A Road Map for Resilient, Greener Healthcare

The healthcare sector consumes significant energy and resources, leaving a carbon footprint and huge amounts of waste — either directly or indirectly through the products and services it acquires, uses and discards. A report from Health Care Without Harm (HCWH) finds that, globally, the healthcare sector accounts for about 10% of gross domestic product and is responsible for 4.4% of total net emissions. If the health sector were a country, it would be the fifth largest emitter on the planet. Ironically, healthcare itself has a negative effect on human and environmental health through its emissions of greenhouse gases. These health effects need to be mitigated.

To operate in a less harmful, climate-neutral way, healthcare institutions first need to understand the nature and extent of their greenhouse gas emissions. For this, organizations use the classification framework introduced by the Greenhouse Gas Protocol. Launched in 1998, it’s the global standard for measuring and managing greenhouse gas emissions for public and private sector organizations across all industries.

In summary, Scope 1 is used to categorize direct emissions such as on-site burning of fuels in healthcare facilities and the operation of vehicles, as well as from on-site waste disposal. Scope 2 covers indirect emissions from the generation of purchased energy consumed by a healthcare organization such as electricity and heat. Scope 3 emissions are also indirect, resulting from sources not controlled by the organization itself. Examples include construction, food and catering, inhalers such as life support machines, medical instruments and equipment and pharmaceuticals.

A Closer Look at Healthcare’s Carbon Footprint

In terms of greenhouse gas emissions in the healthcare sector globally, HCWH finds that Scope 1 represents 17%, Scope 2 accounts for 12% and Scope 3 represents 71%. This means that almost 30% of worldwide healthcare emissions are linked to the direct burning of fossil fuels and the purchase of electricity, heat or steam. However, the report found that the remaining 70% of emissions are indirect, including those from healthcare’s supply chain. The worst offenders are pharmaceuticals at 12%, followed by business services at 10.7%, then food, catering and accommodation at 7.2%. IT is only responsible for 2.5% of healthcare greenhouse gas emissions. There are few emitters unique to the healthcare sector, most notably anaesthetic gases and metered dose inhalers.

Growing Awareness of Healthcare as a Substantial Emitter

This rising awareness of the significant environmental role that healthcare plays reached a height at the 2021 UN Climate Change Conference, where there was a Health Pavilion for the first time. During the event, more than 50 countries pledged to decarbonize their healthcare sectors and make them climate-resilient. Among them were nine European countries — Belgium, Denmark, Germany, Georgia, Ireland, the Netherlands, Spain and the UK. Together they account for roughly 60% of healthcare emissions in Europe.

However, with so many countries committing to decarbonizing healthcare delivery, how will healthcare systems go about fulfilling their pledge?

Environmental Stewardship Efforts Gain Momentum

The healthcare industry has been facing more regulatory requirements to mitigate the negative impact it has on the environment. In addition to this, university hospitals have taken an important role in leading environmental stewardship efforts to make healthcare delivery climate-neutral.

Professor Dr Ingo Autenrieth, chief medical director and chairman of the board of the University Hospital Heidelberg (UKHD) in Germany, believes climate protection is health protection. In a recent public health conference on the impact of climate change on healthcare, he emphasized the UKHD’s commitment to endorse climate-friendly behaviour and technology to aid sustainability efforts.

Professor Dr Autenrieth also stressed the importance of raising staff awareness of how healthcare contributes to climate change and how this can be mitigated. Consequently, the UKHD has initiated several sustainability measures. In response to reviewing their greenhouse gas emissions in anaesthetic units, the hospital changed its policy on gases and chose less harmful but more expensive products. This step was discussed with the hospital’s stakeholders, who considered the socio-economic impact of this decision alongside economic factors.

Another initiative with a much broader remit is the UKHD’s Climate Protection in Hospitals by Optimizing Supply Chains. It targets the reduction of Scope 3 emissions by at least 6,000 tonnes of carbon dioxide equivalents over three years. Using the UKHD as an example, the aim is to create a greenhouse gas calculator for hospitals with a special focus on emissions from supply chains. In parallel, exemplary climate protection measures are being implemented and evaluated in terms of their impact on the greenhouse gas balance, financial aspects and possible health effects.

There are several other healthcare providers across Europe that follow a bottom-up approach to decarbonization. However, to advance a net zero healthcare approach, facilities throughout Europe and beyond will also need the support and direction of a system-level approach.

A Net Zero Road Map for Healthcare

To help the sector achieve net zero emissions, HCWH launched its project Designing a Net Zero Roadmap for Healthcare: Technical Methodology and Guidance on 1 September 2022 in Brussels. The non-governmental organization, which represents more than 50,000 hospitals in 74 countries, has created a decarbonization road map, which is the first of its kind in Europe, specifically developed for and by the healthcare sector. It aims to support any health authority to measure its healthcare emissions and develop a decarbonization road map that’s compatible with the Paris Agreement.

The plan was developed over two years in collaboration with a London-based technology partner working in the climate and sustainability field and three health authorities from Italy, the Netherlands and Portugal. Although it was piloted in selected European countries, the road map is designed for global use — it’s based on the understanding that each healthcare system is unique and funded differently. The outline is a set of guiding principles that can and should be adjusted on a national, regional and municipal level.

Healthcare Suppliers Must Become Climate-Smart

Healthcare institutions will increasingly be held accountable for creating an environment that’s conducive to health. Hospitals and other healthcare organizations will become more concerned with the environmental impact of their activities and reduce those that are harmful for the climate. As Scope 3 emissions are the main source of greenhouse gas emissions, healthcare providers will increasingly scrutinize the supply chain for low-carbon alternatives. This will be an area for differentiation, and pressure will mount on suppliers to produce climate-smart goods and services.

As the example from the UKHD highlights, healthcare organizations are putting more and more effort into embracing climate protection. The mitigation of environmental health risks also poses an opportunity to benefit patients, providers and the healthcare workforce, and will ultimately bring down costs and make healthcare more resilient.

The road map to net zero is a helpful framework for healthcare entities and authorities to get started on their decarbonization journey and to compare their efforts. The outline will need to be adjusted in light of user experience and technical innovations. The big challenge, however, will be for organizations to incorporate environmental sustainability into their core functions in ways that fit their institutional frameworks and resource constraints.