The Sustainable Healthcare Podcast

Why do hospitals with good data, proven cases and clear economics still fail to implement sustainability solutions at scale?

That is the question Maria Gaden is spending three years answering.

Maria returns to the podcast as Chief of Development at Center for Sustainable Hospitals in Central Denmark Region, and as a public industrial PhD student at the University of Copenhagen's Globe Institute. Her research is in implementation science: what actually determines whether a sustainability intervention gets adopted across a whole hospital - not just one passionate department.

In this conversation, Frederik and Maria cover:

- Why the reusable surgical gown project has not yet launched and why she still calls it a success
- Moving from "heroes" to systems, and from passion to governance
- 38 hospital interviews across Denmark, a trip to Karolinska Institutet, and a visit to Singapore's Centre for Sustainable Medicine
- How to start if you work inside a hospital and how it differs if you sit inside pharma
- Why human irrationality is the real implementation barrier, and what to do about it

**Timestamps**
00:00  Welcome back
01:30 New title, new PhD
02:30 The reusable textiles project update
07:30 Heroes to systems, passion to governance
09:00 Why implementation science
13:30 The research: 38 interviews, four countries
17:30 Rationality is not the main driver
22:30 Advice for healthcare professionals
29:30 Advice for pharma and medtech
38:30 What gives Maria hope

**Pull quote (Maria):** *"We know the solutions. We have the data. So what is really hindering implementation right now? That is what I keep asking."*

**References and links from the episode**

- [Center for Sustainable Hospitals, Central Denmark Region](https://www.rm.dk/om-os/organisation/center-for-baeredygtige-hospitaler/) [URL to confirm]
- [Globe Institute, University of Copenhagen](https://globe.ku.dk/)
- [Global Green and Healthy Hospitals (GGHH)](https://greenhospitals.org/)  free to join; hosted by Health Care Without Harm
- [Health Care Without Harm  Europe](https://europe.noharm.org/)
- [Centre for Sustainable Medicine, NUS Singapore](https://medicine.nus.edu.sg/cosm/)
- [Karolinska Institutet](https://ki.se/en)
- [*Harry Potter and the Methods of Rationality* (free online)](https://hpmor.com/)  referenced by Frederik

**Connect with Maria**

- [Maria Gaden on LinkedIn](https://www.linkedin.com/in/mariagaden/)
- [Center for Sustainable Hospitals](https://www.rm.dk/om-os/organisation/center-for-baeredygtige-hospitaler/) [URL to confirm]

**You might also enjoy:**

- Episode 090 — *Data-Driven Decarbonisation of Danish Hospitals* (Rasmus & Thea, Region Midt)
- Episode 087/086 — *Sustainability insights from 290 nurses and clinicians* (Michael Maagaard, Region Midt)
- Episode 044 & 043 — Maria Gaden's previous appearances on the show

**Host links**

- [Joachim Almdal on LinkedIn](https://www.linkedin.com/in/joachim-espeland-almdal-017a6973/)
- [Frederik van Deurs on LinkedIn](https://www.linkedin.com/in/frederikvandeurs/)
- [Care Pathway Consulting](https://carepathwayconsulting.com)

Liz Willetts has spent 20 years at the intersection of nature and health.

In this conversation, she explains why nearly 200 governments have been asking for integrated biodiversity-health indicators for over a decade, and why the scientific community still hasn't delivered them. About the guest: Liz Willetts is a science-policy expert on global governance of the health-environment nexus.

She has served as Planetary Health Policy Director at Harvard T.H. Chan School of Public Health, science-policy advisor to the Convention on Biological Diversity, and is a Team Leader, Editor and Writer at IISD's Earth Negotiations Bulletin. She is also a primary care clinician with experience in Micronesia, Central America, and the US. Key takeaways:
196 countries have called for biodiversity-health metrics through the Convention on Biological Diversity for decades, but the health and environmental science communities remain siloed, and integrated indicators still don't exist
Even senior clinicians with 10+ years of experience may not know how to define "biodiversity", pointing to a fundamental gap in medical education
The post-consumption lifecycle of pharmaceuticals, what happens when drugs exit patients and enter wastewater, represents a massive blind spot in both environmental monitoring and clinical training
Timestamps:
00:00 - Introduction and Liz's background
03:00 - How environmental decisions are public health decisions
08:00 - Air quality policy as a biodiversity example (Copenhagen low emission zones)
12:00 - The decade-long gap: governments asking for indicators nobody has built
18:00 - The grand rounds anecdote: a clinician who didn't know "biodiversity"
22:00 - Plant blindness and the siloing of scientific education
26:00 - Chronic kidney disease carbon footprint and biodiversity
30:00 - Practical advice for national biodiversity-health strategies
36:00 - Held v. State of Montana: climate litigation as a model for ecosystem values
42:00 - The nature footprint of healthcare: a blank canvas
46:00 - Pharmaceutical pollution and the end-of-life gap
50:00 - What gives Liz hope References mentioned:
Liz Willetts, "Metrics for Biodiversity and Health Policy Integration," PLOS Global Public Health, 2025: PubMed
Convention on Biological Diversity (CBD) and the Kunming-Montreal Global Biodiversity Framework (2022)
Global Action Plan on Biodiversity and Health, adopted at CBD COP16 (2024)
Held v. State of Montana: Climate Case Chart
Plant blindness (academic concept): Literature review 1999-2024
Pharma Pollution Hub / Kelly Thornber: pharmapollution.org
Global Biodiversity Framework: https://www.cbd.int/gbf
Global Action Plan on Biodiversity and Health:
https://www.cbd.int/health/GAP.shtml
Links:Liz Willetts on LinkedIn: https://www.linkedin.com/in/liz-willetts-2336749/
IISD Earth Negotiations Bulletin: https://enb.iisd.org/
Joachim Almdal on LinkedIn: https://www.linkedin.com/in/joachim-espeland-almdal-017a6973/
Frederik van Deurs on LinkedIn: https://www.linkedin.com/in/frederikvandeurs/
Care Pathway Consulting: https://carepathwayconsulting.com
You might also enjoy:Episode 092: Planetary Boundaries & Health with Mia Heide (WELA)
Episode 098: Tackling Pharmaceutical Pollution: A Systems-Based Approach
Episodes 023/024: The Biodiversity Crisis in Healthcare (two-parter)

Meeting Pharma's Rising Sustainability Demands:
Marwin Krull on Körber Pharma and the Alliance to Zero Marwin Krull is Sustainability Lead for the Pharma business area at Körber Pharma and Vice President of the Alliance to Zero. He explains how pharma customer requests have evolved from broad questions about EcoVadis scores and green electricity to specific demands around product carbon footprints, SBTi alignment, CDP thresholds, and ISO-based LCAs. Key takeaways:Pharma sustainability demands have matured fast - customers now ask for verified GHG inventories and product-level carbon footprints, not just policies
Closing the gap between group sustainability strategy and day-to-day operations requires internal coordination, sales enablement, and e-learning - not just a target
The Alliance to Zero (founded 2021) is driving practical collaboration across the autoinjector value chain, including a syringe packaging redesign and "green premium" transparency research with TU Hamburg
Timestamps:
00:00 - Customer sustainability pressure
00:37 - Meet Marwin Krull and his roles
03:35 - How customer demands evolved
07:13 - What Körber Pharma does
10:21 - Inside the sustainability role
14:58 - Sales enablement and training
18:05 - What is Alliance to Zero
21:30 - Collaboration wins and research
25:33 - Practical advice and wrap-up
Links: Marwin Krull on LinkedIn | Alliance to Zero | Körber Pharma Hosts: Joachim Almdal on LinkedIn | Frederik van Deurs on LinkedIn | Care Pathway Consulting "Customers went from asking 'do you have green electricity?' to asking for ISO-verified product carbon footprints in just a few years." - Marwin Krull

Tackling Pharmaceutical Pollution: A Systems-Based Approach

In this episode of the Sustainable Healthcare Podcast, host Frederik Dam van Deurs welcomes Kelly Thornber, a researcher and advocate for addressing pharmaceutical pollution. Kelly shares her journey from working in Bangladesh to identifying pharmaceutical pollution as a global issue, and discusses the systems-based approach needed to mitigate its risks to public and environmental health.

Episode Summary
Kelly Thornber discusses the complexity of pharmaceutical pollution and the need for a systems-based strategy to address it. She highlights the importance of understanding the entire lifecycle of pharmaceuticals, from manufacture to disposal, and the role of various stakeholders in creating a sustainable solution.

Key Topics CoveredIntroduction to Kelly Thornber:Kelly discusses her background and how she became interested in pharmaceutical pollution while working in Bangladesh.
Her journey into sustainability and how her department is driving change within the company.

Understanding Pharmaceutical Pollution:The importance of addressing pharmaceutical pollution and its impact on public and environmental health.
The complexity of the pharmaceutical system and the need for a systems-based approach to mitigate risks.

The Role of the Pharma Pollution Hub:Kelly’s work with the Pharma Pollution Hub and their efforts to advocate for changes in the pharmaceutical industry.
The need for independent facilitation and oversight to drive meaningful change.

Identifying Intervention Points:The 37 intervention points identified in Kelly’s paper and the importance of starting with actionable steps.
The role of stakeholders in implementing these interventions and the need for collaboration.

Notable Quotes"Pharmaceuticals are designed to be biologically active, and that means they can have physiological effects in non-target species." - Kelly Thornber
"We need to take a systems approach to address the complex issue of pharmaceutical pollution." - Kelly Thornber
Resources MentionedPharma Pollution Hub: Pharma Pollution Hub Website
Pharmaceutical Pollution Paper: Read the Paper
Call to ActionShare your thoughts: What role should the pharmaceutical industry play in addressing pollution? Connect with Frederik on LinkedIn to share your insights.
Subscribe and Share: Help spread the word about sustainable healthcare by subscribing to the podcast and sharing this episode with your network.
Host: Frederik Dam van Deurs Guest: Kelly Thornber, Researcher and Advocate for Pharmaceutical Pollution

Guest: Tamara, PhD Candidate at TU Delft, Department of Sustainable Design Engineering

Episode Summary In this episode of the Sustainable Healthcare Podcast, host Frederik Dam van Deurs welcomes Tamara, a researcher and entrepreneur specializing in circular economy principles for healthcare. Tamara shares her groundbreaking work on the Visual Taxonomy of Circular Healthcare Flows (CHF), a comprehensive map designed to guide sustainable decision-making for medical devices from design to end-of-life. Key Topics Covered
The Visual Taxonomy of Circular Healthcare FlowsTamara introduces her visual taxonomy, which maps out circular economy strategies for medical devices. The taxonomy is designed to clarify the often-confusing terminology (e.g., "reuse" vs. "recycling") and provide actionable pathways for sustainability.
Visual Reference: Visual Taxonomy of Circular Healthcare Flows (CHF)

Misconceptions in Circular Economy TerminologyTamara highlights common misunderstandings, such as the difference between "reuse" and "recycling," and the healthcare-specific term "reprocessing." She emphasizes the importance of clarity in communication to avoid unintended environmental impacts.

Real-World Example: Laparoscopic StaplerUsing a laparoscopic stapler as a case study, Tamara walks through the taxonomy’s steps: Refuse (questioning the need for the device), Rethink (designing multifunctional devices), Reduce (minimizing material use), and Reuse/Recycle (extending product life through maintenance, repair, or reprocessing).

Barriers to Circularity in HealthcarePerceived vs. Actual Safety: The tendency to prioritize perceived safety over evidence-based sustainability, leading to overuse of single-use devices and excessive waste.
Logistical Challenges: The complexity of sorting and collecting devices, especially in hospitals with limited space and resources.
Regulatory Hurdles: Differences in regulations between the EU and the US, such as the reprocessing of single-use devices.

Innovations and Hope for the FutureTamara shares her work on a patient-friendly alternative to the traditional vaginal speculum, designed to reduce pain and improve accessibility. She also discusses her optimism about collaborations among medical device manufacturers to drive systemic change.

Notable Quotes
"The number one barrier is the difference between actual safety and perceived safety. People want to do well in healthcare, but this can lead to unintended environmental consequences."
"We need to ask: Do we really need this device? Can we refuse, rethink, or reduce before we even start producing?"
"Sterilization is not always necessary - sometimes high-level disinfection is enough, and that can significantly reduce environmental impact."
Resources Mentioned
Visual Taxonomy of Circular Healthcare Flows (CHF): View the Visual
Call to Action
Share your thoughts: What circular economy strategies have you seen in healthcare? Connect with Frederik on LinkedIn to share your insights.

Subscribe and Share: Help spread the word about sustainable healthcare by subscribing to the podcast and sharing this episode with your network.
Host: Frederik Dam van Deurs Guest: Tamara, PhD Candidate, TU Delft