An essay in Aeon had me at the title: The Waste Age. The title was so evocative of the world we live in that I almost didn’t need to read further, but I’m glad I did, and I encourage you to do the same. Because if we don’t learn to deal with waste – and, as the author urges, design for it – our future looks pretty grim.
Medical waste at scale
Healthcare included.
The essay is by Justin McGuirk, chief curator of the Design Museum in London, and accompanies an exhibit there: Waste Age: what can design do? Mr. McGuirk states:
…waste is not merely a byproduct of culture: it is culture. We have produced a culture of waste. To focus our gaze on waste is not an act of morbid negativity; it is an act of cultural realism. If waste is the mesh that entangles nature and culture, it’s necessarily the defining material of our time. We live in the Waste Age.
He recaps some of the
depressing facts about how much waste our society produces, and how this
throwaway culture we’ve grown used to is a fairly modern development. Like it or not, Mr. McGuirk points out: “To
say that we live in the Waste Age is not to focus attention on an unpleasant
but marginal problem; it’s to say that the production of waste is central to
our way of life.”
We can blame capitalism, we can blame consumers, we
can blame our typical shortsightedness, but to Mr. McGuirk, waste is, to a
large extent, a design issue: “Design
has been a driving forces behind our prodigious waste streams in the past
century…In short, they’ve been doing what designers do best – creating
desire.”
Design must change, he
says, and designers must as well, reinventing “themselves as material
researchers, waste-stream investigators and students of global economic flows.” It is not enough to ask how something will
look when new or how it will be used, but what will happen to it over time and
how it/parts of it can be recycled/reused.
Powerful stuff. Although Mr. McGuirk’s examples skew heavily
towards common waste culprits like plastics and electronic products, I can’t
help but think about healthcare, because when I think about healthcare, we’ve
been living in The Waste Age for some time.
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Some of this is well
recognized. For example, there has been
grudging acknowledgement for years that, in the U.S. healthcare system, as much
of a third of our spending is “waste” (see, for example, Shrank,
et. alia). We get procedures we don’t need, have tests that are
duplicative, take too many prescriptions, use the ER instead of an office
visit, and so on. We waste
too much of our time waiting. We
have too many healthcare facilities in heavily populated areas – and are building
more – and not enough in less populated areas.
Our administrative costs are much too high.
Waste defines our
healthcare system.
Some of this is known but
not often thought about: the actual waste our healthcare system produces. It has
been estimated that each staffed hospital bed generates 33 pounds of medical
waste each day, resulting in 5.9 million tons per year – and that doesn’t count
waste from nursing homes, doctors’ offices, pharmacies, and other healthcare
facilities. For example, there are over 16
million injections annually (worldwide), and those needles and syringes end up
somewhere. Even worse, about 15% of
medical waste is
considered infectious, toxic, or even radioactive.
Even worse, a number of us
take prescriptions that don’t benefit the majority of us, and may actually
result in some harm (e.g., statins
for low risk individuals, not to mention all the antibiotics taken
for viral infections). They’re just wasted.
We’re not even mining the
waste we produce for valuable information it can provide. Even in a pandemic, where is our wastewater monitoring
to detect and pinpoint outbreaks? In a time of digital health, where are our smart toilets to
help us track changes in our health?
Mr. McGuirk discusses plastics and microplastics as a
huge problem. As I wrote
in 2020, microplastics are everywhere: in the air, in the ocean, in the
land, in the water we drink, in the food we eat, and, at this point, probably
in our cells. No one really knows what
the impact on all this waste is/will be on our health, but I’m betting it won’t
be good.
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Mr. McGuirk writes: “it [waste] is now an internality – internal to every
ecosystem and every digestive system from marine micro-organisms to humans.” It needs, he urges, to become a central issue,
“brought into the heart of every conversation about how things are extracted,
designed and disposed of.”
As Mr. McGuirk suggests more generally, design can
help. For any physical object in the healthcare system – from pills to devices
to buildings -- designers need to view it “as a vehicle towards understanding the complex systems that
produce it, and the even more opaque systems that dispose of it.” All designers -- healthcare included -- need
to be thinking about what happens to their products and their packaging; otherwise,
they may generate, at best, those pesky microplastics and, at worse, even more
toxic waste.
Waste isn’t just what happens to physical objects. When it is our health or the health of a loved one, we think “more is better” -- damn the waste, damn the potential adverse consequences.
We’re going to learn how to temper our expectations. Our
clinicians need to learn how to avoid the “more is better” mindset and how to
help us understand cost/benefit tradeoffs. We’re going to have to be more
discerning about when what we think we want in healthcare may actually be
wasteful.
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Our current healthcare system is not sustainable – not
from an ecological, economic, or even health standpoint. For it to survive, we
must design for The Waste Age.
To close with Mr. McGuirk: “Recognising that waste is central,
not peripheral, to everything we design, make and do is key to transforming the
future.”
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