How Medicine Becomes Trash: Healthcare Waste as Environmental Crisis

Jeremy Greene, MD, PhD, William H. Welch Professor of Medicine and History of Medicine; Director, Institute of the History of Medicine; Director, Center for Medical Humanities & Social Medicine, John Hopkins University

The modern medical enterprise is distinctively wasteful. This may seem to result inevitably from the hazardous nature of medical substances, whose infection risk, chemical toxicity, or radioactivity and accordingly requires more extensive techniques of waste handling. Yet only 15% of global healthcare wastes fit this specialized profile. The remaining 85% are simply materials that have been built to be disposable rather than reusable: a staggering volume of single-use items that emit toxins and carbon dioxide when incinerated, give off methane and other greenhouse gases while decomposing in landfills, or, if they escape these two fates, float on the surface of the oceans.

It was not always this way. In a relatively short period of time, we have naturalized the use of single-use masks, single-use surgical drapes, single-use plastic syringes, single-use surgical tools, and single-use diagnostic tests, all wrapped in multiple layers of single-use plastics—and then forgotten there was ever any alternative. In this lecture, Jeremy Greene traces the links between environmental history, the history of technology, and the outsized role that the global healthcare sector now plays in contributing to climate change and plastic waste. Greene uses the recent crisis of COVID-waste as a window into the broader infrastructure of engineered wastefulness in modern medicine and its differential effects across rich and poor nations on a global scale, and rich and poor neighborhoods on more local scales. Only through historical analysis, he argues, can we work to unseat medical waste as a natural category and reconsider it as the outcome of a set of value decisions we have made in the past, and can change in the future.

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