Health care's plastic paradox: from life-saving innovation to public health concern

Plastic: a breakthrough innovation 

Plastic has transformed modern life. Light-weight, versatile and cheap to produce, it has enabled innovation that reshaped how we live: making cars lighter and safer, electronics smaller and more affordable, food safer and longer-lasting, and clothing more accessible through synthetic fibres. 

In medicine, it has improved care. From the sterile packaging on surgical trays to the IV tubing delivering medication to critically ill patients, plastic has made healthcare safer and more accessible than any previous generation could have imagined.

However, what started as one of the great enablers of modern life has become one of its most pressing problems. Plastic production entirely outpaces our ability to manage the waste it generates, and as a material that does not decompose back to soil, it is becoming increasingly widespread in our environment. 

Ironically, what started as one of medicine's most transformative innovations is now implicated in patient harm. Recognising the breadth and urgency of that harm, Australia has taken its first steps to address the plastic crisis.

Recognition of plastic pollution as a public health issue 

An Australian Senate inquiry into the impact of microplastics and other toxics on human health  published its findings and recommendations on 26 May. This report marks a significant moment in Australia's formal recognition that plastic pollution is not only an environmental concern but a public health one —acknowledging the inextricable link between the health of our environment and human health. 

Research into human impacts of plastic 

The Senate inquiry heard extensive evidence on the human health impacts of microplastics and other toxics. Establishing direct causation through experimental research would be unethical in this circumstance, as it would require deliberately exposing people to potentially harmful substances. The most appropriate evidence in this context is observational, epidemiological and laboratory data, and the accumulated evidence trends in a direction that is concerning.

Evidence suggests plastic-associated chemicals, notably PFAS (per- and polyfluoroalkyl substances), interfere with hormonal systems and disrupt reproductive function in both men and women — a pattern described by experts at the inquiry as 'the canary in the coalmine', signalling broader toxic exposure before other health effects become apparent (Dr Jacinta Martin et al., Submission 40). PFAS exposure has been linked to adverse pregnancy outcomes including preterm birth, low birth weight and miscarriage (Dr Jacinta Martin et al., Submission 40), while bisphenol exposure has been associated with reduced egg quality and IVF outcomes (Plastics and Female Infertility Research Team, Submission 32). Early life exposure to plastic-associated chemicals has been associated with increased risk of obesity, diabetes, cardiovascular disease and cognitive impairment later in life (RACGP, Submission 11). 

Research on microplastics in human tissues presented to the inquiry raised both clinical concerns and methodological cautions. While microplastics detected in atherosclerotic plaques have been associated with a higher risk of heart attack, stroke or death (Heart Foundation, Submission 58; Stroke Foundation, Submission 73), the inquiry was also told there is no gold standard for measuring microplastics in human tissue, and that contamination and detection accuracy remain persistent concerns (Cancer Council Victoria, Submission 1). These tissue-level findings remain subject to ongoing methodological debate and results should be interpreted with appropriate caution while research methods continue to improve. 

The weight of the evidence prompted inquiry participants to overwhelmingly call for a precautionary approach — uncertainty, they emphasised, is not a reason for inaction. The inquiry responded by recommending a national biomonitoring program, longitudinal studies and a targeted NHMRC research call, with particular focus on priority populations, and specific recommendations to enforce existing PFAS bans and assess PFAS contamination in imported textiles and consumer products. 

Indirect harm to human health: the plastic waste problem  

While the inquiry focused on direct health impacts of plastic, this sits within a much larger and relentlessly unfolding crisis. Global plastic production continues to outpace waste management, with single-use items alone accounting for 35–40% of all plastic produced. Of the estimated 9 200 million tonnes ever produced, only 9% has been recycled and 12% incinerated, releasing toxic gases into the atmosphere. The remaining 79% accumulates in landfills or is spread through the natural environment, where an estimated 6 000 million tonnes has accumulated since 1950.

The physical accumulation is an environmental hazard in its own right — choking wildlife, blanketing coastlines and forming vast ocean garbage patches. All of this degrades the ecosystems, food chains and water supplies that human health depends on.

Most plastic is derived from fossil fuels, with production responsible for an estimated 3.7% of global greenhouse gas emissions, and airborne microplastics have now been identified as a previously unrecognised contributor to atmospheric warming. Additionally, plastic is manufactured using thousands of synthetic chemicals, many never tested for safety. Among the most troubling are 'forever chemicals', such as PFAS, so named because they do not break down but accumulate in soil, water and the human body, warranting the focus on their regulation in the inquiry findings.

Health care generates significant plastic waste

Health care contributes significantly to this problem. Driven by population growth, expanding facilities and an entrenched culture of disposability, health facilities are producing more plastic waste than ever before — an estimated 15 million tonnes annually worldwide, with hospitals generating an average of 0.44 kg per patient per day, though figures vary considerably across facilities and regions. In Australian hospitals, the transition to single-use items is now almost universal, with plastics accounting for around one-third of hospital waste despite around 40-60% being potentially recyclable. 

Much of this plastic waste is single-use (face masks, gloves, gowns, drapes, syringes, IV tubes and sterile packaging) and driven more by convenience than clinical necessity. Sterilisation wrap for surgical instruments alone generates an estimated 115 000 tonnes annually in the US, while non-medical plastics (disposable food containers, drink bottles and toiletry items) add further to the burden, in many settings outweighing the volume of medical devices. 

With the medical plastics market growing at over 6% per year, health care is contributing to the plastic crisis — and the profession has a responsibility to lead change from within. Practical solutions already exist: reusable sterilisation containers have reduced blue wrap consumption by 70% in some facilities, while targeted glove reduction campaigns have saved tonnes of waste without compromising patient safety. Rethinking single-use procedure packs, whether by reducing unnecessary items or switching to reusable alternatives, has also demonstrated significant reductions in waste and cost. The profession can drive that culture change through advocacy to decision-makers, leading by example, and empowering staff to question what is truly necessary. 

From recognition to action 

The Senate's recommendations are significant and welcome, but they are heavily weighted toward monitoring and research, and largely silent on the upstream drivers of the crisis. Of the 12 recommendations, nearly half concern evidence-gathering. There are no production caps, no chemical bans and no healthcare-specific recommendations, despite the sector's significant and growing plastic footprint. The single recommendation on extended producer responsibility (EPR) — which would hold manufacturers accountable for their products' full lifecycle — merely asks states and territories to 'consider' expanding existing schemes. While a phased approach to EPR is understandable given the complexity of implementation, the language falls short of the binding accountability that the scale of the problem ultimately demands.

The Senate inquiry marks an important first step, and its recommendations are both necessary and welcome. However, research and monitoring alone will not solve a problem we are still actively creating. In its submission to the inquiry (DEA, Submission 30), Doctors for the Environment Australia called for: production caps on unnecessary and single-use plastics; class-based bans on toxic chemicals; mandatory full chemical disclosure; manufacturer accountability across the full product lifecycle and a transition to safer, more sustainable alternatives that support a circular economy. 

While Australia has made a start — with most states and territories having introduced some single-use plastic bans — the approach remains fragmented and inconsistent. A nationally coordinated framework is needed that aligns with international standards. On the international stage, Australia has a meaningful role to play in ensuring the UN Global Plastics Treaty delivers binding commitments that match the scale of the problem.

For the medical profession, the imperative is both professional as well as personal. The commitment to ‘first, do no harm’ extends beyond the bedside to the materials we use, the waste we generate and the planet we leave for future generations. The research is consistent, the direction is clear, and we have enough evidence to act now.

Leila Cusack is a medical doctor with a PhD in public health and a member of Doctors for the Environment Australia's Publication Quality Review Committee 

Genevieve Cowie is a public health physician with a doctorate in public health policy. She convenes Doctors for the Environment Australia’s Publication Quality Review Committee

Cara Platts is a Public Health Physician Trainee and PhD Candidate at the University of Melbourne. She is a member of the Doctors for the Environment Australia’s Publication Quality Review Committee