Plastic use in healthcare seems like an obvious starting point when looking to make steps towards sustainability
It is a common misconception that sustainability only applies to certain industries or that it is someone else's concern. Generally, it does not enter into the minds of anyone whose business involves single-use devices and personal protective equipment. Perhaps that is because the concept conjures up this idea of reusing or recycling, and, in any clinical environment, it is easy to assume this would jeopardise the standards of care and quality of treatment. Nevertheless, there are rising pressures to start making more environmentally friendly decisions. An example is the considerable attention given to plastic consumption and the overuse of single-use plastic.
It is estimated that over 133 000 tons of plastic are disposed of by the NHS each year, with plastic amounting to roughly 23% of the total waste generated (Percival, 2019). Therefore, plastic use in healthcare does seem like an obvious starting point when looking to make some steps towards sustainability.
However, there is good reason why so much single-use plastic is used: it is the most efficient and cleanest material to promote health and hygiene in hospitals, and it is provesing difficult to find an equivalent substitute that is kinder to the environment. In theory, syringes could be recycled if collected in large enough quantities, but, as yet, no one has established a safe enough way to handle them to make this happen. So, if we cannot stop all single-use plastic, what can we do?
The healthcare industry is still exploring ways it can become kinder to the environment, in spite of there being no viable solution surrounding the obvious plastic. For example, the NHS has put together a sustainable development management plan that outlines its commitment to save energy, lower emissions and improve waste segregation, among others things. On the other hand, hospitals across the US, having identified that operating rooms have the biggest impact on the environment, implemented the greening the OR initiative to rectify this (Pyrek, 2010). The initiative has reviewed all areas of the operating room, from using sterile casing in place of sterile plastic wrapping, waste management to greener cleaning products. Therefore, if hospitals, places supporting the sick and performing life-saving operations, are still making sustainable changes without interfering with standards of care, the aesthetics industry can do the same.
What sustainability means
To make greener decisions, we need to understand exactly what sustainability is. The Cambridge Dictionary defines sustainability as causing little or no damage to the environment and therefore able to continue for a long time (Cambridge Dictionary, 2020). The process leading to sustainability is known as sustainable development, which is described by the World Commission on Environment and Development (WCED) as satisfying the needs of the present without adversely affecting future generations (Thomsen, 2013). With this in mind, sustainability is often mentioned in reference to three intrinsic platforms in relation to business: the economy, society and the environment, the thought being that if long-term profitability, maximum environmental care and social responsibilities are achieved, then a person or business is considered sustainable. Therefore, being sustainable is not just about eliminating single-use plastics and recycling, it applies to many other areas of consumption and concerns longevity, forward planning and making smart ethical decisions.
There is no planet B
Another common misconception is that environmentally friendly options are more costly, which perhaps used to be the case, but it certainly is not now. So, if cost is not the issue, this raises the question of what else impacts the decision not to become more sustainable—is it negligence or lack of time or understanding, perhaps? As drastic as it may sound, the overall future of the industry and businesses could be impacted if sustainable steps are not taken, whether this is by new legislation or ethical consumerism. Legislation has already occurred, forcing companies and business owners to comply. One example is the surcharge on plastic bags; another surrounds the use of microbeads in personal care products. Microbeads were often added to products as an exfoliating agent, generally made from petrochemical plastics, they were found to pollute water and pose a threat to aquatic life in freshwater and oceans. To reduce water pollution, the US rolled out a law (The Microbead-Free Waters Act 2015) prohibiting the use of microbeads in any rinse-off cosmetic product, and other countries soon followed suit, resulting in the total ban of microbeads in 2018 (Carrington, 2018). The damaging effects of microbeads had been established long before the ban was imposed, causing some companies to source alternative ingredients. Therefore, when the ban was enforced, it did not hinder their produce. As for others, the ban came as an expensive shock, as companies had to take products off the market and reformulate them, resulting in wasted stock and wasted money.
If impending legislation does not encourage change, maybe customers will. Nowadays, consumers are particularly aware of the state of the earth and the negative impact that certain industries and products have on it, so much so that it is affecting their purchasing decisions and the way they shop. According to a survey by YouGov, over 46% of people in the UK are willing to spend more to avoid products with plastic packaging (Waldersee, 2019). Furthermore, a Harris Poll survey revealed that 59% of woman would prefer to purchase products that are more environmentally friendly and from reputable sources over and above those that do not, even if that means spending more money (Kari Gran, 2017). Therefore, if your establishment is not displaying some form of move towards sustainability, customers may well go to someone who is.
Little green steps
As the focus on protecting the planet is not going anywhere, it will prove beneficial to stay ahead of the curve. When approaching sustainability in your business, there is a lot to consider; however, this should be viewed as a positive. It means that you can start by making some relatively easy changes to your business that will still make a difference, while leaving time to work towards some of the more complex issues in the future, almost like a timeline towards sustainability. When reviewing your business, it may be useful to use a three-pillar approach, like the three platforms of sustainability outlined earlier. This way, you will be able to see all aspects of your practice and be provided with a better understanding on what and how to change. Three areas to consider could be domestic, people and service (Tables 1–3). Domestic represents everything behind the scenes of your operation, from waste disposal to your energy providers; service includes your treatment and product choices, while people refers to educating staff and customers about your steps towards sustainability.
Table 1. Domestic
| Considerations | |
|---|---|
| Waste segregation and disposal | Medical waste is costly to dispose of and poses its own threat to the environment through the emissions released when incinerated. It is estimated that tons of clinical waste could be recycled if it was segregated properly but, whether through fear of contamination or lack of awareness, much rubbish gets classified as hazardous, resulting in more cost and a bigger carbon footprint. Look to provide adequate bins to accommodate all types of waste in treatment rooms and common areas. As medical waste accounts for a small percentage of the total waste generated, reducing the size of your hazardous medical waste bins could be considered, as it reminds staff to only discard in there what is necessary |
| Utilities | Switching to a more energy efficient provider will eliminate energy waste, reduce greenhouse gas emissions and will save you anywhere between 25–45% on your energy bills. Look at changing to low-energy lighting, turn off lights when rooms are not in use, as well as what is usually left running overnight when the clinic is closed, like backlit displays and signage |
| Consumables | Review stock holdings and suppliers to find alternative eco-friendly options. Some companies use unbleached, recyclable materials to make things like couch roll, hand towels and toilet roll, for example, which cuts back on raw materials preserving rainforests. Minor ops kits are expensive and particularly wasteful if all tools are not used, you can give a list of what implements your need for your procedures and have your kits custom created, which cuts down on waste. See if anything be swapped out for washable cloth and review what can and cannot be recycled |
| Cleaning | Green cleaning products reduce air and water pollution and are not toxic to marine life when disposed of. If you use a cleaning company, enquire as to their steps towards sustainable practice and products |
| Plastics | Plastic takes roughly 1000 years to decompose; it is estimated that by 2050, there will be more plastic in the ocean than fish. Although single-use plastic in some sterile equipment may not be recyclable yet, there are other plastics that you can recycle/reuse/cut back on—for example, plastic disposable cups offered with drinking water can be swapped out for glasses that can be reused or paper cups that can be recycled. Another consideration is refillable containers for things like soaps, washing up liquids and some products, as well as eliminating all plastic bags and packaging |
Table 2. People
| People | Considerations |
|---|---|
| Staff | Provide training on every aspect you are implementing, including how it will benefit the environment, the ways that staff fit into the steps you are taking and the long-term plan |
| Customers | Update customers about what you are doing to become more sustainable and the success you are having, and encourage them to be a part of it, whether that means refillable products, bringing their own water bottles to drink from or using clinic recycle bins. Most customers will be impressed and it will set you aside from competitors |
Table 3. Service
| Service | Considerations |
|---|---|
| Treatment | Zero Waste Week estimate that 120 billion units of packaging are produced by the cosmetic industry globally each year, which amounts to the loss of 18 million acres of forestry. Ensure that waste from treatments is being segregated properly. If you are unsure of anything, contact the suppliers for advice on ways to cut back on waste and recycle. Think about your stock holding: will you use everything before the use-by date? Do the treatments you offer come from sustainable sources? Depending on the seriousness of the steps you are taking, you may want to reduce doing any treatments that do not come from somewhere with a sustainability development plan in place, similar with your retail holding |
| Retail | Switch or add companies who have a sustainable plan so there is choice for ethical consumers. Request for no packaging to be sent with the products and consider establishing a refill initiative where customers can fill up on certain products, perhaps from professional stock. Offering a discount to do so may encourage more uptake. This will not be feasible on all products, but cleansers, certain moisturisers, sun creams, etc, could work, or implement an initiative for recycling the empty bottles/product containers. All this will reduce waste |
| Paperless | Reducing paper does more than just decrease the impact on forestry; it has a social impact too, in regard to human rights abuse linked to paper production. Look towards going paper-free in relation to patient notes; although time-consuming when transferring digitally, it eliminates excessive amounts of paper and data breaches and creates storage space. Not giving out receipts or written appointment cards also cuts down on paper; opt for email or phone communication with customers instead |
| Marketing | Think about evergreen signage that does not need replacing regularly, likewise with clinic literature, to avoid wasting vast amounts of paper. Digital marketing and utilising social media for promotional activity will reduce paper consumption, too |
Eco inspiration
There are already companies in the aesthetic industry that are taking steps towards sustainability. This may impact your decisions when sourcing/continuing with certain suppliers or provide some welcome inspiration on the kind of pledges that others are making. In 2016, Allergan set an ambitious goal to reduce their environmental impact by 20% by 2020, calling it their 20/20 challenge. To meet this goal, they looked at ways to decrease greenhouse emissions and energy consumption in their manufacturing processes and also reduce their waste across all areas. Cosmetic giant L'Oréal also has a successful initiative that has gained them recognition as a global environmental leader. Launching their global sustainability programme ‘Sharing beauty with all’ in 2013, L'Oréal pledged a number of reductions across multiple aspects of their operation and have been very open about the progress. Their pledges include ensuring that 100% of their products have either a social or environmental benefit and reducing carbon dioxide emissions and water consumption throughout their manufacturing processes by 60%, among many other things. It is this transparency and steps toward making an impact that constantly attracts new customers and maintains L'Oréal's already established following.
Despite the difficulties surrounding needles and single-use plastics in healthcare and aesthetics, there are still companies looking to make these kinder to the environment. For example, the company Stericycle distributes sharps bins that can be sanitised and reused, which saves money on collection, the replacement of bins and reduces emissions through incineration. Furthermore, Complete Needle is a US company that uses the ashes from incinerated medical waste as a component of cement and other building materials, which reduces the need to mine for these resources.
Sustainability is here to stay
Hopefully the information outlined demonstrates that making the switch to a more sustainable practice will not mean impacting patient safety. These changes do not need to cost more. In fact, expenditure should be reduced in the long term with regard to energy savings and purchasing fewer products like paper. Then there is the potential boost in business, as your ethical steps and stance on helping the environment become a unique selling point to patients. Although there are many aspects of running an aesthetic clinic that are a long way from being truly sustainable, there are a lot of areas where change can be made. Whatever you do, no matter how small, will make a difference and all you need to decide is what kind of a difference you want to make.