The direct and indirect impacts of climate change on human health have been extensively documented over the past two decades. The 2015 Paris Agreement and subsequent research have firmly established the association between planetary and human health. However, until recently, less attention has been directed towards the impact healthcare systems have on climate change. This issue is gaining momentum, spurred on by the implementation of the Paris Agreement and the introduction of the UK National Health Service (NHS) net zero carbon strategy.
Healthcare systems occupy a unique position – they are on the frontlines in dealing with climate-induced demands for healthcare, but they are also major greenhouse gas (GHG) emitters, accounting for an estimated 4.4% of global emissions. Healthcare systems must therefore address a complex predicament: maintaining high-quality care with the resilience and capacity to respond to escalating climate-induced demands, while mitigating their own substantial contributions to the climate crisis.
The actions required to manage the environmental and societal costs of delivering health services are not trivial. Healthcare systems, particularly hospital facilities, are energy-intensive, high-consumption organizations that produce considerable quantities of waste. While there is an irrefutable duty of care to patients and a fundamental commitment to “do no harm” at the point of delivery, healthcare systems have until recently remained largely unrecognized contributors to the climate crisis.
However, healthcare systems are well-positioned as environmental stewards to get their own house in order and promote benefits – lowering the collective carbon footprint while simultaneously improving long-term health by reducing low-value care. That said, healthcare systems currently lag behind other service sectors in reducing carbon emissions. To be compliant with the Paris Agreement and contribute to the Intergovernmental Panel on Climate Change’s target of limiting global warming to 1.5°C above pre-industrial levels, healthcare must play its part, aiming for net zero carbon emissions by 2050.
There is a need to act in a swift and decisive manner, as humanity has a limited window to achieve significant progress in reducing carbon emissions before irreversible changes exceed the boundaries of the planet. Most estimates place average global emissions from healthcare at about 4.4%, with a country range of 4-8.5%. As confronting as these numbers are, they may get worse before they get better. More frequent large-scale events stimulated by climate change (e.g., bushfires, floods, cyclones, heatwaves) will require more carbon-inducing care, placing additional, often overwhelming loads on already-stretched healthcare systems grappling with the current high burden of chronic diseases, non-communicable diseases, communicable diseases, constant introduction of new interventions and technologies, and aging populations. With slow progress on reduction strategies, increased demand on healthcare systems generates further environmental impacts in a vicious cycle.
Against this backdrop, a systematic review was conducted to examine the global evidence on ways in which healthcare systems contribute to climate change and the proposed and implemented ways of reducing these effects. The review identified nine key themes across 205 publications, which were grouped into two broad categories: overarching strategies and decarbonization tactics.
Overarching Strategies
The most frequently discussed overarching strategy was the need for effective policies and governance surrounding healthcare sustainability (97 publications). This included priority setting and leadership from national and international bodies, such as integrating sustainability into policy or setting long-term sustainability goals across organizations. The literature also suggested mandating evaluations, benchmarking, and reporting of carbon footprints for healthcare organizations to strengthen the evidence base for future decision-making. Using financial policy and incentives for sustainable healthcare processes, as well as adopting a multisectoral approach to mitigate the carbon footprint of healthcare, were also highlighted.
Organizational change to develop a future-ready workforce was another key theme (76 publications). This involved ongoing education and training within healthcare organizations and tertiary institutions to ensure the workforce is aware of and equipped for sustainability challenges. Implementing multidisciplinary teams, “green champions,” and other organizational role models to manage sustainability at different levels of the healthcare system was also discussed.
The literature outlined several important roles for individuals and groups in reducing healthcare’s carbon footprint (74 publications). This included promoting change through advocacy, lobbying, and open support of sustainability initiatives, as well as the need for community involvement and education when enhancing the sustainability of healthcare practices. Individual responsibility through engaging with low-carbon healthcare and living an active lifestyle was also emphasized.
Decarbonization Tactics
Changing clinical and surgical practices was the most commonly discussed decarbonization tactic (107 publications). This involved replacing high-GHG practices with lower-GHG options, such as choosing anesthetic gas types and systems with lower carbon footprints. The need to assess clinical practices for low-value care, in order to minimize healthcare usage and reduce the carbon footprint, was also reinforced.
Dealing with waste was a focus of 83 publications, including waste minimization methods (e.g., reducing, reusing, and recycling medical equipment) and effective segregation and disposal of waste.
Patient or clinical travel and transportation was emphasized as an important and addressable source of carbon emissions (70 publications). Using carbon-efficient models of care, such as telemedicine or home-based treatment options, as well as alternative forms of transportation for patients and clinicians, were discussed as methods to reduce emissions.
Improving the energy efficiency of healthcare facilities, such as hospitals, and using energy conservation measures to minimize carbon emissions at the facility level, were recommended in 63 publications. Decarbonizing the supply chains was proposed as a way of reducing GHG emissions in 48 publications, focusing on sustainable production and procurement mechanisms.
The systematic review provides a comprehensive framework of strategies and tactics that healthcare systems can utilize to substantially reduce their carbon footprint and support a greener, more sustainable health sector. However, healthcare systems would need to adapt these approaches to their specific context and needs to maximize their effectiveness. Nonetheless, healthcare can lead the way in shifting to net zero by 2050, reducing the burden of patients who would otherwise need more care as a consequence of a warming world.