The global healthcare sector has the potential to make a huge contribution to fighting climate change. In this article published shortly after Earth Day 2021 and ahead of the COP26 summit, we look at how the sector and those who work within it will respond. There is a list of useful resources for hospital and estate managers at the end of the article.

While all sectors should play their part, there is a growing realisation that for healthcare, doing so is mission critical. That is because global warming jeopardises not only our planet but our health, as the Greener NHS programme acknowledges.

“Climate change poses a major threat to our health as well as our planet. The environment is changing, that change is accelerating, and this has direct and immediate consequences for our patients, the public and the NHS.” – Greener NHS

How does healthcare affect the environment?

Healthcare accounts for around five per cent of carbon emissions worldwide, largely because it is a huge sector in most countries’ economies, and the amount of greenhouse gases and pollutants it releases has been rising as the sector expands. As the chief executive of the NHS has said, it is part of the problem but can also be part of the solution.

Pollution problem

Carbon emissions and environmental pollutants are closely linked, so healthcare is also a significant contributor to air pollution, largely in the form of particulates and nitrogen oxides from burning fossil fuels for power and transport.

These substances are factors in numerous diseases, accounting for 900 deaths a week in England and a bill to to the NHS for dealing with the health fallout estimated at more than £18 million over 16 years.

Meanwhile, rising temperatures due to global warming will likely lead to an increase in serious heat-related health issues, as we have seen during recent heatwaves.

All this means that efforts by the health industry to cut carbon and pollutants will not only help to fight climate change but also improve health outcomes.

What about Covid-19?

Covid-19 has certainly not helped. The UN has blamed the pandemic for failure to meet key targets for sustainability in healthcare.

Government plans to set targets for health and other sectors were due to be published last year but were pushed back along with the COP26 Glasgow summit because of the pandemic. An NHS plan is now due this summer ahead of a full report before the Glasgow meeting in November, although it has already set pioneering targets for zero emissions.

The challenge of tackling coronavirus has also underlined the scale of response needed to tackle climate change.

“Covid-19 has shown how the health sector can address huge challenges at breath-taking pace when sufficiently focused and adequately supported … an even greater effort is required to address the health impacts of climate change.” – Dr David Nabarrow, World Health Organisation Special Envoy for Covid-19

Why so high?

The main reason that healthcare’s emissions are so high is that the sector is huge, accounting for up to ten per cent of the entire economy in major western countries. As a result, it is a voracious user of fossil fuels such as oil and gas to power facilities including hospitals and GP surgeries as well as healthcare product manufacturing.

Another reason is the sheer range of areas in healthcare where sustainability is an issue. As an illustration, Health Care Without Harm programmes cover medical waste, toxic materials, safer chemicals, green building and energy, healthy food, pharmaceuticals, sustainable procurement, climate and health, transportation, water.

What should be done?

A report launched at the 2021 Skoll World Forum set out three pathways to decarbonise the sector.

Step 1: Healthcare organisations should decarbonise the fundamentals of their operations, moving towards zero emissions in buildings, infrastructure and healthcare delivery.

Step2: They should use their collective purchasing power to encourage decarbonisation in their supply chain and encourage manufacturers to develop new, reusable products. (As we do at Architectural Wallsz – see our blog on the Circular Economy )

Step 3: This pathway relies on other areas of society. “That might mean transformations across land use and agriculture, energy, infrastructure, transport and housing,” said Sonia Roschnik, of Health Care Without Harm who co-authored the report with consultants Arup.

Although the report looked at the sector worldwide, it also studied individual countries, urging the UK Government to publish a net-zero baseline, roadmap and detailed action map for both the NHS and the private sector as a priority. As mentioned earlier, that is now on the cards for late 2021.

The report also said UK Ministers could do more to join up policy between health regions on decarbonisation, climate resilience, public health and social equality.

Another report, The Green Print, (Advancement of Environmental Sustainability in Healthcare by Jodi D Sherman MD et al released in October 2020) concludes there is an urgent need for research to address the public health crisis from healthcare pollution. It says a vision is required to align research priorities towards a sustainable healthcare system that advances quality, safety and value.

The report focuses on getting to the bottom of unsustainable practices, and it suggests developing a lifecycle inventory database for medical devices and drugs.

Other key recommendations in this report

• Apply sustainability performance metrics at the clinician, hospital/health system, and national levels
• Revise infection control standards driving non-evidence-based uptake of single-use disposable devices
• Increase national research funding (in the US)
• Form a global commission on the advancement of environmental sustainability in healthcare.

Back in the UK, the Chartered Institution of Wastes Management wants to see a wider consideration of the whole system for dealing with health sector waste, something it acknowledges is being approached through the Department of Health’s sustainable development management plan

While it may be true that the sector is only now truly waking up to the problem, it has certainly been on the discussion table for a while.

Research by the King’s Fund published in 2012 (Sustainable health and social care: Connecting environmental and financial performance ) considered how health and social care would need to change to become more environmentally sustainable. Operational efficiencies will not be enough on their own, the King’s Fund report said, calling for a fundamental transformation in service models with more emphasis on prevention, moving care upstream, better co-ordination and focusing on value for patients.

Priorities for health and social care organisations from the King’s Fund

• Developing a more detailed local understanding of the problem through systematic measurement of environmental impacts
• Exploiting the synergies between environmental sustainability and other organisational objectives
• Investing in preventive approaches to reduce demand for formal care
• Exploring the opportunities presented by new technologies such as telehealth and telecare
• Improving medicines management and prescribing practice to reduce inefficient or wasteful use of pharmaceuticals.

The report also urges policymakers to remove barriers that discourage organisations from developing more sustainable approaches and to explore the policy changes needed to create a more enabling environment.

Health sector real estate will certainly be a major target for carbon savings. Going further back to 2001, a report on Sustainable Development in the NHS by NHS Estates emphasised the direct and indirect benefits of a sustainable NHS, including improved working environments, greater cost savings, better service to the community and reduced environmental impact.

For direct benefits, the report states that adopting a sustainable development approach to all aspects of estate management will

• provide a higher quality service
• save money on estate management
• accommodate changing healthcare needs and delivery methods by designing for flexible use, something close to our hearts at Architectural Wallsz as you can see in our isolation pods (pictured)

On indirect benefits, the report points out that the links between environmental and social issues and health are now well established, adding: “It is important to realise that sustainable estate management goes beyond process efficiencies, to include social and environmental initiatives where the financial payback is less direct although not less real.”

But at what cost?

Will tackling climate change come with a big price tag for hospitals? The opposite is true, according to Michael Waller of US healthcare organisation Rochester Health who sets out six key fronts on sustainability that collectively save his organisation nearly US$2.4 million a year.

• Energy systems and conservation
• Sustainable purchasing
• The built environment
• Waste reduction
• Food sourcing
• Community outreach and education

He points out that a typical US hospital has a profit margin of just three per cent so would need to bring in US$80 million more in gross revenues to make the same difference to the bottom line.

 How are things changing?

 According to a paper published in autumn 2020, the healthcare community has low awareness of the effects of carbon emissions on health, and says the sector is only now beginning to recognise its duty to address the issue.

UK policy is moving in that direction, and the NHS figures large in the government’s ambitions set out in the Climate Change Act.

“As the biggest employer in this country, we’re both part of the problem and part of the solution … we are mobilising our 1.3 million staff to take action for a greener NHS.” – Sir Simon Stevens, NHS Chief Executive

In October 2020, the NHS became the first health service in the world to commit to delivering a net zero national health system. The stated aim is to improve healthcare while reducing harmful carbon emissions with top level strategies that include investing in projects to shrink the amount of greenhouse gases in the atmosphere.

To get an idea of the prominence the issue now has in the NHS, just look at the About Us section of NHS England’s website where sustainable development is the top item.

In the march towards zero emissions, the Greener NHS programme is a high-profile initiative. It aims to work with staff, hospitals and others to build on existing work by trusts and share ideas.

Two clear targets are set in the NHS report Delivering a ‘Net Zero’ National Health Service.

• The NHS Carbon Footprint: for the emissions we control directly, net zero by 2040
• The NHS Carbon Footprint Plus: for the emissions we can influence, net zero by 2045.

Other sustainability commitments laid out in the NHS Long Term Plan range from reducing single-use plastics and cutting water consumption to improving air quality.

NHS England has set up a panel of experts to chart a route map to net zero.

Chaired by Dr Nick Watts, of University College London, it will look at changes the NHS can make in its own activities and its supply chain as well as through wider partnerships.

These include its long-term commitment to cut the number of outpatient appointments by up to 30 million by using technology, sparing patients trips to hospital.

It will also look at changes that can be made in the supply of medical devices, consumables and pharmaceuticals as well as other areas that the NHS can influence such as the energy sector through using more renewable energy.

The Panel will submit an interim report to NHS England in the summer with the final report expected in the Autumn, ahead of the COP26 International Meeting in Glasgow.

Meanwhile, NICE, the National Institute for Health and Care Excellence, is exploring how to support the health and care system to promote sustainable implementation of guidance recommendations. This may include publishing environmental impact assessments along with a cost impact assessment for its recommendations. This information would allow commissioners and providers to account for environmental impact at the time of implementation.

How AWallsz can help

Healthcare pods from Architectural Wallsz can be reused and reconfigured to eliminate waste and improve efficiency. They allow estate managers to maximise available space by converting it swiftly and at lower cost than by conventional building methods, which also minimises disruption.

Our testing pods allow for face-to-face consultations between health workers and patients for examinations, vaccinations and other needs with minimal need for PPE, eliminating waste and speeding up the process.

Resources

• Healthcare and nursing pods https://oldaz.clientdevarea.co.uk/covid-19-healthcare-nursing-pods-with-rapid-prefabricated-construction/
• Isolation and segregation pods https://oldaz.clientdevarea.co.uk/healthcare-isolation-and-segregation-pods/
• Face-to-face healthcare vaccination, testing and examination pods https://oldaz.clientdevarea.co.uk/healthcare-isolation-and-segregation-pods/covid-testing-pods/
• Resources available from the NHS SDU: These explain general principles of environmental sustainability and show case studies of how commissioners and providers have reduced the environmental impact of their operations. http://www.sduhealth.org.uk/delivery/plan.aspx