Endocrinologists asked to step up efforts to reduce carbon footprint of healthcare

Modern medical practices make widespread use of plastics, flame retardants, and perfluoroalkyl substances (PFAS), a group of long-lasting chemicals used to make materials water and stain-resistant. These substances contribute towards climate change and potentially expose patients to endocrine-disrupting chemicals (EDCs). EDCs include phthalates (used to soften plastics), bisphenol A (BPA) (found in some medical containers and devices), as well as PFAS. Our endocrine system helps produce and release hormones that regulates essential functions in our bodies. If something goes wrong with the endocrine system, it could lead to disorders such as diabetes, thyroid diseases, infertility, and growth problems.

A new international review led by researchers from the Yong Loo Lin School of Medicine, National University of Singapore (NUS Medicine), has highlighted the often-overlooked environmental impact of healthcare, especially in endocrinology. These conditions are both common and often require long-term treatment, which means the way endocrine care is delivered can have a significant environmental footprint. The study calls on clinicians to be part of the conversation and quest for more sustainable measures.

Published in Nature Reviews Endocrinology, the article brings together perspectives from endocrinologists, ecotoxicologists, and sustainability experts across Singapore, India, the United Kingdom, Canada, and the United States.

“Healthcare aims to protect human health, yet it also generates substantial pollution, from greenhouse gases and microplastics to chemical contaminants,” said Assistant Professor Chantelle Rizan, from the Centre for Sustainable Medicine (CoSM) at NUS Medicine, and lead author of the review. “Endocrinologists have a unique role to play in both recognising and reducing these harms whilst providing high quality appropriate patient care.”

The review outlines concrete strategies to improve sustainability in endocrine care — from switching to reusable medical devices and reducing unnecessary tests, to advocating for stricter regulations on the use of toxic chemicals in healthcare materials. For example, insulin used in diabetes treatment could add over 1,000 kilograms of CO2 emissions to a patient’s carbon footprint over 30 years, which is roughly the same as driving a petrol-powered car for 4,000 kilometres.

By helping patients manage their diabetes more effectively from the start, the carbon footprint of their care can be cut by nearly 18% over 50 years. If their diabetes worsens and they move on to more complex treatments or multiple medications, their care becomes more resource-heavy and creates more carbon emissions. Other sustainable measures, such as reusable medical devices instead of single-use plastics, consolidating clinic visits and improving medication adherence, could further cut emissions by up to 56%[1] for some healthcare items. These changes not only help the environment but can also improve patient care and reduce unnecessary healthcare costs.

Dr Eng Pei Chia, co-author of the study and Consultant in the Division of Endocrinology, Department of Medicine, National University Hospital (NUH), said, “This is a complex challenge for endocrinologists and healthcare professionals. While unintended consequences must be considered, we need open discussions to advance sustainable healthcare. We have been advocating sustainability through recycling of insulin pens over the past few years. More can still be done, through encouraging the use of reusable insulin pens to reduce waste. With younger generations increasingly eco-conscious, promoting reusables could enhance patient engagement in diabetes care. Ongoing awareness and education are key to driving positive change.”

With healthcare accounting for up to 5% of global greenhouse gas emissions, the review serves as a call to action to examine and embrace more environmental responsible models of care. This aligns with broader efforts by CoSM to support data-driven and actionable steps in decarbonising healthcare globally. As the first research centre in Asia and the largest in the world to lead and support healthcare decarbonisation and climate resilience, the Centre is at the vanguard of an emerging multidisciplinary field of practice dedicated to improving the health of patients in the face of climate change and driving the transition to net zero healthcare.

[1] Keil, M., Viere, T., Helms, K. & Rogowski, W. The impact of switching from single-use to reusable healthcare products: a transparency checklist and systematic review of life-cycle assessments. Eur. J. Public. Health 33, 56–63 (2023).