Social equity and environmental risks in health care services
Environmental deficiencies in health facilities reduce the quality and range of service provision, and this, in turn, exacerbates fundamental inequities in access to critical health services among poor populations and vulnerable groups, including women and children. Key environmental issues that, in turn, affect health equity, include:
- Energy access and resilience: Lack of access to efficient, reliable electricity and energy systems for basic lighting, communications, medical devices and small appliances or laboratory equipment. All of these impede delivery of health care services, particularly at primary health care level, as well as impacting on clinic hours and possibly staff retention.
- Limited access to safe drinking-water and sanitation, at primary health care level, also impedes health care delivery and increases the risk of the transmission of waterborne and diarrhoeal diseases.
- Lack of public transport or safe walkways to and from health facilities can create access barriers for patients, families and healthcare workers that don't have cars. The lack of public transport to and from large urban health care facilities may stimulate traffic-related congestion and pollution around facilities, disproportionately affecting patients, health-workers or surrounding neighbourhoods.
Health-workers are another group particularly at risk from poor environmental health practices, including: inappropriate use, management or disposal of drugs, anaesthesia, cleaning materials, medical devices and building materials, ergonomic hazards, and use of protective gear such as latex gloves, as described in the section on chemical, biological and radiological exposures. Efforts to achieve sustainable, safe health sector environments are thus important not only for improving patient and community well-being, but also for reducing the risks to workers engaged in health-related activities.
In addition, health operations in high-income settings may inadvertently generate environmental impacts that also exacerbate social inequities. For instance, hospital pollution or waste incineration can generate high air pollution emissions and health risks for surrounding neighbourhoods.
So in both high-, middle-, and low-income settings, reducing environmental and health risks can also be synergistic with policies that promote equity in sustainable health care delivery. Key approaches are further described in the section on “Strategies for healthy, sustainable, health-care facilities.”