“I’ve learnt that no one is too small to make a difference.”
― Greta Thunberg

The environmental impact of dermatological services may seem negligible compared to that of global events. And the evidence-base may be limited compared to the evidence generated over centuries of dermatological research which guides our clinical decision-making. However, there are changes we can make in our dermatology practice to reduce the environmental impact of providing care to people with skin disease.

What does ‘sustainable healthcare’ mean?

The Centre for Sustainable Healthcare has established core principles to reduce healthcare’s resource footprint:

Prevention. By preventing disease, we can reduce the number of people using the health system, the number procedures taking place, the resources used and therefore reduce the overall carbon footprint of the NHS
Patient empowerment and self-care. Enabling patients to better manage their conditions at home reduces travel time, appointments, and can help conditions from developing to point where more complex interventions are needed. An example of this might be home phototherapy, but could be as simple as helping a patient get a better grip on managing their eczema at home
Lean systems. Utilising innovation can help dermatology departments to become ‘leaner’, examples include teledematology and virtual appointments which reduce the carbon footprint of clinics. Which, when used right, are convenient to patients and can contribute to patients seeing the right expert faster, ensuring prompt diagnosis and management of conditions
Low carbon alternatives. As with any large organisation, particularly those that work in fast moving environments like healthcare, there can be a lot of wastage or unnecessarily carbon intensive practices – often because it is convenient or because it simply hasn’t been questioned. Simple steps include using reusable surgical instruments and adopting sustainable travel policies

Further reading about how these principles can be applied to dermatology is available here.

How do I calculate sustainable value?

The Sustainable Quality Improvement (SusQI) framework was developed by the Centre for Sustainable Healthcare to measure health outcomes of a service against its environmental, social and economic costs to calculate its ‘sustainable value’.

SusQI provides clinicians with the tools to measure and transform clinical services to maximise sustainable value.

The good news is that healthcare workers have collaborated from across the world to create a publicly accessible database of the carbon footprint of specific medical procedures, services and equipment, which you can find here.

What can we do in our dermatology department?

Advocating change to promote environmental sustainability and supporting the development of sustainable initiatives can facilitate transformation even in large NHS organisations. These might include developing an organisational environmental policy, founding or joining a group focused on environmental sustainability, reducing unnecessary organisational energy consumption, developing sustainable travel policies, and making use of digital health records.

In Cardiff dermatology department, we measured the environmental and economic costs of single-use versus reusable instruments which demonstrated carbon and cost savings in switching to reusable instruments. Further detail is available here.

We also reviewed our recycling procedures by introducing recycling bins into procedure rooms and surveying staff about sustainable practice: O10: The Green Initiative: improving environmentally sustainable practice and optimizing waste management in a dermatology department – 2021 – British Journal of Dermatology

Other measures to consider as a department/ service include:

What can I do as an individual?

Finally, here are some ideas for you to consider on an individual level:

Reduce

Avoid unnecessary appointments/blood tests/procedures
Cycle/walk/take public transport to work/meetings
Turn off electrical appliances/lights overnight

Reuse

Use reusable surgical instruments/drapes/personal protective equipment, such as face masks, surgical hats

Recycle

Explore recycling schemes with medical suppliers and introduce collection points for TerraCycle®

And do please consider joining the BAD Working Party Group on Sustainability.