Healthcare sector


The University of California’s Living Green program, is just one example of the progress towards sustainability in the healthcare sector.

Washington Hospital also presents another bold example of how sustainability can be achievable in healthcare.

Some outstanding resources are now available from many different organisations to support and promote sustainable healthcare. For example, Climate for Health have put together an outstanding suite of free resources. Other organisations playing a key role are the Global Green and Health Hospitals, Practice Greenhealth, the UK’s National Health Service and Sustainable Development Unit, as well as Australia’s own Climate and Health Alliance, boasting diverse membership from Australia’s peak medical and health organisations.

Read on to find out more.

WHY SUSTAINABLE HEALTHCARE?

There are considerable opportunities for sustainable healthcare, particularly in cost-saving with eco-efficiency measures. But most importantly, there are considerable health co-benefits associated with sustainable development and climate change action, as well as many negative health impacts of inaction (including climate impacts like heatwaves, fires, floods and mosquito-borne diseases).

Participants in the People’s Climate March in New York City 2014 (Image: Yale University)

Participants in the People’s Climate March in New York City 2014 (Image: Yale University)

Healthcare delivery emits high levels of emissions – in some cases, up to 25% of total public sector greenhouse gas emissions (UK, National Health Service, 2009, p. 74). Australian hospitals consume 14% of energy consumed by all commercial building types (pitt&sherry in DCCEE, 2012, p. 5). Environmental impacts associated with healthcare delivery contribute to disease, given that approximately one quarter of all diseases caused by modifiable environmental causes (World Health Organization). Climate change presents a very concerning set of risks to human health, as detailed in The Critical Decade: Climate change and health (Climate Commission, Australia, 2011).

As above, some of the direct and indirect impacts of climate change on human health are associated with heat waves, rising sea-levels, drought and so on.

[Aside from climate change issues, the healthcare sector is contributing to other environmental harms including toxic waste and other pollution.]

Key resource: ‘Why own a green hospital?’ – from the Green Building Council of Australia

CAPTURING THE BENEFITS / ADDRESSING THE RISKS

On a more positive note, cleaner energy, cycling and walking, protecting bushland, energy efficient buildings and low-carbon food choices all contribute to less chronic illnesses, including heart and lung disease, certain cancers, obesity, diabetes, and depression. For every tonne of carbon dioxide avoided, countries could save an average of $46 in health costs (refer also Our Uncashed Dividend: the Health Benefits of Climate Action, 2012).

Hundreds of health organisations are now beginning to capture these benefits and address environmental risks for which they are responsible.

The Global Green and Health Hospitals (GGHH) network has been formed to bring together health organisations that are committed to reducing their environmental impact and promoting environmental health worldwide. GGHH-news-banner GGHH is a virtual community for hospitals, health systems and organisations around the world — currently across 53 countries. Most healthcare sustainability challenges are common despite different cultural contexts – so if you have a problem, someone in the network has probably already solved that problem and is willing to share how. A global group of experts are also on hand to provide advice and resources. GGHH focuses on a comprehensive environmental health agenda featuring 10 action areas associated with: waste, energy, harmful chemicals, buying safer and more sustainable products, water, transport, food, pharmaceuticals, buildings and leadership. The ‘Agenda’ is available for downloading in four languages.

GGHH Connect online

GGHH Connect online

In 2014, the network launched a multilingual online Cisco platform database to assist the network to share best practice, research issues and overcome barriers, called GGHH Connect. Each organisation that joins goes about focusing on two goals which may often deliver financial benefits in tandem. To help this process, GGHH is publishing a series of webinars on different topics such as waste, sustainable buildings and sustainable energy for healthcare centres.

ACHIEVING SUSTAINABLE HEALTHCARE IN AUSTRALIA

In Australia, the GGHH network is supported by the Climate and Health Alliance CAHA(comprising members from many healthcare peak bodies). CAHA’s GGHH network is growing, with over 40 major hospitals and more than 100 other Australian health services connected. The global GGHH network reaches around 9000 hospitals (2015). The network will drive sustainable healthcare, transform the sector, and encourage the sector to contribute to, rather than harm, public health. The network will also influence supply chains so that healthcare providers can more easily access environmentally-friendly alternative products. In October 2014, the 3rd Annual Think Tank on Greening the Healthcare Sector was held in Brisbane. Below is a 3 minutes snapshot of the event and here is a link to the Storify report from the Twitter feed from the day: https://ahha.asn.au/greening-health-sector-2014-storify Presentations from the 2014 event are available from the Australian Healthcare and Hospitals Association website. For more information visit the Global Green and Healthy Hospitals Network and the Climate and Health Alliance in Australia.

OPPORTUNITIES

NSW energy use in hospitals 2013

NSW Auditor-General’s Report into building energy use in NSW public hospitals 2013

There are many ways to address the environmental harms created by the health sector. For example, greenhouse gas emissions may come from energy consumption, staff/patient transport and procurement, including pharmaceuticals and single-use devices (NHS 2010).

One of the most comprehensive assessment of energy use in hospitals can be found in this 2013 report (pictured at right) and available here.

The following TEDx presentation (mid 2015), highlights that lean, green, digital hospitals can take efficiency and communication to a new level while improving patient care and decreasing environmental impacts.

The following collection of diagrams provide a broad brush impression of where opportunities may lie for improving financial and environmental performance. Some of the data may surprise you!

For example, the following projected savings by intervention is extracted from a study of exemplar hospitals – Can Sustainable Hospitals Help Bend the Health Care Cost Curve? by Kaplan et al 2012. You will note that impressive savings were made by reprocessing single-use-devices and reformulating operating room equipment packs.
Hospitals bend cost curve 2012

The United Kingdom’s National Health Service (NHS) has made a concerted effort over a long period of time to address its carbon footprint – refer to the next few diagrams. The latest report was published in January 2016 and is based on 2015 data.  It shows that the NHS carbon footprint in England is 22.8 million tonnes of carbon dioxide equivalents (MtCO2e). Between 2007 and 2015 the carbon footprint has reduced by 11%.

NHS carbon footprint 2012

Source (above and below): Carbon_Footprint_summary_NHS_update_2013

NHS carbon footprint detail 2012

NHS carbon footprint detail 2012

NHS falling carbon footprint 2016

Carbon footprint update for the NHS published 2016 http://www.sduhealth.org.uk/policy-strategy/reporting/nhs-carbon-footprint.aspx

Europe’s Green@Hospital pilot (2014) found that hospitals could save around 15% of energy consumed through a range of strategies outlined in this 6 minute video.

The following table is taken from Sustainable Health and Social Care: connecting environmental and financial performance is based on a literature review and stakeholder consultation carried out by The King’s Fund on behalf of the National Institute for Health Research and the Social Care Institute for Excellence. The authors consider how health and social care needs to change to become more environmentally sustainable. A key finding is that improving efficiency at the operational level is unlikely to be sufficient. A more fundamental transformation in service models will be needed, with a greater emphasis on prevention, shifting care upstream, better integration and co-ordination of care, and an ongoing focus on maximising value for patients.

Change for sustainable health care Naylor appleby

The following outlines some specific practical strategies although each facility should evaluate each on their own merit in their own context. The table is extracted from Health Care & Climate Change: an opportunity for transformative leadership by Boone (2014), published by Health Care Without Harm.

Boone opportunity framework 2014

HEALTHY ENERGY

The global Healthy Energy Initiative is mobilizing the health sector to play a central role advocating for a move away from fossil fuel-based power generation—particularly coal—and toward clean, renewable healthy energy options. hcwhThe initiative is led by Health Care Without Harm and is comprised of a network of partners made up of health professionals, health organizations, and academic research institutions, from around the world. The approach includes supporting top-notch research on the health impacts of energy choices, developing educational materials for health professionals and the general public, promoting health sector divestment from coal, and advocating for energy policies a the local, national and global level that promote public health. Health Care Without Harm (HCWH) provides global coordination for the Healthy Energy Initiative. For more information see www.noharm.org [HCWH Europe has published online, a one hour webinar on clean energy strategies for hospitals – see below.] Read CAHA’s own Joint Position Paper and Background Paper on healthy energy choices here. Read about energy benchmarking in Canadian hospitals here, Australia here (Fifth Estate, 2013), Victoria here, and by Practice Greenhealth in the USA (members login required).

COMMUNICATING HEALTH AND CLIMATE CHANGE

Check out this podcast (March 2012), ‘Communicating health and climate change’ on the website of the Australian Science Communicators. The panel of speakers includes:

  • Fiona Armstrong, Convener of the Climate and Health Alliance
  • Dr Marion Carey, VicHealth Senior Research Fellow at Monash Sustainability Institute
  • Amanda McKenzie, Communications Director at the Climate Commission (Climate Council on climate and health)

Key communication resources

Conveying the Human Implications of Climate Change

Conveying the Human Implications of Climate Change

Staff engagement

  • See also ‘Stakeholder Engagement’
  • Starting a health care system green team (Mejia & Sattler, 2009, AORN Journal article)

RESOURCES

There are many case studies and other resources on the Global Green and Healthy Hospitals website here (especially for members): www.greenhospitals.net

Financial issues

CASE STUDIES

BOOKS

Carbon Trust UK has an easy to read hospital resource here.

MORE USEFUL LINKS

NB – Other relevant sections of this website include our page on procurement.