| By Jason Gale Just steps from the operating theaters at Melbourne’s Footscray Hospital, a storeroom holds a quiet rebellion against medical waste. Stacked neatly on wire racks are bundles of surgical gowns and drapes — some wrapped in pale blue disposable plastic, others in washable fabric that’s made to last. The difference seems small, but to critical-care doctor and anesthesiologist Forbes McGain, the latter pile signals a hospital daring to push back against the tide of single-use items pervasive in healthcare. It’s not the only part of the hospital where change is visible. Next door, the decontamination room hums with activity. Staff in navy scrubs and hair covers rinse trays, reassemble surgical kits and load bundles of linen into a wall of sterilizing machines. Green and yellow plastic bowls are stacked on a trolley, waiting to be washed, packaged and put back into circulation. “A lot of hospitals wouldn’t have this at all,” McGain says, nodding toward the reusable bundles. “It would all just be chucked away.” Hospitals are among the most resource-hungry institutions, packed with single-use plastics and equipment and energy-intensive machines. They’re also surprisingly large sources of greenhouse gases like anesthesia. In Australia, hospitals are responsible for an estimated 7% of national emissions, while in the US, healthcare accounts for 8.5% of greenhouse gas pollution. Globally, if the healthcare sector were a country, it would be the fifth-largest emitter, well above Japan and Canada. That puts clinicians like McGain at the center of a paradox: The business of saving lives has become one of the planet’s most polluting industries, and breaking medicine’s addiction to disposables is no simple task. The stakes are growing. A warming planet is driving more disease, from heatstroke and heart attacks to mosquito-borne infections, while also heaping new pressures on health services already under strain. That puts hospitals on the frontlines of climate change even as they contribute to it. What’s at risk isn’t just emissions, but the long-term resilience of healthcare systems themselves. Climate MedicineMcGain is an accidental climate reformer. What began as a few suggestions to reduce waste became a doctoral thesis, and eventually a role as associate dean of healthcare sustainability at the University of Melbourne. Between ICU shifts, he is leading a push to replace disposable gowns, drapes and trays with washable alternatives — proving that doing so saves both carbon emissions and money. “We were going to switch to disposables because everyone said it would save us money,” he says. “But in reality, it doesn’t — and that’s what I find disturbing: These assumptions get made without any scientific rationale.”  Dr. Forbes McGain Source: Indimax To take just one example, his team’s time-and-motion study found that even after paying staff to wash and sterilize equipment, single-use products are still more expensive. Fixing the problem won’t just require changing how hospitals run. It will mean upending multibillion-dollar markets: The global medical plastics industry alone is on track to surpass $87 billion by 2030. For decades, manufacturers equated disposability with safety — a narrative that built a global supply chain on fossil fuels and throwaway products. “If you’re a single-use company, you want to flog things,” McGain says. McGain’s awareness of medicine’s material footprint stretches back to Kalgoorlie, the gold mining town in Western Australia where he grew up. His father was a geologist, trained to extract resources from the Earth. “That got me thinking about where things come from and how they get to where we are,” he says. Ore dug up in Australia might be smelted in China, shaped into single-use medical tools in Pakistan or Germany, then shipped back to Australia, only to be discarded after a single use. “That lifecycle is pretty crazy,” he says. “It’s a very unsustainable, linear, non-circular model.” The Pandemic WakeupCovid-19 forced the world to confront the fragile systems that make and manage medical waste. The surge in the use of personal protective equipment exposed gaps in disposal capacity and raised questions about the long-term sustainability of single-use items. During the height of the pandemic, McGain’s hospital group threw away more than a million gowns in a single year. By November 2021, Covid-19 vaccinations had generated an estimated 144,000 metric tons of syringe and needle waste globally, while test kits were responsible for 731,000 liters of chemical waste, according to the World Health Organization. Hospitals only began to lean heavily on disposables after World War II, when plastics got cheaper. The trend hardened in the 1980s amid HIV fears and aggressive manufacturer marketing that sold throwaway items as safer. US healthcare facilities generate an estimated 5.9 million tons of waste each year — almost 30% of it plastic. Intensive care units mirror that trend, with single-use items making up a third of their waste stream.  Modern medicine uses many single-use plastic, paper, cardboard, glass and metal items. Photographer: Steve Allen Travel Photography/Alamy Stock Photo/www.alamy.com Today, waste is entrenched and rising, yet policies to address it are lacking, particularly in the US. In January, the US Department of Health and Human Services disbanded its Office of Climate Change and Health Equity after President Donald Trump ordered the elimination of “environmental justice” initiatives. “Places of healing should be leading the way, not contributing to the burden of disease,” says Tedros Adhanom Ghebreyesus, WHO’s director‑general. “Reducing medical waste must be a mindset that informs every part of health care, including planning, financing, procurement and delivery. That makes it everyone’s job: health ministers, hospital managers, health workers, cleaners and patients themselves.” Read more on the systemic changes hospitals are making to fix the problem of medical waste on Bloomberg.com. | 
