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Katie Lichter: Analyzing Healthcare Through an Environmental Lens

Growing up in Minnesota, Katie Lichter (photographed above) always had a deep appreciation for the environment and the importance of land management and preservation, but it wasn’t until she started working in a global health setting that she saw the impact of climate change on patients and communities around the globe.

Lichter, MD, MPH, is a resident physician in the Department of Radiation Oncology and a UC San Francisco Climate Health Fellow. Before attending medical school, she spent two years living in Central America and East Africa working for an international health organization and launching a startup company.

“Ultimately, I chose to train at UCSF due to the university’s commitment to health disparities, medical advancement, and patient-centered, holistic care.” she said. Attending UCSF has an additional benefit - the campus is surrounded by a wonderful natural environment, perfect for running.

In her work around the globe, Lichter witnessed first-hand the health implications of rising temperatures and drought on local farmers. “They were suffering from heat stroke, renal disease, exposure to aflatoxin, and social displacement.”

When she moved to California to begin her medical training, Lichter realized she couldn’t escape the impacts of climate change. “I saw how local San Francisco communities were affected by wildfires, heat waves, and a global pandemic. During this time I became very aware of resource consumption, especially hospital waste production.”

It’s estimated that the U.S. health care sector accounts for approximately 10 percent of the country’s greenhouse gas emissions. It’s one reason Lichter became interested in climate-smart health care. “This approach bridges the divide between adaptation and mitigation to prioritize both low-carbon and resiliency strategies. Basically, how can we reduce the environmental impact and carbon footprint of our practices today while prioritizing building resiliency within the community and having appropriate emergency preparedness plans in place?”

Lichter said the key steps are in the four R’s – Reduce, Reuse, Recycle, Rethink - and applying these to the field of radiation oncology. “Ultimately, creating a structure to analyze current actions and find opportunities for sustainable, climate-smart practices. Ideally this frame can be replicated in any medical specialty.”

Within oncology, she began critically looking at brachytherapy, a type of internal radiation used to destroy cancer cells and shrink tumors, to determine how to reduce its carbon footprint. “Today, OR procedures generate an estimated 30 percent of hospital waste with a significant proportion of this going unused, or simply inappropriately discarded.”

A UCSF study found the total annual unused surgical supplies within the Neurosurgery Department accounted for 13.1 percent of total surgical supply costs. These discarded, unused supplies had a value of $2.9 million.

“Significant opportunity exists for departments, and other procedural specialties, to perform waste audits to highlight areas of excess waste and implement mitigation efforts,” Lichter said. “Recently, I collaborated with several Stanford residents to design a six-minute waste audit toolkit that can be used by any specialty to track procedural waste, analyze clinical processes, and reduce both financial and environmental costs.”

UCSF learners can help reduce waste by setting sustainability as a priority, she said. “Look for ways to not only transition to more sustainable practices at home such as reducing meat consumption, composting, and biking or walking to work, but also expand this mindset to think about similar sustainability and mitigation practices for your place of study or work.”

Lichter believes UCSF students have a large role to play in introducing new initiatives in climate health at the university. “Many of the initiatives in climate health at UCSF have been spearheaded by students. Students have powerful, empowering voices. Taking action today can help protect the health of our future patients, communities, and families.”