HOSPITALS AND HEALTHCARE

During the past decade or more, healthcare providers are increasingly finding new ways to reduce their environmental footprint. While energy, waste and water have traditionally been the focus, providers are now looking to ecological impacts and all emissions (including both direct and indirect carbon embedded in the supply chain).

Some healthcare organisations like the National Health Service (NHS) in the UK, have even announced ambitious targets and plans to approach net zero emissions.

This page gives just a taste of what’s possible and why it’s become so important. See also this 2021 Intro to climate mitigation and environmental sustainability in healthcare and our YouTube channel, ‘Sustainability in the healthcare’ here.

The University of California’s Living Green program, is just one example of the progress towards healthcare sustainability and corporate social responsibility.

In the UK, Barts Health NHS Trust is another great example of how greening the health care sector can happen. The NHS has it’s own Sustainable Development Unit which has been an outstanding leader in sustainable health care for decades.

Despite progress towards sustainable healthcare, we could do much more. Here is a highly research-focused UK model for healthcare (at least for the public system).

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.

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).

WHY ENVIRONMENTALLY HEALTHCARE SUSTAINABILITY?

Environmental harms are directly linked to health outcomes (Eckelman & Sherman, 2016) and yet the healthcare system contributes to those harms. For example, “the health-care sector causes a substantial share of the world’s emissions of greenhouse gases and air pollutants: 4.4% of greenhouse gases, 2.8% of harmful particulate matter (air particles), 3.4% of nitrogen oxides and 3.6% of sulphur dioxide” (Capon et al in The Conversation July 2020). Furthermore, ambient air pollution accounts for an estimated 4.2 million deaths per year due to stroke, heart disease, lung cancer, acute and chronic respiratory diseases. Around 91% of the world’s population lives in places where air quality levels exceed WHO limits. Approximately one quarter of all diseases caused by modifiable environmental causes (World Health Organization).

Gary Cohen echoes these concerns in this short extract from a 2015 Tedx talk.

Emissions from healthcare delivery are substantial – 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).

The carbon footprint of the Australian health system represents approximately 7% of Australia’s total emissions, with hospitals and pharmaceuticals contributing the greatest share (Malik et al, 2018).

WHAT DO DOCTORS THINK?

Doctors all around the world have been calling for action on environmental harms.

Australia’s Doctors for the Environment released a report in December 2020 which explains why and shows the range of medical organisations with policy positions acknowledging the climate emergency. For example, peak organisations like the Australian Medical Association and various Colleges have published position statements along these lines, such as the Position Statement by the Royal Australian College of Physicians (Nov 2016).

Here are some examples of how doctors are helping the community join the dots between environmental action and health outcomes.

This group of doctors created this video because we believe it is our duty to promote good stewardship of our beautiful home-planet as a public health strategy; even more than prescribing medicines.

And in Australia, doctors feel the same…

Dr Cheryl Holder on TEDMED in 2020 builds a compelling case for doctors and clinicians to play a role in action on climate change and environmental harms.

Clearly there are compelling reasons for healthcare to act on environmental harm.

The Lancet journal has long taken a leadership role. Now The Lancet Countdown: Tracking Progress on Health and Climate Change is an international, multi-disciplinary research collaboration between academic institutions following on from the 2015 Lancet Commission on Health and Climate Change, which emphasised that the response to climate change could be “the greatest global health opportunity of the 21st century”. Check out the Lancet Countdown to track our progress on health and climate change here and below.

HEALTH CO-BENEFITS OF ACTION ON CLIMATE CHANGE

Importantly, there are opportunities to improve health outcomes across the population (and avoid hospital admissions) by acting swiftly on climate change.

The opportunities for sustainable healthcare also include cost-saving with eco-efficiency measures. The health co-benefits associated with sustainable development and climate change action are many and have the potential to improve the air we breathe, water, soils, food security and physical activity opportunities to name a few.

WHY HEALTHY HOSPITAL BUILDINGS?

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

Patients are becoming more aware of the need for healthier healing environments and corporate responsibility in health care with regard to sustainability.

GLOBAL GREEN AND HEALTHY HOSPITALS NETWORK AND AGENDA

The Global Green and Healthy 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 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.

In GGHH, 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.

SUSTAINABLE DEVELOPMENT UNIT (SDU) OF THE NATIONAL HEALTH SERVICE (NHS)

(SDU) in the UK has long been another important leader in sustainable healthcare. The SDU is a proponent of ‘sustainable models of care’ which goes to the heart of healthcare’s core function. The NHS SDU propose that success might include the following.

Examples of how sustainable models of care might be implemented can be found in the ‘Operation TLC’ program rolled out across a number of NHS trusts.

Hear more about the NHS journey towards net zero emissions from Dr David Pencheon who was founder and director of the Sustainable Development Unit of the NHS for 10 years…

ACHIEVING HEALTHCARE SUSTAINABILITY IN AUSTRALIA

In Australia, the GGHH network is supported by the Climate and Health Alliance (CAHA), comprising members from many healthcare peak bodies.

CAHA has published many important publications on greening the sector and was instrumental in gaining bi-partisan support for the National Health and Climate Strategy in 2023.

CAHA’s GGHH network includes hundreds of health services from Australia and New Zealand. Globally the 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.

For more information visit the Global Green and Healthy Hospitals Network and the Climate and Health Alliance (CAHA) in Australia. Hear from the CAHA Director, Fiona Armstrong here…

CAHA was also engaged to develop a Human Health and Well-being Climate Adaptation Plan for Queensland which is written about here.

Other key reports from CAHA can be found here.

RESEARCH ON HEALTHCARE SUSTAINABILITY

Australian researchers are making a contribution in this area.

Other research of interest relates to ‘Sustainable Models of Care’.

Other valuable areas of emerging research and action which clinicians and health service managers can influence relate to:

• Fugitive gases – eg anaesthetic gases and asthma puffers (measured dose inhalers are higher impact than dry powder inhalers)
• Green nephrology and dialysis
• Procurement / supply chains and life-cycle analysis – eg single-use plastics and single-use devices
• Reprocessing of devices and re-using gowns, compression socks and so on
• Pharmaceutical development, management and disposal (a large proportion of scope 3 emissions in hospitals)
• Transport to/from healthcare facilities, tele-health, and hospital fleet vehicles
• Champion development, green teams and advocacy
• Waste management
• Health policy.

Key Australian researchers and academics in healthcare carbon and planetary health respectively include anaesthetist, Dr Forbes McGain and Professor Tony Capon.

PRACTICAL ACTIONS / OPPORTUNITIES FOR SUSTAINABILITY IN HEALTHCARE

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.

One of the most comprehensive assessment of energy use in hospitals can be found in this 2013 report from the NSW Audit Office – pictured at right and available hereavailable hereavailable here.

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.

The UK’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. Find out more on how the NHS will achieve net zero emissions here.

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.

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.

Learn more from hospitals who have saved money (eg with a 2-5 year payback period) by becoming more energy efficiency, using energy management systems, and engaging staff.

Canadian Hospital (2014)

Regular Building Commissioning in Health Care (2017)

ENERGY FOR HEALTHCARE

Energy is a significant part of the healthcare system’s carbon footprint (although carbon isn’t the whole story). Read about energy benchmarking as follows:

• Canadian hospitals here
• Australia here (Fifth Estate, 2013)
• Victoria here,
• Practice Greenhealth in the USA (members login required)
• United Kingdom here. See also https://www.sciencedirect.com/science/article/pii/S0378778816301104

COMMUNICATING HEALTH AND CLIMATE CHANGE

‘Let’s Talk Health and Climate: Communication Guidance for Health Professionals’ combines values research, communications, and specific messaging into a single resource, so you can learn how to create messaging that truly resonates with the health and healthcare audience.

In addition, 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)

Other key communication resources

• Climate science for health professionals and other resources listed on CAHA’s website including presentations from Protecting Health from Climate Change – What’s Needed? (Nov 2014)
• Conveying the Human Implications of Climate Change (Maibach et al, 2011), George Mason University Centre for Climate Change Communication can be found here.
• Health page from Yale University’s Project on Climate Change Communication
• Other parts of the Getting to Sustainability website convey information about communication, pro-environmental behaviours and climate change.

Staff engagement

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

Engaging our communities and leaders

• Join Australia’s campaign for a national implementation plan to address climate impacts on health utilising the national Framework developed through the Climate and Health Alliance (CAHA). More info: https://www.ourclimate-ourhealth.org.au/ 

RESOURCES

• Centre for Sustainability in Healthcare UK
• Green Health Care Buildings – short article by Jerry Yudelson (2008)
• Best Environmental Practices in the Healthcare Sector (approx 2011)
• Environmental sustainability in health care: why do it? – Chris Hill, Director of Environmental Sustainability, Mater Hospital, Qld (2014)
• Green Star – Healthcare – Green Building Council of Australia online course for CPD points
• Health Care & Climate Change: an opportunity for transformative leadership (HCWH, 2014)
• 

  This guide includes case studies and key learnings for translating health promotion techniques into the sustainable futures context

  ‘Health promotion and sustainability: transitioning toward healthy and sustainable futures’ by Rebecca Patrick, Teresa Capetola, and S Noy (Deakin University and Sustainability Victoria, 2011)

• Hospitals & Sustainability – Curtin University of Technology & CRC Construction Innovation (approx 2009)
• How to write a Sustainable Development Management Plan (for health care organisations) – NHS, UK
• Making our health system more sustainable – Dr Lisa Rasmussen (2010)
• Queensland Health Green Office Resource Guide
• Queensland Health Strategic Water Management Guide
• Victorian Government – sustainability in healthcare.
• Why own a green hospital? Green Building Council of Australia – case study of Flinders Medical Centre, Adelaide

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

• Business case reports (2000 – 2009) – Green Guide for Health Care, USA
• Can sustainable hospitals help bend the health care cost curve? by Kaplan et al (2012)
• Creating a Culture of Sustainability: Leadership, Coordination and Performance Measurement Decisions in Healthcare by Boone (2012)
• Energy performance contracting in healthcare facilities – Victorian Government
• Sustainable health and social care: connecting environmental and financial performance by Naylor & Appleby (2012)

CASE STUDIES

• Austin Hospital, Victoria – reaping energy savings at minimal cost
• Barwon Health, Victoria – communicating strategy
• Dunedin Hospital, NZ – the cost of a hospital’s upgrades will be met by energy savings over four years (2013)
• Flinders Centre for Innovation in Cancer, SA (pictured)
  

  Flinders Centre for Cancer Innovation

• Flinders Medical Centre, New South Wing, SA – Australia’s first 5 star green star healthcare facility
• Gold Coast Hospital, Qld – green and transit-oriented new hospital
• Mater Hospital, Brisbane, Qld (brief Pangolin case study) and their sustainability homepage for further details
• Queanbeyan Hospital, NSW – energy savings and fine tuning
• Royal Melbourne Hospital – includes annual reporting
• Royal Women’s Hospital, NSW – insulation
• Sunshine Coast Public University Hospital – environmentally sustainable design
• Uniting Care, Qld – energy saving and green team
• Western Health, Vic – PVC recovery and recycling
• Western Health, Vic – Being a sustainability officer in healthcare – transcript

BOOKS / REPORTS ON HEALTHCARE SUSTAINABILITY

• Climate-smart healthcare : low-carbon and resilience strategies for the health sector (2017) World Bank
• Towards environmentally sustainable health systems in Europe. A review of the evidence (2016)
• Evidence-based Design for Healthcare Facilities by Cynthia McCullough (ed) (2009)
• Green Healthcare Institutions by Frumkin and Coussens (2007)
• Health Practitioner’s Guide to Climate Change (2009)
• Sustainability and Evidence-based Design in Healthcare Estate by Phiri and Chen (2014)
• Sustainability for Healthcare Management – a leadership imperative (2013) – a practical guide with sample data, illustrations and sample conversations throughout to help frame and integrate concepts.
• Sustainable Healthcare by Shroeder et al and BMJ Books (2012)
• Sustainable Healthcare Architecture 2nd edition by Guenther and Vittori (2013)

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

MORE USEFUL LINKS FOR HEALTHCARE SUSTAINABILITY

• Alliance of Nurses for Healthy Environments, USA
• Australian Health Promotion Association (AHPA) special climate change issue of the Health Promotion Journal of Australia (Vol. 22, No. 4, 2011)
• Are Australia’s future doctors being educated about climate change and health?
• CAHA’s 2013 film (16 minutes), The Human Cost of Power and Coal and Health in the Hunter: Lessons from One Valley for the World (2015)
• CleanMed conferences
• Climate Change Health Check 2020 (Climate Institute, 2008)
• Doctors for the Environment (pictured at right)
  

  iDEA15 (Image: Lucy Alcorn)

• European Centre for Environment and Human Health  hospitals carbon management modelling project (2013)
• Health and Environment Alliance (HEAL)
• Healthier Hospitals Initiative (Practice Greenhealth)
• Human Health and Climate Change – Climate Change Communication non-profit
• Medical Journal of Australia special edition on climate and planetary health, 2020
• Sustainability Roadmap for Hospitals (USA) (American Hospitals Association, Association for the Healthcare Environment, Association for Healthcare Resources and Materials Management, and the American Society for Healthcare Engineering)
• Sustainable Hospitals Program (University of Massachusetts Lowell)
• The Lancet series on climate change and health (2010)
• UK National Health Service Sustainable Development Unit UK Chartered Institute of Environmental Health
• US Climate Resilience Toolkit – Building Health Care Sector Resilience
• YouTube channel ‘Sustainability in the health and care sector’
• What are nurses and midwives doing to green healthcare?
• What would a National Strategy for Climate and Health in Australia look like?
• World Health Organization on climate change and human health including McMichael et al, 2003 and Healthy Hospitals – Healthy Planet – Healthy People

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