A pathway to net zero emissions for healthcareBMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3785 (Published 01 October 2020) Cite this as: BMJ 2020;371:m3785
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The biggest global health threat of the 21st century as depicted by Lancet, climate change, is gripping the globe as an undeterred human disaster. The health sector itself is paradoxically making a significant contribution to climate change. The deployment of products and technologies, the consumption of energy and resources, the generation of waste and construction and operation of the buildings, all drive the health sector towards a significant source of carbon emissions globally, labelling it as an unintentional contributor to climate change trends that undermine public health. The health sector, deviating from its mission to protect and promote health, turns out to be a major contributor to the crisis and therefore has an important role to play in its resolution.
While healthcare emissions have rarely been assessed in isolation, the analysis suggests that in most countries they are only surpassed by those from the heaviest polluting sectors, related to energy, transport and construction.(1) Healthcare’s climate footprint is equivalent to 4.4% of global net emissions, which is equivalent to the annual greenhouse gas emissions from 514 coal-fired power plants--that is, more than the aviation and shipping footprints. If the health sector were a country, it would be the fifth-largest emitter on the planet (2). The sector’s potential for critical improvisations to cut emissions with improved public health provisions as it is a major component of the global economy.
However, despite efforts by the likes of the Lancet Commission on Health and Climate Change for promoting the tracking of emissions, there is a paucity of attention from the wider research community. So far, only four nations including England havwe undertaken an analysis of the greenhouse gas footprint of this sector specifically. The popular misconception that the healthcare sector has negligible emissions because it does not produce material goods attributes to this scarcity which led to these emissions being overlooked. The domestic energy system of a country is by far the biggest influence on a country’s health carbon footprint. This makes sense considering the healthsector’s carbon footprint generally mirrors overall emissions from a nation and, predictably, means that decarbonising the energy system will go a long way to decarbonising healthcare (2).
Energy efficient hospitals have an answer by choosing low-carbon medical products with minimal packaging and avoiding unnecessary medical procedures. The misconceptions about cutting emissions from the sector is that doing so would undermine service provision. In reality, a variety of improvements to health services in this direction would benefit public health. Reducing the carbon footprint of healthcare requires direct action to reduce waste and energy use, and radical reform of care pathways like energy efficiency, green building design, alternative energy generation and transportation, sustainable local food, alternatives to waste incineration and water conservation (3). Environmental sustainability should be the next dimension of the quality of healthcare alongside safety, timeliness, effectiveness, efficiency, equity and being patient centric (4,5). The hospitals of the future have major opportunities to mitigate climate change directly by reducing their own carbon footprint, and indirectly by influencing others in the societies they serve (6).
The optimism in the face of the drastic consequences of climate change is that we can turn the tide, because as long as the road ahead may be, we have already travelled far, powered by the energy and ingenuity of organizations and individuals around the world that are already making their impact. Health systems understand the urgency of climate change and have chosen to rise to the occasion. The threat and opportunity of climate change enables meaningful changes to the business and sustainability to fit into the competing priorities. U.S. health systems at Cleveland Clinic, Kaiser Permanente, Boston Medical Centre and Partners Healthcare are finding solutions. They are on track to make their facilities carbon neutral between 2020 and 2027 while building climate resiliency, even as they expand their operations, tend to the bottom line, and provide excellent health care (7). Kaiser Permanente becomes the first carbon neutral healthcare provider in the US.
The UK’s commitment to zero carbon by 2050 and the preceding Climate Emergency Declaration represent a change to policy. Tackling climate change creates opportunities in innovation and leadership but it will not be easy, and the solutions will be contested. The NHS pathway can be a model script for the health care system globally to follow (8). The role of the health systems, health professionals, and patients in the global journey to net-zero carbon soon is important because of their size, reach, trust, and exemplary role. Moreover, the environmental threats we are faced with are health threats. We should live up to our historical commitment and duty of care to do no harm (9). Doctors, nurses and health professionals are bound by an oath to first do no harm and some of that practice is doing harm. It’s obviously not a call to immediately shut everything down and stop it as there is some inevitability here, but there is a responsibility here to reduce those emissions.
1. Josh Gabbatiss, 2019 https://www.carbonbrief.org/healthcare-in-worlds-largest-economies-accou...
2. Pichler, P. et al. (2019) International comparison of health care carbon footprints, Environmental Research letters, www.iopscience.iop.org/article/10.1088/1748-9326/ab19e1
3. Charlie Tomson, 2015, Reducing the carbon footprint of hospital-based care Future Hosp JFeb; 2(1): 57–62.doi: 10.7861/futurehosp.2-1-57
4. Atkinson S, Ingham J, Cheshire M, Went S. Defining quality and quality improvement. Clin Med 2010;10:537–9..
5. Connor A, O’Donoghue D. Sustainability: the seventh dimension of quality in health care. Hemodialysis International 2012;16:2–5
6. 8. Naylor C, Appleby J. Sustainable health and social care: connecting environmental and financial performance. London: King's Fund, 2012. www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/sustain...
7. Alice Chen and Vivek Murthy, 2019 https://hbr.org/2019/09/how-health-systems-are-meeting-the-challenge-of-...
8. Richard Pancost 2019, The Pathway toward a Net-Zero-Emissions Future, 1; 1, 8-20, https://doi.org/10.1016/j.oneear.2019.07.001
9. David Pencheon and Jeremy Wight, Making healthcare and health systems net zero, BMJ 2020;368:m970 doi: 10.1136/bmj.m970
Competing interests: No competing interests