Despite improvements in the efficiency of energy, material and water use, the ecological burden of healthcare provision has increased globally.¹ Aside from greenhouse gas (GHG) emissions from power consumption, transportation and service delivery, the healthcare sector and its supply chains contribute to the degradation of the biosphere in less apparent ways. Toxic products and their metabolites pass into drinking water and are already being detected in the bloodstream of newborn babies.² Similarly, non-degradable materials such as macro- and microplastics used in pharmaceuticals and their packaging accumulate in marine environments where they may threaten the ability of natural carbon sinks to remove CO2 from the atmosphere.³ Particularly relevant to dermatologists are the harmful ingredients in topical medications, sunscreens, cosmetics and cosmeceuticals, which can be transmitted from skin to sewage systems through handwashing and showering, and directly to aquatic environments through recreational activities such as swimming.
Although physician organizations agree on the need for environmental protection measures, their members currently lack reliable information to consider questions of sustainability in their medical decisions. This lack of guidance in the face of a growing crisis calls for a thorough conceptual shift in the provision of evidence-based recommendations rather than a mere call for ecological awareness. The concept of planetary health transcends that of environmental protection by conceiving of health care as both perpetrator and victim of ecological disruption. Following this logic, in addition to focusing on proximate effects such as GHG emissions and air pollution, attending to endpoints further down the causal chain becomes critical to appreciate fully the ecological footprint of health care. This is because emissions and pollution ultimately lead to adverse health impacts, such as surges in the incidence of respiratory and vector-borne diseases, allergic reactions, and ultraviolet (UV) and heat exposure.⁴ In this position statement, we argue that, by systematically considering the ecological ramifications of healthcare practices, guideline developers should anticipate likely environmental and political changes and articulate an adequate response. The concept of planetary health is well suited to this purpose and can serve as the philosophical basis for ecologically conscious medical decisions.⁵