It is fair to say that carbon reduction has not had a high priority in the NHS compared with waiting lists, hospital acquired infections, and general practice opening hours. But the recent launch of the new NHS carbon reduction strategy,1 fronted by chief executive David Nicholson, might be about to change that.

The report by the NHS Sustainable Development Unit includes some eye popping figures about the carbon waste in the English health service, which amounted to 18.6 million tonnes in 2004, equivalent to a quarter of all public sector emissions and 3.2% of the country’s total footprint.

But what will really concentrate minds are the targets. Despite the fact that in the past 20 years the health service’s emissions rose by 40%, it is now committed to reversing that trend and cutting them by 10% by 2015 and a staggering 80% by 2050.

If that is to happen one of the first priorities will be tackling the huge carbon cost of our drugs and medical equipment. Detailed analysis of the NHS’s carbon footprint shows that drug procurement is responsible for 22% of total emissions—as much as travel or buildings—and medical equipment for 9%.2

One of the reasons for these startling figures is that the report takes into account indirect as well as direct emissions. That means the drug footprint, for example, includes not simply the costs of transport, waste, and misuse by the patient but also the manufacturing process and even supplying the raw materials to the plant.

And what emerges is that these indirect carbon costs around manufacturing are far higher than the direct ones—accounting for 80% of pharmaceutical emissions and 70% …