Sustainability in healthcare: the impact of the health sector on the environment | Care means the world

A pledge to do no harm is often central to oaths taken by medical students on their way to becoming doctors. It’s a tenet that dates back to Hippocrates and the Ancient Greeks – but is it still being followed?

As the climate crisis intensifies and new information comes to light, it seems that the global healthcare industry, with its vast carbon footprint, needs to take action now to protect those it serves.

Climate change is described by a recent report in the Lancet medical journal as the biggest worldwide health threat of the 21st century. Growing rates of long-term illnesses are being triggered by air pollution and more communities find themselves living in disaster zones as a result of global warming.

The contribution of the world’s health systems is significant. In 2019, a now landmark report calculated that healthcare’s total carbon footprint is equivalent to 4.4% of global net greenhouse gas emissions, almost twice that of the aviation industry. To put this into perspective, if the healthcare sector were a country, it would be the fifth largest emitter on the planet.

Four years on, there is increasing international awareness among health and climate leaders. Cop28 recently released the first ever declaration to place health at the heart of climate action and accelerate the development of climate-resilient and sustainable health systems, with significant emissions reduction across the sector.

Multinational corporations are taking note too, with Philips Healthcare vocalising the need for sustainable change in healthcare through its newly launched Care Means the World platform, and also leading a number of initiatives.

“There’s a global momentum within the healthcare industry now,” says Robert Metzke, global head of sustainability at Philips, who attended Cop28. “A huge number of care providers are realising the need to tackle their impact on the environment. Whether it is using less energy and materials or producing less waste. Or adopting a circular approach by choosing products with eco design at their core and extending the lifetime of a piece of equipment.

“Our hospital customers tell us they want to commit to becoming carbon neutral, but healthcare is in the early stages of the journey, and many don’t know where to begin.” He suggests that conducting sustainability audits can often be an important starting point.

He adds: “Ultimately, it’s about moving away from a single-use mindset and embracing circularity. To make a lasting change, procuring with sustainability criteria in mind is critical. Only then can we look after the patient and the planet in equal measure.”

At a glance, healthcare might not seem an obvious contributor to emissions, but there are many energy-intensive aspects to it. These include the energy required to power and heat hospitals, and run the machinery within them.

Research also shows that around 25% of total healthcare emissions originate from energy consumed in manufacturing supply chains, such as those producing drugs and vaccines. But there are other less obvious sources too. NHS England’s annual carbon footprint has been placed at 25m tonnes, with contributing factors including gases such as nitrous oxide, used as anaesthetics, emissions relating to waste disposal, and patients using inhalers that rely on carbon-based propellants.

So how can we go about decarbonising healthcare while still ensuring patient safety, and without drastically increasing costs? A paper in the New England Journal of Medicine in April drew attention to the “cost myth” around reducing healthcare emissions.

The authors reported suggestions that initiatives such as installing solar power, waste reduction schemes and the long-term purchase of renewable energy could ultimately yield a positive return on investment, and would reduce greenhouse gases. In the medium term, this might mean more stable energy prices. In the long term, investing in climate solutions now would save money by reducing the need to treat patients for climate-related illnesses such as chronic lung diseases caused by air pollution.

There are plenty of other areas where improvements are possible. Research conducted by Philips Healthcare, in partnership with Vanderbilt University Medical Centre, in Nashville, investigated the carbon emissions of 13 diagnostic imaging devices, including MRI, CT, ultrasound and X-ray, which together account for about 12,000 patient scans a month. The research found that over a decade they emit as much CO2 as 1,000 petrol cars being driven for a year. The project suggested that implementing sustainable initiatives could help address this problem. Initial results indicated that rather than replacing imaging devices, upgrading or refurbishing them offered the twin benefits of reducing carbon emissions and the cost of ownership.

In future, AI may help hospitals to reduce emissions by, for example, accurately reading minute details on scans and identifying when repeats are unnecessary. Next generation devices such as Philips Incisive CT are more energy efficient than their predecessors and embed AI within the system to improve precision in the radiation dose and enhance image quality, reducing the need for repeat scans.

While cutting healthcare emissions will not be straightforward, a commitment to change seems to be emerging. At Cop28, the WHO director-general, Dr Tedros Adhanom Ghebreyesus, acknowledged the need to build low-carbon health systems, while NHS England has outlined a plan for reaching net zero by 2040 for emissions it controls directly, and 2045 for wider emissions. This will involve increasing the use of solar panels and ultra-low emission vehicles, including hydrogen-electric zero-emission ambulances. There are also plans to decommission desflurane – an anaesthetic with a global warming potential 2,500 times greater than that of CO2. The Greener NHS programme, meanwhile, is working with catering leads and suppliers to increase the provision of locally sourced food for patients and staff to cut transport-related emissions.

There are still significant challenges afoot, but positive signs are also emerging from the pharmaceutical industry. The Sustainable Markets Initiative Health Systems Task Force reports being in advanced discussions with energy providers in China and India to scale renewable power across many of the supply chains used to procure vital raw materials for medicines. The task force, a public-private partnership of CEOs and healthcare leaders, also says it has set minimum environmental targets for 100 of the world’s largest pharmaceutical suppliers. These targets, it adds, have the potential to address 3.5m tonnes of CO2 emissions each year.

The Cop28 UAE Climate and Health Declaration, signed by 123 countries, can be seen as a breakthrough in the fight to decrease healthcare emissions. The problem is urgent, but if healthcare professionals worldwide act quickly, globally, and collectively, it is one that can be addressed. Then the international healthcare industry can feel it is walking in the footsteps of Hippocrates – for the good of the planet and every person on it.

Find out more about the ways Philips Healthcare is driving a sustainable future for the health sector