Overall plastics production is also soaring¹. In 2022, 400 million metric tonnes of plastic were manufactured² and global production is expected to triple by 2025³. The global medical plastics market is also exploding. It is forecast to increase from 26 to 41 billion dollars in the next five years - a 10% compound annual growth rate. 

Almost all plastics (99%) are a combination of oil and chemicals, creating pollution and emitting greenhouse gases throughout their cycle. A small percentage of plastics are made from plant-based sources, but they exhibit many of the same problems as conventional plastics, as well as presenting some unique issues, such as land use. Over 16,000 chemicals are used in various combinations in the plastics industry, of which at least a quarter are known to be hazardous but fewer than 1,000 are regulated⁴. Recycling and disposal systems cannot cope and cannot be designed to cope with the vast quantities of different plastic materials made each year, so millions of tonnes are leaking into the environment, clogging rivers, entangling wildlife and spreading microplastics and nanoplastics around the globe. 

References 

[1] Sparrow (2024) Medical Plastics Market Projected to Soar by Double Digits

[2] Garside (2024) Global plastic production 1950-2022

[3] Project TENDR (2024) Protecting the Developing Brains of Children from the Harmful Effects of Plastics and Toxic Chemicals in Plastics. Recommendations for Essential Policy Reforms in the New Global Treaty on Plastics

[4] Wagner et al. (2024) State of the science on plastic chemicals: identifying and addressing chemicals and polymers of concern

The planet faces a triple crisis of climate change, chemical pollution and environmental contamination, and biodiversity loss⁵, and plastics play a role in each of these threats⁶. 

Climate change: In 2023 plastic production was estimated to contribute 3.7% of greenhouse gases, and unless significant changes are made, this will reach 4.5% of the global total⁷ by 2060.  Single use products can have a huge impact: in the US alone, in 2020, single use surgical masks and isolation gowns contributed the carbon dioxide equivalent of 78 coal fired power plants operating continuously⁸.

Chemical pollution: Over 16,000 chemicals are used in the plastics life cycle, of which more than 4,200 are of concern for their persistence, toxicity, mobility or tendency to bioaccumulate. Fewer than 1,000 are currently covered by international regulations and vital hazard data are missing for over 10,000 chemicals, meaning that they pose unknown risks⁹.

Biodiversity loss:  It has been estimated that there will be more plastic than fish in the sea by weight by 2050¹⁰.  Approximately 2.4 million tonnes of waste enters the oceans every year¹¹, threatening wildlife that eat it, or become entangled in it.  Lost fishing gear, known as “ghost nets” tangle and drown millions of animals each year¹², and during the COVID pandemic, medical waste such as gloves and masks was observed harming birds, fish and other animals¹³. Chemical pollution as a result of the plastic life cycle is  also harming wildlife and wildlife habitat. 

REFERENCES 

[5] UN (2022) NEW ENVIRONMENTAL REPORT OFFERS SOLUTIONS FOR ‘TRIPLE PLANETARY CRISIS’

[6] GREENPEACE (2024) PLASTIC’S ROLE IN THE TRIPLE PLANETARY CRISIS

[7] LANDRIGAN ET AL. (2023)  THE MINDEROO-MONACO COMMISSION ON PLASTICS AND HUMAN HEALTH

[8] BROMLEY-DULFANO ET AL. 2024 SWITCHING FROM DISPOSABLE TO REUSABLE PPE  

[9] WAGNER ET AL. (2024) STATE OF THE SCIENCE ON PLASTIC CHEMICALS - IDENTIFYING AND ADDRESSING CHEMICALS AND POLYMERS OF CONCERN.

[10] ELLEN MCARTHUR FOUNDATION (2017) THE NEW PLASTICS ECONOMY: RETHINKING THE FUTURE OF PLASTICS & CATALYSING ACTION

[11] WANI ET AL. (2021) THE JOURNEY OF ALTERNATIVE AND SUSTAINABLE SUBSTITUTES FOR “SINGLE-USE” PLASTICS

[12] CIEL (2017) FUELING PLASTICS: PLASTIC INDUSTRY AWARENESS OF THE OCEAN PLASTICS PROBLEM

[13] HIEMSTRA ET AL. (2021) THE EFFECTS OF COVID-19 LITTER ON ANIMAL LIFE

Health care consumes around 15 million tonnes per year¹⁴, plus medical facilities generate non-medical plastics such as single use plates, drinks bottles and toiletry items. In most cases, these non-medical plastics will outweigh the medical devices¹⁵.

Plastic makes up between 22% to 83% of the health care waste stream, depending on region, facility and department^16,17. 

35-40% of all plastic products produced globally are single use¹⁸ and it is higher in health care.  Packaging is almost always single use, and that can account for up to quarter of the plastic waste from a hospital¹⁹.

The perception that single use plastics are safer is not supported by the evidence. Typically they are used because they are more convenient.  

REFERENCES 

[14] CHAPMAN (2022) TOWARDS MORE SUSTAINABLE USE OF PLASTICS IN HEALTHCARE

[15] HCWH ASIA (2018) PLASTICS IN HEALTH CARE: HEALTH PROFESSIONALS AS ADVOCATES TO REDUCE PLASTIC POLLUTION TECHNICAL REPORT

[16] HCWH EUROPE (2021) MEASURING AND REDUCING PLASTICS IN THE HEALTHCARE SECTOR

[17] HCWH ASIA (2018) PLASTICS IN HEALTH CARE: HEALTH PROFESSIONALS AS ADVOCATES TO REDUCE PLASTIC POLLUTION TECHNICAL REPORT

[18] LANDRIGAN ET AL. (2023) THE MINDEROO-MONACO COMMISSION ON PLASTICS AND HUMAN HEALTH

[19] HCWH ASIA (2018) PLASTICS IN HEALTH CARE: HEALTH PROFESSIONALS AS ADVOCATES TO REDUCE PLASTIC POLLUTION TECHNICAL REPORT

The plastics crisis threatens human health directly and indirectly. People can be exposed to hazards directly from using plastic products - for example from chemicals and microplastics in IV bags or bottled water or indirectly, from air pollution and climate change caused by making and burning plastics.  

Resource extraction and plastics manufacturing facilities are often sited in or near low income or otherwise marginalized populations, who may suffer pollution and environmental degradation from multiple sources and have limited ability to challenge industrial interests.  Air pollution from these facilities are known or suspected to cause cancer, reproductive and birth defects, among other serious health and environmental effects.  People who depend on environments that are affected by the plastics crisis, such as fishers or persons involved in the tourism industry may also suffer due to loss of livelihood.  

Although there is still a lot we don’t know about the risks of plastics, including significant gaps on microplastics ^20,21, and thousands of chemicals used at different stages of the plastics life cycle^22,23, many health impacts are already proven and scientists are uncovering ever more threats as research accelerates.  This often includes polymers or applications that were previously thought to be harmless.

Known and highly likely impacts include inflammation, reproductive and developmental effects, cancer, obesity, diabetes, immune system suppression, asthma.  

For example, phthalates in food contact material are estimated to cause 90,000 deaths in the USA per year with an elevated burden on Hispanic and African Americans^24,25.  Plastic-related chemicals affect the brain development of children²⁶. Endocrine-disrupting chemicals in plastics pose a serious threat to public health and cost the U.S. an estimated $250 billion annually, according to a recent study²⁷. 

Climate-related workplace hazards are on the rise globally²⁸, and the threat to public health from climate related disasters is recognised by the WHO and millions of health workers²⁹.

Despite advertising that stresses the importance of plastics in healthcare, exposure to medical devices and health care-related plastics are part of the problem.  They can release chemicals such as phthalates, or microplastics, directly into the body.  The unborn, newborns, elderly, and those with chronic or multiple health conditions can be at most risk, as can medical professionals who are exposed to plastics on a daily basis through their work.

REFERENCES 

[20] BLACKBURN AND GREEN (2022) THE POTENTIAL EFFECTS OF MICROPLASTICS ON HUMAN HEALTH: WHAT IS

KNOWN AND WHAT IS UNKNOWN

[21] CUSP (2024) MICRO-AND NANOPLASTICS AND PUBLIC HEALTH: A REASONABLE CONCERN

[22] WAGNER ET AL. (2024) STATE OF THE SCIENCE ON PLASTIC CHEMICALS: IDENTIFYING AND ADDRESSING CHEMICALS AND POLYMERS OF CONCERN

[23] UNEP (2023)

[24] TRASANDE ET AL. (2022) PHTHALATES AND ATTRIBUTABLE MORTALITY: A POPULATION-BASED LONGITUDINAL COHORT STUDY AND COST ANALYSIS

[25] TRASANDE AND SARGIS (2023) ENDOCRINE-DISRUPTING CHEMICALS: MAINSTREAM RECOGNITION OF HEALTH EFFECTS AND IMPLICATIONS FOR THE PRACTICING INTERNIST

[26] PROJECT TENDR (2024) PROTECTING THE DEVELOPING BRAINS OF CHILDREN FROM THE HARMFUL EFFECTS OF PLASTICS AND TOXIC CHEMICALS IN PLASTICS: RECOMMENDATIONS FOR ESSENTIAL POLICY REFORMS IN THE NEW GLOBAL TREATY ON PLASTICS

[27] TRASANDE L,  ET AL. CHEMICALS USED IN PLASTIC MATERIALS: AN ESTIMATE OF THE ATTRIBUTABLE DISEASE BURDEN AND COSTS IN THE UNITED STATES. J ENDOCR SOC. 2024

[28] INTERNATIONAL TRADE UNION FEDERATION (2024) INTERNATIONAL WORKERS’ MEMORIAL DAY 2024: ACTION FOR CLIMATE-RELATED WORKPLACE HAZARDS

[29] WHO (2023) OVER 40 MILLION HEALTH PROFESSIONALS DEMAND BOLD HEALTH AND CLIMATE ACTION AT COP28

Since the sick are particularly vulnerable, patient exposures need to be taken extremely seriously.  The most significant route of exposure for the majority of patients is intravenous (IV) and inhalation exposure. 

Intravenous (IV) lines, blood bags, and related products are mostly made of PVC, which needs additives to make it soft and flexible.  These additives can leach out and be transferred to the patient.   Fluids for intravenous use are typically packaged in plastic, and can expose patients to microplastics.

Patients can be exposed to plastic-related chemicals from medical products like medical devices, first aid products and intravenous (IV) fluids, and creams (where phthalates may have been added to stabilise perfumes or other ingredients, or increase the ability of active ingredients to penetrate the skin)³⁰.  It was estimated that the highest exposure could come from a neonatal cannula³¹.  

Practitioners can also be exposed to hazardous chemicals used in the indoor air and dust from plastic products used in healthcare interiors. Flame retardants, metals, perfluorinated chemicals, phthalates and VOCs are among the hazardous chemicals that can be found in indoor environments.

REFERENCES

[30] HUBINGER (2010) A SURVEY OF PHTHALATE ESTERS IN CONSUMER COSMETIC PRODUCTS

[31]  WANG AND KANNAN (2023) LEACHING OF PHTHALATES FROM MEDICAL SUPPLIES AND THEIR IMPLICATIONS FOR EXPOSURE

Both patients and medical staff can be harmed by plastics.  Patients are exposed directly to toxic additives called phthalates via IV tubing, enteral feeding bags and breathing masks and tubes.   Phthalates are endocrine disrupting chemicals which have adverse effects on the liver kidneys and the reproductive systems, particularly the developing male reproductive system.  This places neonatal boys and dialysis patients particularly at risk due to the combination of susceptibility to harm and likely high exposure to phthalates during treatment³². Babies exposed to phthalates in neonatal intensive care units are known to suffer liver problems when fed through PVC-based enteral systems³³ and hemodialysis patients with high levels of MEHP, the breakdown product of the most common phthalate, had significantly higher mortality rates and other adverse outcomes³⁴. 

Although the phthalates are the most well known, they are by no means the only plastic-related chemicals that are of concern; additional chemicals include other plasticisers, monomers, flame retardants, heavy metals, dyes and colorants.  

Dialysis patients are known to be exposed to seven endocrine disrupting chemicals, including three phthalates, three bisphenol compounds and nonyl phenol.  Higher bodily concentrations of the most widely used bisphenol, bisphenol A, is associated with more extensive use of hospital medical devices and links between higher levels of BPA in blood plasma and more severe disease in chronic renal patients³⁵. A comprehensive review of BPA toxicity found “overwhelming evidence of harm” based on human, animal and laboratory studies³⁶.

Medical staff can get dermatitis from wearing gloves for extended periods.  During the COVID-19 pandemic, prevalence worsened significantly, rising from over 21% to 37% of healthcare workers.  Researchers identified avoiding latex gloves and wearing an extra glove liner as preventatives when glove use was necessary, but using gentle alcohol-based hand sanitisers³⁷ and avoiding overuse of gloves in situations where they are not needed have the additional benefit of reducing plastics use and waste³⁸. 

Healthcare workers will be affected by climate-related workplace hazards such as heatwaves³⁹, and health systems themselves are placed under extra pressure as they need to cope with rising levels of ill health in the population and climate-related disasters such as floods and heatwaves.

References

[32] HCWH Europe (2023) Towards PVC-free healthcare: reducing the environmental impact and exposure to harmful chemicals

[33] Von Rettberg et al. (2009) Use of Di(2-Ethylhexyl)Phthalate-Containing Infusion Systems Increases the Risk for Cholestasis

[34] Wu et al. (2023) Association of mono‑2‑ethylhexyl phthalate with adverse outcomes in chronic hemodialysis patients

[35] Guimarães et al. (2023) Human exposure to bisphenol A (BPA) through medical-hospital devices: A systematic review

[36]Von Saal and Vandenberg (2020) Update on the health effects of bisphenol A: overwhelming evidence of harm

[37] Gunasegaran et al. (2024) Review on Prevalence, Risk Factors, and Research Advancements on the Use of Medical Gloves Concerning Hand Dermatitis Among Health Care Workers

[38] HCWH (2021) Personal Protective Equipment for immunizations practices

[39] International Trade Union Federation (2024) International Workers’ Memorial Day 2024: Action for climate-related workplace hazards

Microplastics are now found worldwide, and are transported rapidly by water⁴⁰, and air.

We are exposed to microplastics through what we eat, drink, and the air that we breathe^41,42, and even through medical treatment.  Hypertonic fluids⁴³ packed in both PVC and polyethylene can expose patients to microplastics, including fragments and fibres of 12 synthetic polymers, predominantly polyethylene and cellulose⁴⁴.

Micro and nanoplastics have been found in almost every tissue of our bodies⁴⁵ including placentas, lungs, liver, breast milk, urine, blood, testes (and brains in animal tests) and although we are just beginning to understand their effects, there is already evidence suggesting harm. Patients who had micro or nanoplastics in the plaques in their arteries were more likely to have a heart attack or stroke or die from any cause over a three-year followup period⁴⁶. Micro and nano plastics can be neurotoxic, passing through the protective blood-brain barrier and initiating harmful responses through several different mechanisms.  

Inhaled microplastics can cause irritation and long term exposure can have more serious effects, including cancer ^47,48.  They can also carry toxic chemicals into our bodies, including ones that are linked to diabetes, infertility and hormone disruption⁴⁹. 

REFERENCES

The societal, environmental, and economic costs of plastics produced in a single year-2019- was estimated to be USD3.7 trillion. These combined costs are at least 10 times higher than the value of virgin plastic produced⁵⁰. The costs and benefits are not evenly distributed: even though they consume far less plastic, the costs for low income countries are ten times higher than for richer ones⁵¹.

Ill health caused by plastics also has a significant economic impact. Exposure to just four classes of  chemicals from plastics were estimated to cost the USA US$ 249 billion in 2018, due to the toxic effects of flame retardants (PBDEs), plasticizers (phthalates) and fluorinated chemicals (PFAS)⁵². Lost IQ due to developmental exposure to brominated flame retardants frequently used in plastics and organophosphate pesticides was estimated to exceed 150 billion euros per year and the phthalates that are used in food packaging are estimated to cost the US economy US$39 billion each year in lost productivity⁵³. Since these studies only address very limited ranges of chemicals and health impacts, the total economic losses caused by plastics must be far higher than these estimates. 

REFERENCES

[50] WWF (2021) PLASTICS: THE COST TO SOCIETY, ENVIRONMENT AND THE ECONOMY

[51] GAIA (2024) ECONOMIC BENEFITS OF PHASING OUT PLASTICS

[52] TRASANDE ET AL. (2024) CHEMICALS USED IN PLASTIC MATERIALS: AN ESTIMATE OF THE ATTRIBUTABLE DISEASE BURDEN AND COSTS IN THE UNITED STATES

[53] TRASANDE AND SARGIS (2023) ENDOCRINE-DISRUPTING CHEMICALS: MAINSTREAM RECOGNITION OF HEALTH EFFECTS AND IMPLICATIONS FOR THE PRACTICING INTERNIST

Certain products, such as syringes, and intravenous catheters and tubing, are better designed for a single use⁵⁴. However, many single use disposable items have in fact been promoted by manufacturers rather than driven by demand. Researchers cite products designed intentionally to be obsolete after a single use, perceived cost benefits, convenience and cultural norms as the actual reasons for the trend towards single use medical products and recommend reforming infection and prevention control guidelines including reporting of infections related to single use devices, and incentivizing reusable design and innovation⁵⁵.   

In many cases, hospitals can disinfect medical devices in-house or send them to organizations that reprocess them for safe reuse^56,57.  

Reusable products like gowns are better quality and provide increased protection as well as being more economical⁵⁸. One recent study showed that switching from disposable to reusable gowns at large medical facilities in the USA did not cause any increase in infection rates.  The reusable gowns had economic and environmental benefits, with cost savings of almost 50% per gown while avoiding hundreds of tonnes of waste that would have gone to landfill⁵⁹.  

During the COVID-19 pandemic, one large medical center introduced reusable alternatives to disposable N-95 masks.  The cost per month of reusable masks was one tenth of single use ones. Removing dependence on single use masks also protects against supply chain shortages⁶⁰. 

^REFERENCES

[54] MACNEILL ET AL. (2020) TRANSFORMING THE MEDICAL DEVICE INDUSTRY: ROAD MAP TO A CIRCULAR ECONOMY

[55] SMITH ET AL. (2023) INFECTION PREVENTION, PLANETARY HEALTH, AND SINGLE-USE PLASTICS

[56] WHO (2022) DECONTAMINATION AND REPROCESSING OF MEDICAL DEVICES FOR HEALTH CARE FACILITIES: AIDE-MEMOIRE

[57] EC REPROCESSING OF MEDICAL DEVICES WEBSITE ACCESSED 12 MAY 2024

[58] MCQUERRY ET AL. (2021) DISPOSABLE VERSUS REUSABLE MEDICAL GOWNS: A PERFORMANCE COMPARISON

[59] BROMLEY-DULFANO ET AL. 2024 SWITCHING FROM DISPOSABLE TO REUSABLE PPE

[60] CHALIKONDA ET AL. (2020) IMPLEMENTATION OF AN ELASTOMERIC MASK PROGRAM AS A STRATEGY TO ELIMINATE DISPOSABLE N95 MASK USE AND RESTERILIZATION: RESULTS FROM A LARGE ACADEMIC MEDICAL CENTER

Biobased plastics are made from biomass, such as sugarcane, oil crops, wood, or waste products such as bagasse or cooking oil; they may also include some fossil-fuel based elements. Biobased plastics may or may not be biodegradable - in fact they can be identical to oil-based plastic. Biodegradable plastics can be made from fossil and biobased sources, and are designed to be completely broken down by microbes under suitable conditions.  Compostable plastics are a particular type of biodegradable plastics which will similarly break down, typically in special industrial facilities for composting or anaerobic digestion.  Biodegradable plastics, like conventional plastics, have complex chemistries, include additives, and can have similar toxic properties⁶¹.  

Biobased, biodegradable and compostable plastics only represent around 1% of plastics production⁶² and are more limited in their properties⁶³.  Scaling them up to the extent necessary to replace fossil fuel based plastics would require huge amounts of land, water, fertilizer and pesticides; and similar expansion of manufacturing and disposal systems.  

Biodegrading or composting plastics at the end of their lives precludes recycling, and does not solve the problem of littering and poor waste management as they will not break down quickly enough to prevent harm to wildlife or ecosystems. 

REFERENCES

[61] EC (2022) COMMUNICATION- EU POLICY FRAMEWORK ON BIOBASED, BIODEGRADABLE AND COMPOSTABLE PLASTICS.

[62] EC (2022) COMMUNICATION- EU POLICY FRAMEWORK ON BIOBASED, BIODEGRADABLE AND COMPOSTABLE PLASTICS.

[63] FERREIRA-FILIPE ET AL. (2021) ARE BIOBASED PLASTICS GREEN ALTERNATIVES?—A CRITICAL REVIEW

Some plastic medical products are essential, such as syringes and IV lines. But plastic use in health care is growing rapidly⁶⁴ and much of it is unnecessary, single use products⁶⁵, which are used for convenience, rather than because they have been proven to be safer.

Efforts to reduce plastic use should encompass phasing out products with the most toxic polymers and additives, as well as targeting non-essential and single use plastics to reduce overall consumption.

From a lifecycle perspective, the most toxic polymer is PVC. Polycarbonate and polystyrene should also be prioritized for phase-out, based on lifecycle toxicity and poor potential for being integrated into a circular economy.  Likewise, alternatives should be sought for plastic products containing hazardous additive including phthalates, bisphenols, PFAS, other priority groups of chemicals of concern⁶⁶ and any products for which contents are unknown.

A range of resources are available to help reduce plastics on the healthcare sector, including: 

guides on avoiding unnecessary plastics use⁶⁷, phasing out PVC⁶⁸, audit tools^69,70,  information on sustainable food contact materials for healthcare⁷¹, guidance on hazardous chemicals in healthcare^72,73, waste trackers⁷⁴ and more⁷⁵

The main steps to reduce plastic use are: 

1. Create a plastics reduction team
2. Audit plastic use and waste.  
3. Review plastic products and prioritize them for action, considering the waste hierarchy -  first eliminating unnecessary uses, reducing and reusing where possible, then recycling and finally disposal.  Consider prioritizing products which:
   1. are made with the most toxic polymers and additives, eg PVC, BPA, polystyrene, phthalates
   2. Are non-essential, or single use
   3. Are used in the largest quantities
   4. Are easy or economical to eliminate, reduce or substitute
   5. Cannot be recycled (via mechanical recycling)
   6. Are difficult or expensive to dispose of
4. Identify and test alternative products
5. Expand use of the alternatives
6. Set a purchasing policy to ensure continued use of the alternatives.

REFERENCES

[64] STATISTICA WEBSITE ACCESSED 26 APRIL 2024

[65] MACNEILL ET AL. (2020) TRANSFORMING THE MEDICAL DEVICE INDUSTRY: ROAD MAP TO A CIRCULAR ECONOMY: STUDY EXAMINES A MEDICAL DEVICE INDUSTRY TRANSFORMATION

[66] WAGNER ET AL. (2024) STATE OF THE SCIENCE ON PLASTIC CHEMICALS - IDENTIFYING AND ADDRESSING CHEMICALS AND POLYMERS OF CONCERN.

[67] HEALTH CARE WITHOUT HARM (2021) GUIDANCE FOR PERSONAL PROTECTIVE EQUIPMENT FOR IMMUNIZATIONS PRACTICES: [ENGLISH] [SPANISH] [PORTUGUESE]

[68] HCWH EUROPE (2023) TOWARDS PVC-FREE HEALTHCARE: REDUCING ENVIRONMENTAL IMPACT AND EXPOSURE TO HARMFUL CHEMICALS

[69] HCWH EUROPE (2022) MEASURING AND REDUCING PLASTICS IN THE HEALTHCARE SECTOR

[70] HCWH ASIA (2019) MOBILIZING HEALTH CARE TO PREVENT PLASTIC POLLUTION: A PLASTICS TOOLKIT FOR HOSPITALS

[71] HCWH EUROPE (2021) SUSTAINABLE FOOD CONTACT MATERIALS IN HEALTHCARE

[72] UNDP AND HCWH (2021) CHEMICALS OF CONCERN FOR THE HEALTH SECTOR: [ENGLISH] [SPANISH]

[73] HEALTH CARE WITHOUT HARM LATIN AMERICA (2015) GUIDE FOR THE SUBSTITUTIONS OF DANGEROUS CHEMICALS IN THE HEALTH CARE SECTOR [SPANISH]

[74] HCWH (2022) HEALTH CARE WASTE TRACKERS - AN INTERACTIVE TOOLKIT

[75] HCWH (2024) RESOURCES ON PLASTICS AND HEALTH

There are many case studies on reducing plastics in health care. This is a small selection of case studies and related resources on minimizing the quantity and hazards from plastics in health care.

• Measuring and reducing plastics in the healthcare sector [English] [French] [Spanish] [Dutch] [Portuguese] (Health Care Without Harm Europe, 2021) includes case studies
• Removing harmful PVC from healthcare (Health Care Without Harm Europe, 2023)
• Guidance for Personal Protective Equipment for immunizations practices: [English] [Spanish] [Portuguese] (Health Care Without Harm, 2021) including reduction of plastic waste 
• Sustainable food contact materials in healthcare (Health Care Without Harm Europe, 2021)
• Sustainable procurement quick guide - Reducing PVC and DEHP in IV bags [English] [Spanish] (Health Care Without Harm, 2020)
• Reducing plastic in healthcare | Best practice (06/06/2022)
• Minimizing plastic straw use, 2021
• Reducing single use plastic, 2021
• Tackling syringe waste and sustainable solutions, 2023
• Video: Voices from Madrid: A day of training on #PlasticFreeHealthcare (Health Care Without Harm Europe, 2023)
• Mobilizing health care to prevent plastic pollution | A toolkit for COVID-19 waste management (Health Care Without Harm Southeast Asia, 2022)
• Toolkit - Sustainability criteria for examination and surgical gloves [English] [Spanish] [Portuguese] (Health Care Without Harm, 2021) including links to resources to reduce glove use
• Webinar: Reducing plastic and harmful chemical exposure to children [EN, FR, ES, NL] (Health Care Without Harm Europe, 2022)
• Webinar: How to reduce the impact of plastics in healthcare [EN, FR, ES, NL, EL] (Health Care Without Harm Europe, 2022)
• COVID-19 and medical waste management: Plastic issues during a global pandemic - A study of five hospitals in the Philippines (Health Care Without Harm Southeast Asia, 2021)

The plastics treaty can set legally binding goals and deadlines to reduce and detoxify healthcare plastics.  That will stimulate manufacturers to phase out older, less well designed products, and prioritize development of new ones where they are needed.  It will also provide a level playing field, so that innovative products and practices are incentivized, and help support the existing momentum for change in the sector.  

The chemical Industry has highlighted the medical uses of plastics to argue that current plastic production saves lives. Instead, we know that plastic production and disposal is responsible for significant disease. We also know that plastic reduction and detoxification in health care is already underway, and is necessary to protect people, patients, and the environment. 

Only mechanical recycling of products that are made from non-toxic polymers that do not contain toxic chemicals should be considered, and final disposal should be via non-burn routes, avoiding incineration, pyrolysis, gasification and waste-to-energy.

In a circular economy, everything should be designed to be returned to use, so final disposal would be much more rare.  

The two main final disposal routes are incineration and landfilling. Of these, incineration is the more significant contributor to global pollution and climate change, so that is the worst option.  Note that waste to energy is part of this problem.

Only 9% of all the plastic produced by 2015 has been recycled⁷⁶, and the amount being made is increasing all the time, so we can never recycle our way out of the plastics crisis.  Instead, reducing and reusing plastics must come first.  

Mechanical recycling, where non-toxic plastics are melted down and made back into products, is the best type of recycling. Even this can pose certain risks. If plastics containing hazardous additives are recycled, any new products made will contain these “legacy toxins”, which can expose future users.  

Plastics recyclers are also at risk of exposure to additives and other chemicals created during recycling, including dioxins and furans. This often happens in informal settings, where workers have little or no protection^77,78.  The crushing and grinding of plastics during recycling also creates microplastics which can be inhaled by workers or discharged to the environment via wastewater⁷⁹.

Chemical recycling, sometimes called advanced recycling, is a false solution, and is neither financially viable nor operationally feasible outside small, often experimental facilities.  In most cases it starts with pyrolysis, which breaks down the plastic into a mixture of small, and often toxic molecules.  These have low value and are hard to turn back into new products.  Often they are just burned as a low-value fuel, making this a form of incineration.

REFERENCES

[76] GEYER ET AL. (2017) PRODUCTION, USE, AND FATE OF ALL PLASTICS EVER MADE

[77] SALHOFER ET AL. (2021) PLASTIC RECYCLING PRACTICES IN VIETNAM AND RELATED HAZARDS FOR HEALTH AND THE ENVIRONMENT

[78] HUMAN RIGHTS WATCH (2022) "IT'S AS IF THEY ARE POISONING US": THE HEALTH IMPACTS OF PLASTIC RECYCLING IN TURKEY

[79] SUZUKI ET AL. (2024) GLOBAL DISCHARGE OF MICROPLASTICS FROM MECHANICAL RECYCLING OF PLASTIC WASTE

The IPEN plastics FAQ answers the most common questions about plastics and chemicals in the broader context.  Health Care Without Harm also has a dedicated page of resources about plastics in health care⁸⁰.

References

[80] Health Care Without Harm (2024) Resources on plastics and health