LCA for Pharmaceuticals and Healthcare

The healthcare sector has a significant environmental footprint—estimated at 4-5% of global greenhouse gas emissions. From pharmaceutical manufacturing and medical device production to hospital operations and waste management, Life Cycle Assessment provides insights for reducing impacts while maintaining or improving health outcomes.

Why LCA for Healthcare?

Significant impact: Healthcare systems globally contribute substantially to carbon emissions, resource consumption, and waste generation.

Growing attention: Healthcare organizations are setting sustainability targets; LCA supports evidence-based strategies.

Complex trade-offs: Environmental impacts must be balanced against health outcomes—a unique ethical dimension.

Regulatory interest: Pharmaceutical environmental assessments are increasingly required (EU, some products).

Innovation opportunity: Sustainable healthcare can reduce costs while improving environmental performance.

Pharmaceuticals

Key Characteristics

Pharmaceutical LCA faces unique challenges:

High-value, low-mass products: A kilogram of active pharmaceutical ingredient (API) may be worth thousands of dollars, making mass-based comparison misleading.

Complex synthesis: Multi-step chemical processes with low yields generate significant waste and solvent use.

Stringent requirements: GMP (Good Manufacturing Practice), regulatory compliance, and quality requirements constrain sustainability options.

Long supply chains: Active ingredients may be synthesized in one country, formulated in another, and used globally.

Data confidentiality: Proprietary processes limit data availability.

Functional Unit Considerations

For pharmaceuticals, functional units might include:

• "Treatment course for condition X"
• "1 defined daily dose (DDD)"
• "1 kg API at factory gate"
• "1,000 tablets of product Y"

Treatment-based units are most meaningful but require efficacy equivalence between alternatives.

Life Cycle Stages

API synthesis:

• Often dominates environmental impacts
• Solvent use, energy, process emissions
• Typical yields: 10-40% (significant waste per kg product)

Formulation:

• Combining API with excipients
• Tableting, encapsulation, filling
• Typically lower impact than synthesis

Packaging:

• Primary (blister packs, bottles)
• Secondary (cartons)
• Tertiary (shipping)
• Regulatory requirements for child-resistance, tamper-evidence

Distribution:

• Cold chain for biologics
• Global distribution networks
• Shelf life considerations

Use phase:

• Generally minimal direct environmental impact
• Patient compliance affects total doses required

End of life:

• Unused medication disposal
• Pharmaceutical residues in wastewater
• Packaging waste

Impact Hotspots

Typical pharmaceutical LCA findings:

Emerging Areas

Biologics and biosimilars:

• Fermentation-based production
• Different impact profile than small molecules
• Cold chain requirements throughout

Continuous manufacturing:

• Replacing batch processes
• Potential for efficiency improvements
• Growing regulatory acceptance

Green chemistry:

• Solvent reduction and substitution
• Catalytic processes
• Biocatalysis

Medical Devices

Product Categories

Medical devices span enormous range:

• Single-use consumables (syringes, gloves)
• Implantables (joint replacements, pacemakers)
• Diagnostic equipment
• Imaging systems (MRI, CT)
• Surgical instruments (reusable and single-use)

Reusable vs. Single-Use Debate

A central LCA question in healthcare:

Single-use (disposable):

• Eliminates reprocessing impacts
• Ensures sterility
• Generates significant waste
• Lower per-unit manufacturing may offset volume

Reusable:

• Higher initial manufacturing impacts
• Sterilization (energy, water, chemicals)
• Requires collection and logistics
• Number of uses before disposal critical

LCA findings generally show: Reusables are favorable when:

• Number of reuses is high (>50-100 for simple items)
• Sterilization is efficient
• Transport distances are reasonable

Case Study: Surgical Gowns

Results highly dependent on system assumptions

Medical Equipment

Large medical equipment (MRI, CT scanners) presents different challenges:

• Long lifetimes (10-20 years)
• Use phase dominates (electricity consumption)
• Embodied impacts amortized over many procedures
• End-of-life management for complex electronics

Healthcare Facilities

Hospital Carbon Footprints

Hospitals are energy-intensive facilities:

Procurement (Scope 3) often dominates, but building energy (Scope 1 & 2) is more directly controllable.

Healthcare System LCA

System-level assessments consider:

• Building construction and operation
• Medical supplies and equipment
• Pharmaceuticals
• Food services
• Staff transportation
• Patient transportation
• Waste management

Anesthetic Gases

Anesthetic gases (desflurane, sevoflurane, nitrous oxide) have significant GWP:

Switching from desflurane to sevoflurane is a significant carbon reduction opportunity.

Waste Management

Healthcare generates diverse waste streams:

General waste: Similar to commercial waste Infectious/clinical waste: Requires special treatment (incineration, autoclaving) Pharmaceutical waste: May require high-temperature incineration Sharps: Needles, scalpels (puncture-resistant containers) Chemical waste: Solvents, reagents

Waste Treatment Options

Methodological Considerations

Unique Aspects

Health outcomes: Difficult to incorporate into traditional LCA; quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs) can link to health benefits.

Ethical constraints: Can't compromise patient safety for environmental benefit.

Regulatory requirements: Many changes require regulatory approval, slowing innovation.

Data availability: Proprietary processes, confidential formulations limit access.

Functional Unit Challenges

Comparing treatments requires equivalence:

• Same therapeutic outcome
• Same patient population
• Same time frame

Example: Comparing inhalers

• "Delivery of 1 dose of medication" is incomplete
• "Control of asthma symptoms for 1 year" is more appropriate but requires efficacy data

Key Organizations and Standards

Industry Initiatives

Sustainable Healthcare Coalition:

• Developed Sustainable Care Pathways methodology
• NHS England partnership

Health Care Without Harm:

• Global network promoting sustainable healthcare
• Climate-smart healthcare guidance

Pharmaceutical Supply Chain Initiative (PSCI):

• Supply chain sustainability standards
• Environmental expectations for suppliers

Standards and Guidance

ISO 14001: Environmental management (widely applied in pharma) GHG Protocol: Emissions accounting Science Based Targets (Healthcare): Sector-specific guidance available

Key Takeaways

1. Healthcare represents 4-5% of global emissions; sustainability efforts are growing
2. Pharmaceutical APIs typically dominate drug product footprints due to complex synthesis
3. Reusable vs. single-use requires careful LCA—results depend on specific circumstances
4. Hospital procurement (Scope 3) often exceeds direct energy use in total footprint
5. Anesthetic gas choice is a high-impact, readily actionable opportunity
6. Functional units should reflect health outcomes, not just physical products

Resource List

Organizations

• Health Care Without Harm
• Sustainable Healthcare Coalition
• Practice Greenhealth

Publications

• Karlsson, M. & Pigretti-Öhman, D. (2005). Material consumption in the healthcare sector. Journal of Cleaner Production.
• Chung, J.W. & Meltzer, D.O. (2009). Estimate of the carbon footprint of the US health care sector. JAMA.
• Eckelman, M.J. & Sherman, J. (2016). Environmental impacts of the US healthcare system. PLOS ONE.

Guidance

• NHS Net Zero commitment and guidance documents
• Health Sector Climate Action Summit resources

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Healthcare LCA requires balancing environmental impacts with health outcomes. Engage clinical stakeholders early to ensure proposed changes maintain care quality.