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Synthesis/Regeneration 55   (Spring 2011)

Looking at the US and Cuba

What Does Health Care Have to Do
with the Environment?

by Don Fitz

Should we call it the health care industry or the sickness industry? As you might guess, it makes more money the sicker you are, not from creating health. But did you suspect that it might be making the environment sick? Here’s how.

If there weren’t so many insurance companies, we wouldn’t need so much cement and steel and all sorts of other construction materials. That would mean fewer buildings contributing to urban sprawl and habitat destruction.

It would mean less water used to construct and maintain buildings and less fossil fuel wasted for heating and cooling them. And, of course, less fuel would be used for transporting people to and from unproductive jobs. Fewer parking lots would mean more green space and less stormwater runoff.

Do you like forests? Imagine the trees that could be spared if a smaller sickness industry did not waste reams of paper for documenting and billing over and over and over.

If there weren’t so many insurance companies, we wouldn’t need so much cement and steel.

Think of drugs that rarely help people get better and often make them worse: high-dose chemotherapy, proton pump inhibitors, hormone replacement therapy, anti-osteoporosis drugs, anti-depressants. If America was less addicted to prescription medication, fewer rivers in India would turn orange from the effluent of pharmaceutical factories and less land would become barren of anything green. Sewers in the US would be less filled with pills thrown into toilets and chemicals discharged from manufacturers.

How many MRI and CAT scan machines are used more for the bottom line of hospitals and medical offices than to promote health? If there were fewer diagnostic machines, there would be less need to extract rare metals from the Earth, transport them across oceans and combine them in factories that waste materials, energy and labor in producing excessive numbers of those machines. And there would be fewer “false positives” or indications of illnesses that aren’t really there.

Think of all the people who get sicker by driving (or flying) to a hospital for a disease they don’t have. There’s probably even more who really are sick, but who won’t be helped by a hospital stay which could give them an infection or a procedure which has more negative effects than positive ones. These include frontal lobotomies, tonsillectomies, hysterectomies, coronary artery catheterizations, cardiac stents, angioplasties and lower lumbar spinal fusions.

If America was less addicted to prescription medication, fewer rivers in India would turn orange.

American society might actually be healthier with fewer hospital beds. The environment would indisputably be healthier because smaller hospitals would produce the same benefits as smaller insurance buildings.

The flip side of some people getting too much treatment is millions of others not getting enough. If they were not denied treatment for the crime of not being able to pay, many minor problems would not turn into strokes, heart attacks, amputations or kidney failures. It takes a lot more environmental resources to deal with the flu than a cold. Increasing preventive treatment would reduce hospitalization stays.

If hospitals were to shrink, there would be a much smaller quantity of plastics (which make up the majority of medical waste) to be incinerated and turned into dioxin spewed into the air or landfilled where it leaches toxins into groundwater for centuries (or millennia). This would mean fewer places like Cancer Alley in Louisiana.

If the number of insurance buildings decreased, there would be that much less need for electricity from coal or nuclear plants. If the number of hospitals were to shrink, the need for electricity would shrink even faster. That’s because of their diagnostic machines that are energy gluttons and computers that rely on similarly gluttonous server farms.

Imagine the economy as a whole. Effects of reducing the sickness industry would ripple far and wide. Medical care is 16% of the Gross Domestic Product (GDP) and growing more rap-idly than the rest of the economy. Devoting less money to it would disproportionately drop the GDP.

Even more important, since people like good health, medicine may be the area of production which people are most reluctant to reduce. If it became clear that we could shrink the sickness industry with no decrease in health or the quality of life, it would have a huge effect on convincing people of the viability of de-growing the entire economy.

So what does this have to do with Cuba? A recent article I wrote for Synthesis/Regeneration (SR 54, Winter 2011, pp. 29–33; s-r/54-10) documents that Cuba spends merely 4% per capita of what the US does on health care. But Cuba has exactly the same life expectancy as the US: 78.0 years. Widely recognized for its low carbon footprint, Cuba has first-world health care within a third-world economy.

How does Cuba accomplish this? By walking. Well, there may be a bit more to it than that, but Cubans do walk to 80% of the health care they receive. This is because the Cuban model of primary and preventive medicine is based on neighborhood health care by family care doctors, an endangered species in the US.

This is because the Cuban model of primary and preventive medicine is based on neighborhood health care.

These physicians are each responsible for 150 or so families (600–900 people) who live in a geographical area which is served by the consultorio, or neighborhood doctor’s office. For treatment after working hours or for most specialized care, Cubans go to the neighborhood policlínico.

In addition to patients coming to doctors, family doctors are required to visit every patient in their home annually. More frequently if the person is disabled. In a neighborhood health care system, doctors walk to people’s homes. Family dynamics are part of medical training and doctors are often able to treat by addressing family issues or using traditional and alternative medicine rather than high tech approaches that have big environmental impacts.

Cubans do not change physicians because an employer switches health care providers, meaning that doctors know patients very well and can recognize small problems before they become big ones. Treating problems in their early stages reduces the need for hospitalizations.

The goal of Cuban medicine is to have hospitals and long-term care facilities (such as nursing homes) account for less than 20% of treatment. Accomplishing quality health care with very few resources means that Cuba has far less environmental impact from transportation, electricity, construction, water usage, paper wastage, and diagnostic machines.

If Americans were to get the idea that we could reduce the sickness industry massively, they might realize that we could have great lives by cutting every other area of the economy by 50% or more. Maybe, just maybe, having a 30 hour work week to reduce unemployment might not be enough. Could it be possible that a 20 hour work week is central to good living and environmental sanity?

Instead of spiraling upward with ever-increasing production for manufactured needs, could we design an economy to carefully move toward sanity? That requires figuring out how to produce less while living better.

Don Fitz teaches Environmental Psychology at Washington University in St. Louis and is continuing to evolve a vision of how shrinking the sickness industry could improve health. If you know of something he left out of this analysis, contact him at fitzdon@aol.com

[2 jun 11]

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