Invent: Health

Sustainability: A New Paradigm
Speakers: Matt Parker, Ama Frimpong, Freddie Scott
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Matt: Hello, and welcome to Invent Health, a podcast from Technology and Product Development company, TTP. I'm your host, Matt Parker.
Over the course of this season, we're going to be exploring the fascinating future of health technologies. Today, we ask what will it take to create a new paradigm for sustainability in healthcare?
Sustainability: it's a word now ubiquitous in healthcare and for good reason as the world looks to reach net zero emissions to mitigate against the worst consequences of global warming, healthcare is a key sector in its sites.
Some studies suggest healthcare represents 4% of global emissions which is a really significant figure, and that could reach nearly 10% for industrialised nations. But straightforward CO2 emissions is not the only issue to consider here. Equally important, is the issue of waste. The consequences mean not just environmental degradation but the supply chains these rely on really impact on CO2 as well.
It can all feel pretty overwhelming. The sheer scale of all of this is extraordinary. Many people working in this space say we're in fact thinking about sustainability and healthcare all wrong because when you begin to scratch beneath the surface, the binary choice of good healthcare versus good sustainable policy crumbles pretty quickly.
To find out some more, I knew I had to speak to a couple of people whose enthusiasm for the subject could make things a little clearer.
So, Ama, thank you very much for joining us to talk about sustainability and healthcare today.
Ama: Thanks for having me. It's a real pleasure.
Matt: That's Ama Frimpong, she's the Head of Product Development at 52 North Health, a company who work across the medical device space as they seek to improve health outcomes by reinventing care pathways using affordable, human-centred technologies.
Ama has a materials and mechanical engineering background as well as a real grounding in medical devices from laparoscopic instruments to orthopaedics. And the work she does at 52 North always has a focus on how they can be created with sustainable thinking at their core.
She was also recently awarded the hugely prestigious young woman engineer of the year award for her work with 52 North. So, we were really thrilled to have her on to shed some light on how we might get that sustainable future.
First, I wanted to get a sense of the extent of the issue we're dealing with here. What's the big picture when we think about sustainability in healthcare?
Single-use products and single-use disposable products are almost ubiquitous across healthcare at the moment. And I wonder if you could just take us through that a little bit. Why is it that this has become such a thing within healthcare at the moment?
Ama: This is a big thing in healthcare. So, the biggest driver really in general has always been patient safety. Safeguarding against infections and controlling contamination. In the past, lots and lots of decades, there was always sort of metal equipment instruments, washable things that were used.
But to try and make it safer, there was a big move towards single-use and being able to dispose of, but actually that is starting to have a big impact on sustainability, because we're now not able to dispose them off properly and then that's starting to be a big issue.
So, that's where the environmental burden sort of come from the clinical waste that we are creating. Incineration is not so great, landfill, all of that sort of issues around there.
And that's where the damage is coming and that's where people like us, sort of innovators creating new technology that's going into healthcare are thinking about how we cannot contribute to that.
But also, the healthcare system in the UK here, the NHS are thinking about their impact as well, so it's not just the product, it’s the emission, it's everything. Sustainability is all of those all-encompassing areas.
And so, they're starting to think about long-term, how can we be better? It's gone that way towards single-use but they're starting to think about it in a different light and pulling it back somewhat, and have lots of initiatives around that at the moment.
Matt: So, in terms of things like recycling, is that more challenging for medical products/things that are coming from medical background? Why can't we just recycle these products in the same way we do with other devices?
Ama: So, the problem in healthcare in general is the contamination. And I think it creates a big problem. That contamination means that healthcare products can't go through the same way that other household recyclables will go through a process because they've got body fluids, blood, saliva, whatever that needs to be.
So, it's a little bit harder to just take a healthcare or a health product, a medical device that's contaminated, even if you use recyclable material and just put it through that same chain.
So, that's some of the challenge that healthcare in general faces, and that's why sometimes they look to things like incineration to sort of get rid of that. But that's one of the big issues, it’s the thing that we're trying to safeguard ends up creating a problem for us.
Matt: And I guess within the NHS at the moment, is this increasingly forming part of the decision-making process around what products and what services and what devices get used and prescribed?
Ama: Absolutely. The NHS now have this Net Zero Initiative, where they're wanting to be net zero across their business, but also, their supply chain. And so, this is something that they're for sure thinking about and rightfully, it's not an easy fix.
So, they have stepped changes and are doing things, incrementally, something like making sure that immediately, 10% of their procurement decisions are made considering the environmental and social impact on the people around. So, it's a growing and changing sort of mindset, but also, system, but that people are actively doing things in the space to make it better.
And this is good because the more people are aware about this, the more we're engaging the conversation, it will start to create a shift across the globe. And we're hoping that that will take real effect soon.
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Matt: These conversations about changing healthcare, root and branch really do have to start at the top. You can't change systems as vast and wide reaching as global health without buy-in from all sectors.
So, it's really exciting to hear that the NHS are leading the way in this with a top-down approach. And this kind of thinking is equally true when we turn our gaze to climate change rather than waste alone. I wanted to speak to someone at TTP for this.
So, I sat down with Freddie Scott, part of our passionate sustainability team here at TTP, who have developed a method for assessing the environmental impact of medical devices in the context of their wider care pathway. They've done this by exploring the downstream emissions of products, meaning the scope for design interventions to reduce their environmental impact becomes increasingly broad and impactful, all with the goal of enabling the decarbonization of healthcare in the shortest time possible.
He's perfectly placed to give us some more detail on this issue. So, I asked Freddie to set the scene for us as we delve into sustainability and healthcare at a larger level.
So, welcome Freddie, thanks for talking to us on infant health. So, if we're to take a step back here, what are the biggest contributors to global emissions from healthcare?
Freddie: It's a real mix, so plastic and things like that, there's different numbers banded around, but I've seen, I think in the NHS, about 10% of it is attributed directly to medical devices that they buy in. But there's plenty of other things.
So, 5% (and this is something that surprised me when I found out about it) is attributed to anaesthetic gases that are used in surgery, for example, and the propellants in inhalers. And that's because those just have a really, really high greenhouse gas effect and global warming potential.
The other one that is not really talked about as much is travel. So, I've seen 5% in the NHS is attributed to patient travel, similar for clinician travel, visit travel, all of those things. So, it's a much, much bigger impact than just the healthcare that's being delivered.
Matt: And clearly, it's a really complex picture. There's lots of things going on here. How can we start to get ahead around this? How can you measure this kind of global warming impact across a healthcare system?
Freddie: It's a really hard problem and you're totally right. And obviously, if you want to try and tackle it, you need to characterise it first. And the standard tool that's used — it's called a lifecycle analysis. And what a lifecycle analysis does is it basically looks at a product.
So, if we're talking about medical devices, a particular device, and it tries to calculate all of the emissions that have occurred due to it being produced. And that's called the cradle to grave impact.
So, the energy associated with drilling the oil out of the ground with cracking it, with synthesising it, with moulding it, with assembling it with other components, electronics, et cetera, and then transporting it to where it's going to be used or stored. And then it also takes into account the emissions that happen when it's used.
So, in the case of an inhaler, that use phase is really significant because you're releasing a really high impact gas. But things like if, you've got an injection, an auto injected device, that might need to be refrigerated, so what's the impact of the refrigeration and that sort of thing.
But the real challenge is that it's very easy to get a precise result but very hard to get an accurate result. And so, sometimes they can be a bit misleading and you always have to draw a boundary around it somewhere because it becomes an impossible challenge otherwise.
Matt: For something like your devices, we talked about manufacturer use — is disposal part of that as well?
Freddie: Yes. So, disposal's the final part, and that's the kind of cradle to grave part of it.
So, you've got landfill recycling or incineration. And normally, the three main ones, and especially in healthcare, it tends to always be incineration.
Matt: And you can sort of perform this analysis, you get a number at the end, like you say, but is that number comparable? Can I compare different devices? How can I use that, I guess to help me both assess and see where there might be some improvement here, or is that still quite hard to do?
Freddie: So, you definitely can but you've got to be careful when the two things you are comparing start to differ more and more.
So, things like — it's really useful for comparing if you've got a device that's maybe single-use compared to a device that's multi-use. If it's going to be prescribed in the same way and essentially, used in the same way with the exception that one is single and one is multi, that's a really nice way of comparing it. And actually, sometimes that reveals really interesting things.
So, single-use devices tend to be way simpler than multi-use devices. If you're talking about maybe a single-use inhaler, for example. And so, sometimes if you're only going to use it four or five times, a single-use actually is less impact than a much more complex multi-use one.
So, you can do that, but you have to be careful because again, you've drawn a boundary and you've made a lot of assumptions with that. And so, really if you want to have a better comparison, you need to consider the wider care pathway.
So, say you're prescribing an inhaler, you need to really set the boundary to be a delivery of an inhalation treatment for one year. And that's completely agnostic of any sort of methods, devices or treatments that patient has within that one year.
Matt: I think inhalers are is a really interesting example that we talked about some of the — there's a huge global warming potential of some of the propellants that are used in these systems.
If we want to be more sustainable, I mean, the obvious answer there is do we need to have fewer inhalers in the world? But is there then a question around promoting sustainability over delivering healthcare services? How can we assess that kind of trade-off?
Freddie: It's a really hard one and I think the reason why it's so hard is that when you think about the risks of climate change, they are health risks.
So, you've got freak weather, you've got flooding, you've got risk of greater integration with nature that might cause further zoonotic pandemics like COVID. I think that the trade-off people struggle with is that, well, you've got the kind of healthcare today versus healthcare of the future.
And for things like asthma or inhaler treated illnesses, you've got the issue of air pollution and things like that. So, there are co-benefits of treating sustainability now that are a bit more direct than just climate change, but also that kind of perceived antagonism is just wrong because there are ways of treating asthma or COPD that are better for the environment.
So, other types of inhalers are dry powder inhaler, a soft mist inhaler. So, one of the most common pressurised inhalers is a salbutamol inhaler, which is a reliever. So, if you are having an acute restriction of your airways, you take that reliever.
And so, people feel quite attached to that because they feel like whatever happens, they can take their reliever and that's great. But if you look at some of the treatments that a dry powder or something delivers, that's a longer term — that's a preventative one.
So, if you want to try and get someone onto that, it's a more of a psychological challenge and you've got to work with the healthcare providers to try and encourage the patient that actually they need to take their preventer regularly rather than their reliever.
And so, it makes sustainability more of a human problem rather than just an engineering problem. There are engineering solutions but just inventing something that is more sustainable is not the solution. You've got to integrate that and ensure that there's adherence and et cetera.
Matt: So, is there a false dichotomy here between effective healthcare and sustainability?
Freddie: I think there is if you think about it in the wrong way. So, if you think about treatment, the ways of making that more sustainable might be through improved engineering solutions.
But the other one that I think maybe some people jump to is that you could just treat less people. And so, obviously, that sounds bad because you are treating less people in the name of sustainability, but that's because you're thinking just about treatment.
If you think about actually trying to mitigate the need for treatment and that's again, sustainability, but it's also a game for healthcare because people don't want to be patients, if they can avoid it. They don't want to go into hospital and they don't want to be given drugs or have to use devices that they don't need to if they can avoid it.
So, really, there's a double benefit to be had if you can develop technologies that prevent people from needing to be treated or maybe detect particular illnesses early, allow you to have a less intensive treatment, which is better for the patient and better for the environment at the same time.
So, I think you can think about it in this way but really as device engineers, we've got to look for those opportunities that improve patients' lives, but also our wins, economically for hospitals are wins for the environment.
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Matt: That idea of prevention is so important. Let's look at, for example, the impact of halving the footprint of a year's worth of monthly injectors, which is equivalent to around three kilograms of CO2 emissions.
While this change might seem like a worthy goal, what happens, say if because of this change, the patient has to drive to the doctors for another visit, well that in emissions alone might be eight kilograms of CO2. And if they were to spend one more day in hospital, well that's 38 kilograms, and the ICU for a day, a staggering 103 kilograms of CO2.
So what this illustrates is that while reducing the footprint of an individual device is a noble pursuit, some of the most exciting and impactful benefits can only be had by considering the broader healthcare pathway. If your device reduces the need for hospital visits, or additional travel, your intervention can have a much more significant contribution than the carbon footprint of the device alone.
To tackle this problem seriously, you have to consider the downstream effects of device usage.
One good case study that shines a light on this comes from 52 North. Ama is working on a product which proves that by thinking holistically about the entire care pathway, not just the impact of the devices themselves, we can drastically improve both emissions and waste in medical devices. I asked her to tell me some more about the device.
So, I guess maybe to start with, could you tell us a little bit about what you are developing at 52 North Health?
Ama: So, at 52 North, this is our vision statement: we want to improve health outcomes and health equity by reinventing care pathways across the world. And to do this, our first device is NeutroCheck, which is a rapid at-home test kit that people on chemotherapy who are at risk of a life-threatening condition called Neutropenic sepsis can use.
And what that does, it aids the diagnosis of the condition and it reduces the inefficiency in that particular care pathway at the moment. Neutropenic sepsis, it takes tens of thousands of lives. So, being able to use this test kit at home to give the healthcare professionals some additional triaging information will actually help save lots of lives.
And so, that's what we're doing and we're working with multiple partners with the NHS, we're working with Macmillan Cancer Support; we're working with the UK Sepsis Trust. And what we're doing is we're not just creating a device, we want to be able to create the device and impact the care pathway.
So, that again, going back to that sustainability, we're looking in a holistic way, how we can make an impact to our patients and the people that use our device.
Matt: I wonder if you could just give us a description of the device and how it works.
Ama: So, our device NeutroCheck and what it does — it's similar to what you would see on a lateral flow test for a COVID test, except it's looking at two things at once.
So, neutropenic sepsis is two parts. It's neutropenia, which is a lowering of your white blood cell which is a fighter cell in your body and sepsis, which is the infection.
So, a combination of these two things is where it can get quite tricky. So, what the device does is, it looks for signals for both of those things. So, are you neutropenic and do you have a risk factor for sepsis?
And so, you take a finger prick of blood and you put it onto the device, and then the device will run, and it will tell you — it'll give you two lines similar to what you would see on your COVID test to give you an indication of whether or not you are at risk of neutropenic sepsis.
And that's how it works, we've got a one-stop shop simple test for people to able to use.
Matt: I guess we can sort of look at this in terms of that product, but we described a little bit some of the health consequences if this isn't diagnosed early, but I'm interested in if this isn't picked up soon, would you be hospitalised for an extended period of time? And does that come with its own sustainability impact?
Ama: Yes, absolutely. And this is why we believe so strongly in our product and in the work that we're doing because we've looked at the whole pathway, we've looked at everything that is currently available and is currently the norm.
The symptoms for neutropenic sepsis are fairly generic, so there's a lot of travelling to hospitals and a lot of antibiotic administration as a precaution. So, there's lots of inefficiencies that are in the current pathway because we're wanting to safeguard against the fatalities that can result from this.
But yes, prolonged admissions, burden on the emergency units because that's where they go. If you have the symptoms, you go straight to AME, and we know 2022, 2023 lots and lots of queuing, lots of hours waiting in emergency units, ambulances, there's lots of things happening.
So, the product is there and the work that we're doing is there to help streamline that process, get it to be more efficient, just doing our bit to help the subset of patients who we can support and can help to create better triaging outside of the hospital, and sort of create efficiency and improve sustainability that way.
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Matt: Ama sepsis test is now getting pretty close to market. So, watch this space. And this is not the only thing they're working on. Ama told me about another digital platform 52 North is developing, which will collect carbon patient reported outcome data from devices they are using.
This will bring so much more data about the system level impact of devices, allowing designers to create a much fuller roadmap to lowering emissions and ultimately, reaching net zero.
It's exactly these sorts of projects and devices which should make us all feel more confident about the future of the planet. And it is also indicative of a company thinking about the bigger picture, thinking about healthcare beyond narrow views of the impact of specific devices, to creating a paradigm of preventative medicine, which keeps people out of hospitals, out of the ICU.
Freddie had a lot more to say about this as well.
Maybe you could explain to us what a better paradigm for thinking about sustainability and healthcare would be compared to how we've outlined it at the start here.
Freddie: Yeah, I think it's all about widening the boundary of the LCA.
Matt: That's the life cycle analysis.
Freddie: Yeah, the life cycle analysis. So, as I said, we focus a lot on cradle to grave, but that's not agnostic of the different types of treatment that just focuses on a device or on a pharmaceutical.
And you need to broaden it, I think, to a consistent level of caregiving that's completely agnostic of the method that that's given, because that allows you to assess different methods of treating something, and also, different methods of early detection, things like that, that allow you to really identify what is the most sustainable option.
Matt: We've covered this a little bit earlier, but just to sort of have another look: what kind of things is that looking at compared to what we're proposing here?
Freddie: So, let's take something simple like an inhaler. So, we've got the environmental impact of the inhaler through use. We know that. What we don't know is how many times does the patient need to go to a GP, maybe get referred to have that prescribed to them.
What's the environmental impact of their travel? What's the environmental impact of the GP travelling to the GP surgery to go and assess that patient? What's the environmental impact of them adhering to their treatment or not adhering?
There's so many other options and you've got to be careful not to bore the ocean. Once you have an idea of the other pathways that can happen because it's never as straightforward as a patient gets given an inhaler and they use it. They use it all the way through, they don't lose it. They use it perfectly as was intended and happy days because it's never that simple.
And obviously, you have to make assumptions with probabilities of how often someone might lose it, someone might not use it correctly. But if you make those rationally, you get a much richer image of the overall impact of using that intervention.
Matt: And so, why is it so important to take that step back and look at the bigger picture? What's that going to let us do when we're considering these interventions?
Freddie: So, from the healthcare provider side, it allows them to actually assess, okay, which of the options should we be pushing for more and how can we push that for more?
And then from the side of the people developing the devices, it allows them to really understand where's the biggest impact within that entire care pathway, and maybe it's not reducing the material.
And so, it allows them to tune their sustainability strategy more wisely to have an even bigger impact because everyone wants to try and tackle this challenge, and if there are easy wins that you're missing by looking too narrow in your scope, then that's a real shame.
Matt: Fantastic. And how do you think we can communicate this bigger picture analysis to more people? How can we bring others on board to this way of thinking?
Freddie: That’s a difficult question, but I think really, you've got to talk about the opportunities, and I think examples like 52 North are a fantastic opportunity of how something on the face of it seems quite wasteful, what a single use device has potentially an order of magnitude greater positive impact than it does a negative impact through the bit of plastic that it is.
So, I think you've got to get people really excited about it.
Matt: 52 North really are a great example of this. Ama's approach is absolutely focused on a greater positive impact overall. It speaks to that rational considered approach that Freddie is getting into there.
So, I asked Ama the same question: what would this new paradigm look like from her perspective?
If you were to think more holistically, what would that look like and what would some of the impacts be?
Ama: The word you use there is exactly the word that I'd like to use, the holistic approach to sustainability.
I heard a quote very recently from one of the NHS directors and it said something like “Sustainability is more than just lasting and surviving. It means delivering and designing better healthcare that don't prejudice future health and wellbeing.”
And that I thought was so pertinent because it actually encompasses all sorts of aspects of sustainability. It's not just looking at today and the solution, it's about thinking about the future, but also making sure that we're putting things in place to make that sustainable when we get to it.
And that's a really interesting way of thinking about it because exactly like you say, it's very multifaceted. It's a holistic look that we need to be giving it. And so, that's a way of looking from all sorts of angles to make sure that we're not focusing on the small issues. It's a much bigger picture that we need to be looking at.
Matt: But I think that's a really inspiring vision and I think that's absolutely right. I wonder if you had any thoughts about how we can help in the work that we're doing at the moment. Are there things that we can be doing today that will make an impact for products that are going to launch down the line?
Ama: Yeah, I think when it comes to technology and innovation, sometimes, we get very excited about the immediate challenge and don't quite look at everything.
And so, looking at that entire lifecycle really should be what we should be doing when we start to develop and start to look into creating new innovation for healthcare.
Just sort of stopping for a minute and just looking from conception, I suppose of the phrases, cradle to grave, from right from creation to when we dispose of the thing, what is the impact that that new innovation is going to create on the environment.
It is an additional step, but I think we all have a responsibility now to do our bit. And so, if we're excited about our innovations, we should also be excited about the fact that our innovations are sustainable, and can do good from the healthcare standpoint, but also, on the environmental standpoint as well.
And that's something that I think all of us in the technology and innovation space should be tasking ourselves with to do when we start to create new products.
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Matt: As we come to a close on this deep dive into sustainability in healthcare, I wanted to conclude with the optimistic note, Freddie and Ama have both been moving towards, because for me, it feels like a combination of top-down and bottom-up measures is the way forward.
In designing exciting new devices which simultaneously keep people out of hospitals while minimising their own carbon footprint, both of these things become grey allies on the way to net zero for healthcare as a whole.
It's a task that needs to be taken up by those working in health at every level. So, to end, I ask both our guests if they're optimistic about the future, here's Ama first. What is she excited about?
Ama: I think it would be amazing if in the coming years, in my lifetime, we can say that we truly have a net zero healthcare system. It's a big task, having sort of spent some time looking through some of the impacts that the healthcare system is having on the environment.
But the multifaceted — it's the little things. People don't always realise that things like food that goes to the canteen and the way that that gets to the canteen and the hospital has a carbon impact, a carbon footprint.
And so, in my lifetime that is my one dream that I want to see that our healthcare system, because I love healthcare. I mean, that is my vision and mission as well.
Matt: And for Freddie, is he optimistic?
Freddie: I think you have to be optimistic because it's counterproductive not to be. But I think my time looking at this has given me a lot of hope because one, the industry has a huge amount of potential to have a massive, massive impact.
And I think by framing it in a way that also improves patient outcomes, then sustainability will be a fantastic driver for improving healthcare more widely.
I think it's a really serious challenge and I think us as an industry kind of lean back into the fact that, oh, well, we're saving people's lives, maybe we don't need to care so much about sustainability. And I think we need to kick that quite hard.
Matt: I think that's a very powerful message to deliver that. It's really exciting to see the potential.
Freddie: Excitement's the way to do it a hundred percent. You can't drive things forward on kind of doom and gloom. You need to be excited about them, but there is so much excitement to be had.
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Matt: Thanks so much for listening to this week's episode of Invent Health from TTP, and a huge thank you to both Ama and Freddie for that optimistic look at sustainability and healthcare.
You can find out more about both their work in the show notes. We'll be back next time with a new episode on medical imaging technologies, exploring how device innovation is bringing imaging to more context than ever before.
If you enjoyed this episode and you want to let us know, please do get in touch on LinkedIn, Twitter, or Instagram. You can find us @TTP. And don't forget to subscribe and review Invent Health on your favourite podcast app as it really helps others find our show.
We'll see you next time.