After the Single Use, a collaborative project led by Professor Alice Street of the University of Edinburgh, explores the history, impact and solutions to global healthcare waste and pollution. In partnership with Health Care Without Harm and Norwegian Bioart Arena, the project received £5.9M in funds through the Wellcome Trust Discovery Award to investigate single-use plastics in health systems across eight countries. The project will start on 1st September 2024 and run until 31st August 2029. 

A pile of wasted lateral flow cassettes

The growing impact of climate change on human health is widely discussed by scientists and policymakers worldwide. In a single generation, the healthcare industry has replaced once commonplace washable surgical drapes and tools with single-use, disposable products. Single-use medical products can emit harmful dioxins, leak toxic chemicals into water sources and pollute oceans, in addition to the emissions produced from the manufacturing, transportation and incineration of these products. A 2019 report found the healthcare sector contributes between 4% to 5% of carbon emissions globally. If the global healthcare sector were a country, it would have the 5th largest carbon footprint in the world.  

“In a relatively short period of time, we have naturalized the use of single-use products and then forgotten there was ever any alternative,” Street said.  

There is growing recognition of this issue on the global stage. The COP28 Declaration on Climate and Health identified curbing emissions and reducing health sector waste as key priorities at the intersection of climate change and health. Yet, how can we understand how the systems created to protect and heal us are actually harming us and the planet? How did we get here? And what are the potential ways forward? 

After the Single Use harnesses critical approaches from anthropology and history to tackle these questions. Street and colleagues will focus on the proliferation of single-use plastics in Switzerland, USA, Senegal, India, Norway, Tanzania, Papua New Guinea, and Scotland. Single-use items like syringes, diagnostic tests, face masks, and IV bags are part of a linear economy based on waste and discard. The collective will explore how throwaway healthcare culture becaome normal by drawing on archival, ethnographic and arts-based research to examine the historical, local and global contingencies that have brought us to the present moment of crisis in medical waste. The collective also will analyse the circulations and lifecycles of single-use medical technologies designed for disposal in landfill and incinerators, and establish collaborations with policy-makers, activists and engineers/designers to build circular healthcare solutions.  

Street and colleagues are also partnering with Health Care Without Harm, the leading global voice in healthcare sustainability, to help document the scale and impacts of waste from single-use plastics in healthcare.  The partnership aims to develop toolkits and recommendations for healthcare managers and policy makers. Collaborations with medical device manufacturers and biomedical engineers in Senegal, USA and Scotland will explore the material constraints and the sometimes surprising possibilities for reinventing medical devices along more sustainable lines, as shown by a recent Edinburgh-based project to engineer lateral flow tests from recycled chewing gum. Norwegian Bioart Arena, an exhibition space for art that engages with biology and scientific research, is also joining the project to deliver a global artist in residency programme. The organisation will curate an online art exhibition of the findings produced by the collective, further emphasizing the interdisciplinary nature of the project. 

Research in the participating countries will unpick both global interconnections between health systems, for example how syringes manufactured in India are used in clinics in Senegal. The initiative will also consider the unique perspectives that particular places offer on the problems and solutions of healthcare waste. For example, the medical devices industry in India has been a central pillar of the country’s economic policy for decades, establishing the country as a major consumer and exporter of single-use medical devices globally.  

Complementary studies in the other countries will emphasize both the importance of local stories of how we got here, and how local solution-makers are helping to build new, innovative paths forward. Street and colleagues’ work will form the basis for a new field of historical and anthropological analysis on disposability and reusability in healthcare. They draw on emerging fields of scholarship in environmental justice, discard studies, repair studies, and art research to approach single-use medicine as a sociotechnical system that can be re-imagined and reshaped.  

More locally, two upcoming Earth Fellow positions at the Edinburgh Earth Initiative will be made available to support the After the Single Use project. The Fellows will produce data visualisations related to healthcare waste audits and collaborate with partners from Health Care Without Harm to develop a plastic waste reduction toolkit for hospitals.