The future is now

After attending Health Care Without Harm’s CleanMed conference as a Stephanie Davis Award winner, medical student Sarah Hsu gained the knowledge and inspiration she needed to conduct her medical school research project. Her recently published research helps us understand the magnitude and impact of emergency department waste. (Photo: Sarah Hsu)

I always knew I wanted to explore the intersection of health and the environment. In my first year of college, I wrote a paper on the broader health and environmental impacts of hospitals. It didn’t take long for Health Care Without Harm to turn up in my research. My undergraduate work later turned to sociology, as I advanced toward becoming a primary care physician.

Several years into my studies I discovered that resources and guidance focused on the environment and health care were difficult to come by in my program — in fact, they were hard to find anywhere. I dug up my old paper and rediscovered Health Care Without Harm, which led me to Dr. Jonathan Slutzman, an instructor in emergency medicine at Harvard Medical School, who became my research mentor.

Over these years I have done a deep dive into research — even into a dumpster, conducting the first audit of emergency room waste — as well as policy, advocacy, and of course, patient care. I helped launch Medical Students for a Sustainable Future as well as a podcast dedicated to climate change and health, and contributed to syllabi for medical schools to increase understanding of the negative impacts of the health care sector and its greater potential to contribute to wellness and healing.

Through it all I’ve held a clear vision of team-based, patient-centered care that acknowledges the challenges we face. One of the reasons I entered this field was because I knew that in the future more people would require more support because of climate change. Patients would need reliable access to electricity for medications. They would need shelter as disasters drive displacement. They would need mental health services as trauma spreads.

When I began my rotations, I realized that my preparation was not for the future. The future is here. The future is now.

There is one landfill for the entire state of Rhode Island, which will be full in 10 to 15 years. Will another have to be created, causing more health issues for another under-resourced community? Or will we ship our waste, incurring costs as we impact the health of others somewhere else? We are the fastest-warming state in the continental U.S. What will happen to those who must walk to work or struggle to pay electric bills? When a Category 1 hurricane hit our coast recently, some could not find shelter and were injured as they endured the storm outdoors. What will happen as more have to flee their homes and storms increase in strength and frequency?

What I find over and over is that the biggest thing that stands in our way is education, within and beyond the health care sector.

It sounds simple. Yet, when I share what is happening and what is possible — the suffering and harm we can prevent, and all that I have learned through the Health Care Without Harm network — lightbulbs switch on.

Health care is caring for the planet. It is caring for those who struggle the most because the systems we are all a part of do not care for them.

Health care providers have outsized power and capacity to change these systems and support health beyond their walls. Today’s ‘medicine bags’ can be filled with new tools, along with commonsense tools we have barely considered: In places with heavy air pollution or frequent wildfires, we can secure bus passes so pregnant individuals can arrive safely at appointments. We can write a letter for a patient with multiple sclerosis so their electricity won’t get cut off in a heat wave. We can provide data-driven testimony for legislators crafting laws to keep constituents safe and healthy.

“So much of the conversation around health care, resilience, and sustainability focuses on individual responsibility. We must shift focus from what an individual should do, to what we can all do, to protect communities and patients from environmental factors beyond their control.”

We have a long way to go. Programs and studies must be funded to create new resources and to share what we already know. It is not sustainable or efficient for doctors and nurses to do this work for free, knowing it is the right thing to do, alongside the incredible demands of patient care and administrative duties. We all need to expand our understanding of what health care can achieve, and invest accordingly.

My dream is to practice primary care alongside social workers and mental health professionals for our most marginalized and at-risk neighbors. When I finish medical school and take an oath to do no harm, I recognize that my work will become more difficult as conditions change. But I will never give up my vision of making sure the care I provide, the institution I work for, and the sector I am part of contribute to a deeper commitment: to provide real healing.

Sarah Hsu is a third-year medical student at Brown University, pursuing her degree through the Program in Liberal Medical Education, an eight-year training program that combines undergraduate education with professional studies in medicine. She is also pursuing a master’s degree through the Primary-Care Population Medicine Program at Brown. She received Health Care Without Harm’s 2019 Stephanie Davis Waste Reduction and Pollution Prevention Award and Scholarship.




Health Care Without Harm seeks to transform health care worldwide so the sector reduces its environmental footprint and becomes a leader in the global movement.

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Health Care Without Harm

Health Care Without Harm

Health Care Without Harm seeks to transform health care worldwide so the sector reduces its environmental footprint and becomes a leader in the global movement.

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