Intended for healthcare professionals

Letters Net zero healthcare: call for clinician action

Aiming for economic recovery from covid-19 and better climate resilience is a win-win

BMJ 2021; 375 doi: (Published 29 November 2021) Cite this as: BMJ 2021;375:n2884
  1. Alexander von Hildebrand, WHO consultant in environmental health
  1. Montemor-o-Novo, Portugal
  1. alexvonhil{at}

I agree with Sherman and colleagues that “health professionals should encourage change through individual practice, influencing healthcare organisations, and contributing to standards and policy.”1

As an environmental health field worker for over 35 years in countries of the global south, I encountered too many healthcare facilities with no access to functional basic water, sanitation, and hygiene services. In these places, strategising for a net zero status is still far removed.

In 2015, the World Health Organization and Unicef reported that one in four healthcare facilities in low and middle income countries lack basic water services, one in five have no sanitation service, and 42% lack hand hygiene facilities at the point of care; 40% do not segregate infectious waste.2 WHO and partners are thus promoting climate resilient and environmentally sustainable healthcare facilities as a fundamental contribution to universal quality of care.3

Covid-19 green recovery efforts4 provide the opportunity to ensure that healthcare facilities provide water, sanitation, and hygiene and are climate resilient. The United Nations Environment Programme assessed how covid-19 recovery funding covered global greening needs. Of $14.6trn total spending “only $368bn (2.5%) was announced for green initiatives.”5

As national governments are committing large sums to maintaining and resuscitating economic activity to preserve people’s wellbeing, policies geared to help economic recovery from covid-19 and at better climate resilience are true win-wins.6 The Lancet confirmed in 2017 that “the ratio of health co-benefit to (climate change) mitigation cost ranged from 1.4 to 2.45, depending on the scenario.”7

In 2020 Tedros Ghebreyesus, director general of WHO, said: “Any efforts to make our world safer are doomed to fail unless they address the critical interface between people and pathogens, and the existential threat of climate change, that is making our Earth less habitable.” The call on health professionals to achieve net zero healthcare should also engage along these lines.


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