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The health care sector is a substantial contributor to the plastic pollution crisis due to our reliance on single-use plastic packaging.
We manufacture more and more plastic every year. Plastic production has doubled in the last two decades, with over half of all plastic manufactured in the last 13 years. Around half of the plastic we produce today is single-use plastic, and is often used for mere minutes before being discarded, yet it persists in our environment for hundreds, even thousands of years, polluting our oceans, soil, drinking water, air and bodies. And we know plastic waste is not inert — as was initially claimed — but is harming our planetary and human health.
The health care sector is a substantial contributor to this plastic pollution crisis. Around one-third of our waste is plastic and predominantly single use. Plastic packaging of medical devices, therapeutics and equipment in particular plays an outsized role as it constitutes 40% of health care’s plastic waste. Therefore, through the delivery of our care, we are harming our planet and our patients. Especially, the health of future generations, who will suffer the consequences of the proliferating plastic pollution most acutely. As described in The Rockefeller Foundation – Lancet Commission, “we have mortgaged the health of future generations … to realise gains in the present”.
Plastic packaging waste costs health care
Plastic packaging of medical goods is generally soft plastic or made of composite plastic, which has poor recyclability. Soft plastic costs up to 50% more to recycle into plastic resin than resin derived from virgin fossil fuel feedstocks.
Overall, the environmental costs of Australia’s packaging waste has been calculated to be $340 million per year in the form of water pollution, emissions, soil contamination and water and energy usage.Analysis from Australian Packaging Covenant Organisation (APCO) in 2024 suggests that packaging sent to landfill in Australia has an estimated unrealised value of $900 million. This highlights a significant capacity for health care to reduce its environmental impact and make substantial cost savings through changes to its management of packaging and packaged items. Western Health in Melbourne implemented a reusable surgical gowns program, resulting in savings of over $100 000 per year. Greater opportunities remain to further reduce unnecessary and excessive plastic packaging. For example, sterile items in a single-strike wrap have no increased risk of contamination than those in the usual double wrap.
Plastic waste is not just about cost – it has significant health impacts
Health impacts can arise as plastic degrades and fragments into microplastics, and as chemical additives and plasticisers leach out during all stages of the plastic lifecycle. A recent study in the New England Journal of Medicine examined atherosclerotic plaques for microplastics in 257 patients undergoing carotid endarterectomy for asymptomatic carotid artery disease. It identified 150 patients (58.4%) with microplastics, consisting of polyvinyl chloride and polyethylene, embedded in these plaques. The patients with microplastics were observed to have significantly more cardiovascular and cerebrovascular events than the controls (hazard ratio, 4.53; confidence interval, 2.00–10.27, P < 0.001). Moreover, microplastics have been found in virtually every human organ including our brains, testicles, placentas, breast milk and even in fetal meconium. Thus, from conception, we are subjected to plastic exposure.
In vitro studies have demonstrated that micro and nanoplastics are transported into cells through lysosomes, where they then become cytotoxic and stimulate oxidative stress and inflammation. Ragusa and colleagues identified human placental cells containing nanoplastics, which exhibited mitochondria and endoplasmic reticulum dysfunction. Similar to the pathology findings observed in pre-eclampsia and intra-uterine growth restriction.
Plastics contain additives and plasticisers that give unique properties such as stain resistance or heat stabilisation; however, exposure to these additives has been linked to endocrine disruption. For example, PFAS (per- and polyfluoroalkyl substances, also known as forever chemicals due to their exceptionally long half-life) used in products such as Gortex and Teflon, have been strongly associated with low birth weights, obesity and thyroid dysfunction. Other endocrine disrupting chemicals such as phthalates and bisphenol A, have been linked with infertility, impaired fetal neurodevelopment and several cancers.
Plastic packaging has substantial environmental costs
Plastics contribute significantly to climate change. Some 98% of plastics are derived from virgin fossil fuels and are responsible for 3.7% of global greenhouse gas emissions. Plastic production is only expected to accelerate as consumption and demand increase and by 2040, plastic is expected to be responsible for around 20% of global emissions.
Additionally, plastic pollution has substantial impacts on biodiversity. A report by the Secretariat of the Convention on Biological Diversity found that more than 800 marine species are affected by plastic pollution and by 2050, it is predicted that there will be more plastic in the oceans by weight than fish. Packaging is a critical contributor to this plastic pollution. Clean Up Australia found that plastics accounted for 81% of litter in 2022–23, most of which was plastic packaging.
Proposed solution
Currently packaging is under a co-regulatory arrangement. Both industry and government share the responsibility of managing the impacts of packaging waste. However, an independent review in 2021 found significant failures in implementation, industry compliance and enforcement. The APCO, a non-governmental organisation responsible for industry-led stewardship schemes for packaging, confirmed that the current national packaging targets will not be met. The Australian Government endorsed the findings of the review and agreed to reform Australia’s packaging regulations. This reform engaged with stakeholders involved in the production, use and recovery of packaging. In December 2024, we expect to hear the Australian Government’s report on the consultation process, followed by an announcement in 2025 on the direction of the new packaging regulations, which will likely take effect from 2026 onwards.
Doctors for the Environment Australia (DEA) has just contributed a submission to the National Reform of Packaging Regulation consultation, with a focus on the impacts of packaging in health and health care.
To effectively reduce the production of and improve the recovery of packaging, DEA advocates for the implementation of a mandatory product stewardship scheme for packaging, as proposed by the Boomerang Alliance advocacy network. This scheme would hold industries financially and legally responsible for the packaging that they manufacture and place on the market.
Under such a model, eco-modulated fees would apply to all packaging – this entails adjustable fees proportional to the environmental impacts of the packaging. If it contains circular design choices, such as incorporating increased recycled materials or designed for reuse, then it would have a lower fee than packaging that did not meet these same targets. The fees collected could fund the scheme and be used to build material recovery facilities and improve waste collection systems.
Furthermore, DEA proposes a ban on chemicals of concern such as PFAs and problematic single-use packaging that cannot be recovered. The scheme should be enforced by an independent regulator to ensure businesses are held to account and are meeting the mandatory targets set. Industry self-regulation has already been proven to be ineffective and is clearly not up to the challenge of the plastic waste crisis.
Extended producer responsibility schemes have been successfully implemented elsewhere with the European Union introducing the Packaging and Packaging Waste Regulation. This promotes circularity and sustainability with eco-modulated fees to incentivise recyclability and other sustainable design choices while also setting mandatory targets for packaging reduction, recycling rates, reuse and the inclusion of recycled content. This substantially reduces packaging waste sent to landfill.
To address the growing health, environmental, and financial consequences of increased packaging production and pollution, Australia needs an extended producer responsibility scheme for packaging. This has the potential to deliver significant benefits, including strong incentives for behaviour change and innovation, flexibility for regulated entities to improve, and nationally consistent regulations while aligning our domestic markets with international best practice.
Dr Mitchell Hickson is an NSW physician and a member of Doctors for the Environment Australia, where he chairs the plastic and waste pollution special interest group
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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Excellent article. Lead, arsenic, and mercury as well as PFAS in tampons and other menstrual products, which come into prolonged contact with sensitive tissue, microplastics throughout the body…but all we hear about is carbon dioxide.
V important that as health professionals we take responsibility for our plastic waste. It’s costing us money, and harming human and planetary health so very much part of our duty of care to do something about this.
Thanks Dr Hickson for this great article, esp showing ways forward and how we as clinicians have an opportunity to act. Obviously we need top down action but we can also do the right thing in our own practices.