Intended for healthcare professionals


COP26: Fifty countries commit to climate resilient and low carbon health systems

BMJ 2021; 375 doi: (Published 09 November 2021) Cite this as: BMJ 2021;375:n2734
  1. Jacqui Wise
  1. Kent

Fifty countries have committed to creating climate resilient, low carbon, sustainable health systems, including 14 countries that have set a target date of reaching net zero emissions by 2050.

Health services are currently a significant source of greenhouse gas emissions, accounting for around 4.6% of the worldwide total. If they were one country, health systems would be the world’s fifth largest emitter.

All four UK health services have committed to net zero carbon emissions in line with the government’s commitment for the whole of the country to be net zero by 2050. The NHS in England has committed to being net zero by 2045, Scotland has committed to being a net zero carbon emissions health service by 2045, and in Wales the ambition is to reach net zero by 2030.

Making the announcement, England’s health and social care secretary, Sajid Javid, said, “As a health community, we cannot simply sit on the sidelines—we must respond to climate change through urgent action, with global collaboration at its core.”

The commitments were made in Glasgow as part of the COP26 Health Programme, a partnership between the UK government, the World Health Organization, the United Nations Framework Convention on Climate Change, and health groups such as Health Care Without Harm.

Aside from the four UK countries, others that have set a target date to reach net zero health systems include Spain, Kenya, Jordan, and Nigeria. Countries that have committed to achieving low carbon, sustainable health systems include Argentina, Fiji, Malawi, Spain, the United Arab Emirates, the United States, and 39 others. Countries that have committed to enhancing the climate resilience of their health systems include Bangladesh, Ethiopia, the Maldives, the Netherlands, and 45 others.1


Tedros Adhanom Ghebreyesus, WHO director general, said, “The future of health must be built on health systems that are resilient to the impacts of epidemics, pandemics, and other emergencies, but also to the impacts of climate change, including extreme weather events and the increasing burden of various diseases related to air pollution and our warming planet.

“Health systems must also be part of the solution, by reducing carbon emissions. We applaud those countries that have committed to building climate resilient and low carbon health systems, and we hope to see many others following their lead in the near future.”

Aminath Shauna, Maldives minister for environment, climate change and technology, told a press conference, “Our coral reefs are dying, our islands are eroding and becoming more frequently flooded. This is having a significant impact on public health.”

She added that the country was already running out of fresh water and seeing a rise in vectorborne disease such as dengue. She said that the Maldives was responding by building a more climate resilient health infrastructure and providing healthcare facilities with sustainable low carbon health systems.

In addition to the national commitments, 54 institutions from 21 countries representing more than 14 000 hospitals and health centres have joined the United Nations Race to Zero campaign and committed to achieving net zero emissions. Josh Karliner, international director of programme and strategy of Health Care Without Harm, said, “Around the world doctors, nurses, hospitals, health systems, and ministries of health are reducing their climate footprint, becoming more resilient, and advocating for a just transition that puts health at the centre of a decarbonised civilisation.”

A WHO survey published this week has found that over three quarters of countries have developed, or are currently developing, national health and climate change plans. However, only about a quarter have been able to fully implement these because of a lack of funding or other support mechanisms.2