What a Waste of a Healthcare System

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By KIM BELLARD

An essay in Aeon had me at the title: The Waste Age.  The title was so evocative of the world we live in that I almost didn’t need to read further, but I’m glad I did, and I encourage you to do the same.  Because if we don’t learn to deal with waste – and, as the author urges, design for it – our future looks pretty grim.

Healthcare included.

The essay is by Justin McGuirk, chief curator of the Design Museum in London, and accompanies an exhibit there: Waste Age: what can design do?  Mr. McGuirk states:

…waste is not merely a byproduct of culture: it is culture. We have produced a culture of waste. To focus our gaze on waste is not an act of morbid negativity; it is an act of cultural realism. If waste is the mesh that entangles nature and culture, it’s necessarily the defining material of our time. We live in the Waste Age.

He recaps some of the depressing facts about how much waste our society produces, and how this throwaway culture we’ve grown used to is a fairly modern development.  Like it or not, Mr. McGuirk points out: “To say that we live in the Waste Age is not to focus attention on an unpleasant but marginal problem; it’s to say that the production of waste is central to our way of life.”

We can blame capitalism, we can blame consumers, we can blame our typical shortsightedness, but to Mr. McGuirk, waste is, to a large extent, a design issue: “Design has been a driving force behind our prodigious waste streams in the past century…In short, they’ve been doing what designers do best – creating desire.”

Design must change, he says, and designers must as well, reinventing “themselves as material researchers, waste-stream investigators, and students of global economic flows.”  It is not enough to ask how something will look when new or how it will be used, but what will happen to it over time and how it/parts of it can be recycled/reused. 

Powerful stuff.  Although Mr. McGuirk’s examples skew heavily towards common waste culprits like plastics and electronic products, I can’t help but think about healthcare, because when I think about healthcare, we’ve been living in The Waste Age for some time.

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Some of this is well recognized.  For example, there has been grudging acknowledgment for years that, in the U.S. healthcare system, as much of a third of our spending is “waste” (see, for example, Shrank, et. alia). We get procedures we don’t need, have tests that are duplicative, take too many prescriptions, use the ER instead of an office visit, and so on.  We waste too much of our time waiting.  We have too many healthcare facilities in heavily populated areas – and are building more – and not enough in less populated areas.  Our administrative costs are much too high.

Waste defines our healthcare system.

Some of this is known but not often thought about: the actual waste our healthcare system produces.  It has been estimated that each staffed hospital bed generates 33 pounds of medical waste each day, resulting in 5.9 million tons per year – and that doesn’t count waste from nursing homes, doctors’ offices, pharmacies, and other healthcare facilities.  For example, there are over 16 million injections annually (worldwide), and those needles and syringes end up somewhere.  Even worse, about 15% of medical waste is considered infectious, toxic, or even radioactive.   

You and I generate medical waste.  A surprisingly large amount of those prescriptions we take, or flush down the toilet, end up in the water.  We’d like to think that our water treatment plants remove these traces of pharmaceuticals, for the most part, that’s not true.  They end up back inside us.  The problem is worse than that. Antidepressants, for example, have been found to impact crabs’ behavior.  Some fish have built up high levels of pharmaceuticals. 

Even worse, a number of us take prescriptions that don’t benefit the majority of us, and may actually result in some harm (e.g., statins for low risk individuals, not to mention all the antibiotics taken for viral infections). They’re just wasted.

We’re not even mining the waste we produce for valuable information it can provide.  Even in a pandemic, where is our wastewater monitoring to detect and pinpoint outbreaks? In a time of digital health, where are our smart toilets to help us track changes in our health?  

Mr. McGuirk discusses plastics and microplastics as a huge problem.  As I wrote in 2020, microplastics are everywhere: in the air, in the ocean, in the land, in the water we drink, in the food we eat, and, at this point, probably in our cells.  No one really knows what the impact on all this waste is/will be on our health, but I’m betting it won’t be good.  

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Mr. McGuirk writes: “it [waste] is now an internality – internal to every ecosystem and every digestive system from marine micro-organisms to humans.”  It needs, he urges, to become a central issue, “brought into the heart of every conversation about how things are extracted, designed and disposed of.”

As Mr. McGuirk suggests more generally, design can help. For any physical object in the healthcare system – from pills to devices to buildings — designers need to view it “as a vehicle towards understanding the complex systems that produce it, and the even more opaque systems that dispose of it.”  All designers — healthcare included — need to be thinking about what happens to their products and their packaging; otherwise, they may generate, at best, those pesky microplastics and, at worse, even more toxic waste. 

Waste isn’t just what happens to physical objects. When it is our health or the health of a loved one, we think “more is better” — damn the waste, damn the potential adverse consequences.  

We’re going to learn how to temper our expectations. Our clinicians need to learn how to avoid the “more is better” mindset and how to help us understand cost/benefit tradeoffs. We’re going to have to be more discerning about when what we think we want in healthcare may actually be wasteful. 

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Our current healthcare system is not sustainable – not from an ecological, economic, or even health standpoint. For it to survive, we must design for The Waste Age.

To close with Mr. McGuirk: “Recognising that waste is central, not peripheral, to everything we design, make and do is key to transforming the future.” 

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.