The first carbon-neutral district in the Netherlands says no to modern healthcare, which is completely dependent on fossil fuels. Yet the inhabitants are just as healthy as other Dutch people.
How sustainable is modern healthcare?
Modern healthcare is getting better and better thanks to new technology, new medicines, and new procedures. However, it is also a major consumer of energy and a major producer of greenhouse gases and other pollution. According to an international study, about 7% of all emissions in the Netherlands (13 million tons of CO2e) are due to healthcare. The health care carbon footprint per Dutch person amounts to 0.76 tonnes per year, which corresponds to the emissions of more than 6,300 km of driving the average European car.
The modern healthcare system is highly dependent on fossil fuels. Part of the emissions come from direct energy consumption – electricity and heating. Hospitals in particular have a very high electricity consumption due to the large number of medical devices and the high requirements for lighting and ventilation in operating theaters. For example, a recent study found that the electricity consumption of all CT- and MRI-scans worldwide causes as much as 0.77% of all global emissions.
Medical equipment & medicines
In addition, more than half of the total energy consumption is caused by the production of medical equipment, medicines and other medical products. For example, a study concluded that the global production of pharmaceuticals produces more emissions than the global production of cars.
Anesthetic gases are also an important source of emissions: they are potent greenhouse gases that are released into the atmosphere immediately after they have been inhaled by the patient. Maintaining a 70 kg adult anaesthetised for an hour produces from 25 kg to 60 kg greenhouse gas emissions, which corresponds to the emissions of driving an average European car for 200-500 km.
Disposable products are another source of emissions. These are products worn by patients and medical personnel (face masks, gloves, overshoes, hats), but also, for example, towels, basins, sterile plastic packaging, syringes, medical devices and instruments. Although all these products can in principle be disinfected, washed and reused, they are increasingly discarded after use. This produces a mountain of waste, but it also costs a lot of raw materials and emissions to produce everything over and over again.
Human Powered Healthcare
The first carbon neutral neighborhood in the Netherlands is independent of fossil fuels. All energy comes from locally produced, renewable energy: human power, biomass, sun and wind. In that context, there is no room for energy and carbon intensive healthcare.
Since all medical devices must be human-powered in BoTu’s hospital, their number is limited. Furthermore, many of the medical devices were originally developed for developing countries, where an unreliable electricity supply makes the use of “normal” equipment impossible. For example, the hospital has a machine that can treat cervical cancer using compressed air, a much more economical method than using cryonic gases.
Herbal Medicine
Because the production of modern medicines requires so much energy, the BoTu hospital relies on herbal medicine, for which it has its own laboratory, herb garden, and medicine men and women. Herbal medicine is based on the preservation and transmission of customs from different cultures for centuries. Modern medicines are often based on plants and herbs, but while traditional herbal medicine uses whole plants (and combinations of plants), the pharmaceutical industry only extracts the active ingredients. This makes dosage and use much easier, but the chemical steps to achieve this require a lot of energy.
Examples of medicinal plants that are grown in the BoTu hospital are marigold (helps against laryngitis and stomach ulcers), St John's wort (infections and depression), chamomile (heartburn and colds), valerian (stress and palpitations), rose hip (arthrosis and diseases of the respiratory tract), hemp (pain and asthma), nettle (cystitis and diarrhea), cloves (disinfection and anesthetic) and ginseng (diabetes and erectile dysfunction). There are also medicinal foods, such as lemons (increase resistance to infection), onions (provide relief from bronchial infections) and garlic (strengthen the lungs).
Anesthetics
Few operations are possible without anesthesia. However, inhaling gases produces too many emissions, which is not possible in a carbon-neutral hospital. For some surgical operations, a switch is made to intravenous anesthetics, a technique that does not produce greenhouse gases. However, the production of these drugs costs energy and generates a considerable amount of toxic waste. Where possible, use is therefore made of preindustrial anesthetics, such as alcohol. In combination with holding the patient firmly, shorter operations - such as amputations - can be performed successfully in this way.
Finally, the hospital in Bospolder-Tussendijken does not use disposable materials. Sterilizing, disinfecting, and washing medical items also requires energy, but much less than producing new products.
Preventive medicine
Although the healthcare in the neighbourhood is carbon neutral, it does not offer the quality of care of other hospitals that run on fossil fuels. Some diseases cannot be detected or treated. Some medical procedures are more painful. The use of herbal medicine and the reuse of medical products carry a number of risks. Nevertheless, the inhabitants of BoTu are not unhealthier than other Dutch people, and their life expectancy has not decreased.
For years, researchers have argued that attention must shift from treating diseases to preventing them. After all, if people don't get sick, then they don't have to go to hospital. Many patients end up in health care because of lifestyle diseases, which are due to poor nutrition, lack of exercise, stress, drug abuse, or social isolation. Examples are cardiovascular diseases (the cause of death of 1 in 3 Dutch people), obesity (a risk factor for all kinds of other diseases), type 2 diabetes (which affects 1.2 million Dutch people), depression (which affects 1 in 5 adults) and cancer (which is caused in 50-70% by an unhealthy lifestyle).
All these lifestyle diseases have disappeared in Bospolder-Tussendijken. Because the energy production in the neighborhood is largely based on human power, the inhabitants have sufficient exercise, a strong heart and good stamina. Because household chores are organized communally, people do not suffer from loneliness or depression, and do not turn to drugs or alcohol to feel better. The neighborhood grows its own fresh food, and stress at work is rare: mind-numbing jobs have disappeared.
Holistic view of health
Research shows that poverty and social inequality are an important cause of health problems. However, Bospolder-Tussendijken is an inclusive neighbourhood, where the communal organization of household takers ensures that no one lives in poverty. The design of the district also has a significant impact on the health of the residents. For example, there are no more cars in BoTu. This leads to a reduction in the number of serious injury accidents, less damage to health due to air pollution, less stress due to noise, more space for playing children (no ADHD), and of course also less lifestyle diseases because people are physically more active. In summary: BoTu takes a holistic view of health.
However, the choice for renewable energy also entails a number of drawbacks, which local healthcare must respond to. The higher physical activity improves general health, but it also leads to more problems with muscles and joints. The number of fractures has increased, too. The use of biomass and fire has in turn led to a higher number of burns. Initially it was also feared that the use of fire would lead to poor air quality. In the end, that turned out to better than expected. Other sources of local air pollution have disappeared, such as cars and scooters. Moreover, research has shown that the air pollution from the open fires is usually carried by the wind to Utrecht.
Corona crisis
Bospolder-Tussendijken took the first steps towards a climate-neutral neighborhood when the corona crisis broke out in 2020. However, unlike other parts of the Netherlands and Europe, the neighborhood did not go into a lockdown. After all, this strategy is only possible thanks to fossil fuels, for example in industrial agriculture and food distribution. Agriculture and food distribution in Bospolder-Tussendijken are based on human power, so in a lockdown everyone would starve. In addition, no one would be able to shower, cook or go to the toilet, because all household tasks are organized communally.
Yet the corona virus has not caused more deaths than in other parts of Rotterdam and the Netherlands. This has a lot to do with the fact that the inhabitants have an above-average fitness level and do not suffer from lifestyle diseases, which are a major risk factor for complications. Moreover, people spend a lot of time in the open air, where the chance of contamination is much smaller.
Inhabitants who do get the disease and are short of breath, are not left to their own devices. Traditional breathing ventilators use too much electricity for a carbon-neutral hospital, but there also exists a human-powered alternative that produces no emissions at all: the “Ambu-bag”. It is operated 24 hours a day by the patient's family and friends to pump oxygen into the lungs. Blood transfusions are also performed in the hospital: the blood of people who have already produced antibodies to the virus is given to people who have become ill.
Next episode: Sustainable decadence.