Intended for healthcare professionals


A pathway to net zero emissions for healthcare

BMJ 2020; 371 doi: (Published 01 October 2020) Cite this as: BMJ 2020;371:m3785

Linked Editorial

Towards a carbon neutral NHS

  1. Renee N Salas, affiliated faculty123,
  2. Edward Maibach, distinguished university professor4,
  3. David Pencheon, associate and honorary professor5,
  4. Nick Watts, executive director6,
  5. Howard Frumkin, professor emeritus7
  1. 1Harvard Global Health Institute, Cambridge, MA, USA
  2. 2Center for Climate, Health, and the Global Environment, Harvard TH Chan School of Public Health, Boston, MA, USA
  3. 3Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
  4. 4Center for Climate Change Communication, George Mason University, Fairfax, VA, USA
  5. 5Medical and Health School, University of Exeter, Exeter, UK
  6. 6Lancet Countdown: Tracking Progress on Health and Climate Change, London, UK
  7. 7University of Washington School of Public Health, Seattle, WA, USA
  1. Correspondence to: R N Salas rnsalas{at}

The healthcare sector has a profound responsibility and opportunity to reduce greenhouse gas emissions to limit the widespread health harms of climate change. Renee N Salas and colleagues chart a path to net zero emissions for healthcare

Key messages

  • Greenhouse gas emissions from healthcare are substantial, and the health sector has generally lagged most other industries in reducing its carbon footprint

  • Healthcare leaders and organisations have both a responsibility and an opportunity to chart a path to net zero emissions

  • Doing so can improve health, protect healthcare delivery by minimising disruptions, yield economic benefits, and establish the healthcare sector as a leader in climate action

  • Rising to the challenge of net zero in healthcare will require broad transformative steps, such as reducing demand through preventive care, powering the entire enterprise with clean energy, choosing medical supplies and equipment with lower carbon footprints, and reducing travel through telemedicine

The Intergovernmental Panel on Climate Change has made clear that limiting global heating to 1.5°C above pre-industrial levels will greatly reduce the probability of sustained public health catastrophes. To achieve this, human caused carbon dioxide (CO2) emissions must fall to roughly half of 2010 levels by 2030 and to net zero by 2050. Emissions of other greenhouse gases (GHGs) must reach net zero soon thereafter (between 2063 and 2068).1

To achieve net zero GHGs, emissions from all sources—electricity generation, industry, transportation, buildings, and so on—must be reduced to as close to zero as possible, and any remaining emissions must be balanced by removing CO2 from the atmosphere, through such means as reforestation and direct physical-chemical removal. Modelled estimates vary on the specifics, but the needed direction of travel is clear—we must urgently and radically reduce GHG emissions.

Net zero is technically feasible across much of the world’s economy, although some sectors, such …

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