into the environment...Wastes and by-products can also cause injuries, for example radiation burns or sharps-inflicted injuries; poisoning and pollution, whether through the release of pharmaceutical products, in particular, antibiotics and cytotoxic drugs, through the waste water or by toxic elements or compounds such as mercury or dioxins."

But the medical industry is a disposable industry. The value of the human life is worth more than the value of all it takes to produce the chemicals, plastics, metals, and elements to provide health - and we end up "disposing" these materials, either incinerating them, or landfilling them. Patient care generates, on average, 5 to 6 kg of waste per bed daily, or about 750 to 800 million pounds of waste annually in the United States. Of this, about 6% constitutes biomedical waste while the remainder consists of general waste, i.e., paper, plastics, and food (full text here).

Brian shared some thoughts with me a few days ago: Is avoiding the spread of disease fundamentally at odds with reducing waste? It just struck me when working on the ambulance: for the care of one patient, we create more waste than you do in a year. I'm not sure it has to be that way. We already autoclave and reuse a ton of equipment, but some seem impossible to circumvent. Gloves are a good example.

Can we be healthy in full harmony with nature?

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