Circular economy in the health sector
The health sector is responsible for a significant share of the German raw material consumption. Its contribution to the sustainable use of natural resources or resource conservation must, therefore, not be underestimated. However, the linear economic model, or the “take, make, waste” approach has been firmly established in the healthcare sector – made visible in the ubiquity of single-use products, the necessity of which is not always justified from a hygiene perspective. Waste is, therefore, a major problem. Waste prevention and management is becoming increasingly important. The health sector juggles between patient safety, economic efficiency, and sustainability. There must be a willingness but also leadership and clear guidance to make the transition towards a circular economy in the health sector.
In all sectors of the economy, there is now an awareness that changes are necessary to promote the circular economy. However, the healthcare sector is still far from being circular. Rather, the linear “take, make, waste” model has become firmly established in the healthcare sector. According to calculations by the Fraunhofer Institute for Systems and Innovation Research (ISI), the total raw material consumption of the German health sector amounts to about 107 million tonnes per year (as of 2016), or about 1.3 tonnes per capita and year. This is an increase by about 80 per cent from around 60 million tonnes in 1995. The health sector is thus responsible for about 5 per cent of the total German raw material consumption and comes in fourth place after construction, public administration and processed foods. Since the health sector is likely to continue to increase its economic output, its consumption of raw materials is likely to rise further. The sector’s contribution to the sustainable use of natural resources in Germany is, therefore, becoming increasingly important.
The health sector generates large amounts of waste
At the same time, the health sector generates considerable and increasing amounts of waste. The online magazine abfallmanager-medizin.de states, with reference to figures from the Federal Statistical Office from 2014, that a hospital produces around seven to eight tonnes of waste per day. Extrapolated to all hospitals, this would make around 4.8 million tonnes per year. Thus, hospitals are the fifth largest generator of waste in Germany. In comparison, the total volume of waste produced in Germany is around 401 million tonnes. Around 90 per cent of all medical waste is not hazardous from an infection prevention point of view.
For a study on climate protection in German hospitals, the German Hospital Institute (Deutsches Krankenhausinstitut e.V.) conducted a survey on waste generation in participating hospitals. According to the survey, the waste generated per hospital in 2019 was 420.19 tonnes (median) or 1,430 kilogrammes of waste per hospital bed. This is almost three times the annual waste generated by a person (457 kg) in a private household. A large share of the waste was non-infectious medical waste, followed by mixed municipal waste, and kitchen and canteen waste.
According to the Ärzteblatt, many doctors would like to produce less waste. A survey at the Bonn University Hospital showed that 84 percent of participants agreed with the statement that they could make an important contribution to sustainable medicine. However, commitment to climate protection in general and waste management in particular varies from hospital to hospital and is often dependent on highly engaged individuals. Hospitals with dedicated sustainability managers, whose work is supported by the management, have already experienced progress in their transition towards a circular economy, while others are still at the very beginning. Moreover, inpatient care providers seem more inclined to address the issue of resource conservation than outpatient care providers. And sometimes there is a willingness to transform, but a lack of experts to support the hospitals in proper waste segregation.
Circular economy: extending the product life cycle
Waste management will undoubtedly become increasingly important in the health sector in order to conserve resources, use fewer raw materials, recover recyclable materials or dispose of waste in an environmentally sound manner. Waste prevention and management are an essential part of the circular economy envisaged by the EU.
„The circular economy is a model of production and consumption, which involves sharing, leasing, reusing, repairing, refurbishing and recycling existing materials and products as long as possible. In this way, the life cycle of products is extended. In practice, it implies reducing waste to a minimum. When a product reaches the end of its life, its materials are kept within the economy wherever possible thanks to recycling. These can be productively used again and again, thereby creating further value.“Source: European Parliament, https://www.europarl.europa.eu/news/en/headlines/economy/20151201STO05603/circular-economy-definition-importance-and-benefits, (accessed 21.05.2023)
According to the EU, creating more efficient and sustainable products from the start would help to reduce energy and resource consumption, as it is estimated that more than 80 per cent of a product’s environmental impact is determined during the design phase. A shift to more reliable products that can be reused, upgraded and repaired would reduce the amount of waste. This would slow down the use of natural resources and reduce landscape and habitat disruption.
Patient safety, economic efficiency, sustainability
Juggling between patient safety, i.e. hygiene, economic efficiency, and sustainability, the health sector struggles with the concept of reuse. The use of disposable products, be it single-use plastic products or surgical instruments made of steel, is increasingly seen as a major environmental problem by stakeholders in the health sector. For example, the non-governmental organisation Health Care Without Harm (HCWH) Europe advocates for a reduced use of single-use plastic products in its #PlasticFreeHealthcare campaign. However, although resource efficiency could be increased by promoting reuse, for example, the high costs of reprocessing surgical instruments act as a disincentive. Another obstacle to reuse is the belief that disposable products are better for hygienic reasons anyway.
Circular economy: projects in the health sector
There has been a shift in thinking towards a circular model of production and consumption. Projects with the aim to contribute to a circular economy have been initiated. One example is the EU-funded project “Digital Health in a Circular Economy” (DiCE). The project objective is to develop and demonstrate novel, circular and environmentally sound solutions to design, collect, directly reuse, refurbish, remanufacture and recycle digital health devices to help alleviate the growing problem of healthcare waste worldwide. It focusses on four products: ePaper label, smart wearable sensors, smart pill boxes, and endo-cutters. Project partners include companies like Janssen-Cilag and Johnson & Johnson, and Universities such as the Ruhr-University Bochum. The innovations developed by the project will be implemented, tested and demonstrated in five healthcare ecosystems through community-engaged pilots in Norway, Belgium, Slovenia, Spain and Germany.
Meanwhile the German Federal Foundation for the Environment (Deutsche Bundesstiftung Umwelt, DBU) is looking for “innovative, exemplary, and selectively implemented lighthouse projects that serve as a ‘proof of concept’ in demonstrating concrete solutions for the responsible and economical use of resources in the health sector”. (Source: https://www.dbu.de/themen/foerderinitiativen/circulaid (accessed 21.05.2023)). Within the #DBUcirconomy initiative, the DBU launched the funding initiative „CirculAid – Circular economy in the healthcare sector“ with the aim to reduce resource consumption in the health sector. The initiative targets manufacturers of chemical-pharmaceutical products and medical devices, care providers in the health sector, as well as universities and training institutions in the medical field.
Eager to increase circularity within the organisation, medical device company Philips has adapted its product offering by embracing new business models:
- Trade-in schemes: Medical equipment can be traded in by customers and refurbished by Philips.
- Refurbished systems: Philips Circular Edition systems play a key role in the transition to a circular economy by prolonging the use life of medical hardware, which significantly reduces the demand for virgin raw materials and lowers carbon emissions.
- Service-based solutions: By providing equipment through a service contract, Philips maintains ownership and responsibility for the hardware.
- Digital solutions: Digital products and services can reduce emissions and material use by, for example, enabling remote interaction between patients and caregivers or extending performance of equipment via upgrades and predictive maintenance.
Top-level management priority – circular economy
However, for a nationwide implementation of measures to achieve a circular economy in the health sector, clear guidance is needed. In a survey on the status of the transformation towards a climate-neutral and climate-resilient healthcare system, the Berlin-based Centre for Planetary Health Policy found that the topic has not yet been taken up as a top-level management priority in hospitals. The Fraunhofer ISI recommends that the topic of resource conservation in the health sector should be higher up on the political agenda and concludes in its study carried out for the German Environment Agency: “There is no lack of relevant knowledge for the implementation of concrete resource conserving measures, but rather a lack of consolidation of the available but scattered information.“
There is an awareness for a transformation of the linear economic model towards a circular economy. However, there is a lack of an overarching strategy for the health sector to achieve a comprehensive transformation beyond individual or lighthouse projects.
Thip Pruckner, Market Intelligence Expert
Quellen: Fraunhofer-Institut für System- und Innovationsforschung ISI (im Auftrag des Umweltbundesamtes) „Ressourcenschonung im Gesundheitssektor – Erschließung von Synergien zwischen den Politikfeldern Ressourcenschonung und Gesundheit“ (Abschlussbericht), August 2020, unter https://www.umweltbundesamt.de/sites/default/files/medien/5750/publikationen/2021-01-25_texte_15-2021_ressourcenschonung_gesundheitssektor.pdf (abgerufen am 21.05.2023);
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