The healthcare sector has been at the forefront of managing the fallout of the climate crisis as it unfolds globally. With altered disease patterns, rising heat and air pollution-related illnesses and increased vector-borne diseases among other issues, health professionals and the sector as a whole have had a ringside view of how climate change is impacting human health. However, as the climate crisis starts taking a toll on human health, it has been equally instructive for the health sector to also better appreciate its own footprint and contribution to climate change. The 2022 Lancet Countdown report on climate change highlights the impact of the healthcare sector on global emissions. The report indicates that the total emissions footprint of the global health sector is 5.2% or 2.7 GtCO2e of total global emissions, while contributing to 10% of global GDP. Additionally, the extensive use of anaesthetic gases, single-use plastics, generation of biomedical waste, and a poor substitution uptake of renewables makes the issue more germane. This current footprint, along with a likely increase, and with countries and health systems across the world rightly expanding health services, the eventual climate impact of this sector in the decades ahead will only increase.

The issue has not gone completely unaddressed across the world. The UK’s NHS and the Department of Health and Human Services in the US have given clear reduction and net-zero targets for their health institutions. Similarly, the Race to Zero initiative by the United Nations Framework Convention on Climate Change has seen a wide uptake from hospitals and health systems from across the world. The developing world, where the impact of climate change has been felt most acutely, too has initiated steps on decarbonisation and sustainability. India’s federal Health Ministry has a taskforce operating the National Program on Climate Change and Human Health, which is undertaking capacity building, awareness, and mitigation approaches across the vast public health system in the country. The not-for-profit sector has also played a pivotal role in building global coalitions on healthcare sustainability – notable examples include Health Care Without Harm and India Health and Environment Leadership Platform. Along with this, the global movement towards sustainability standards, ESG reporting, risk management frameworks, and larger stakeholder minded corporate compliance standards have all driven decarbonisation into the private health sector globally. These measures augur well for the decarbonisation journey, one which needs to accelerate the pace of adoption and action in the years ahead.

As we approach healthcare sustainability and decarbonisation, it is pertinent to understand the key contributors to the emissions inventory in a typical hospital. Studies by the UK’s NHS indicate that 24% of emissions are through delivery of care, which includes energy use, procurement of pharmaceuticals and chemicals, use of medical equipment, and materials such as anaesthetic gases and metered dose inhalers. Add to that another 10% of emissions, which are contributed by patient and visitor travel to hospitals and through staff commutes. Most of the emissions, however, come from the supply chain, averaging at 62% of the total carbon footprint. Of this, pharmaceuticals, chemicals, and medical devices make much of the emissions inventory, with non-medical equipment, food and catering, and business services such as indemnity insurance bringing up the rear.

Indian healthcare offers slight variations but are broadly in line with global peers. As per a 2019 report by Health Care Without Harm and ARUP, on an average 8% of total emissions in Indian healthcare are attributable to direct emissions, i.e., those generated through operational emissions. A further 11% of emissions come from indirect emissions, those from purchased energy sources for a hospital or health centre. Almost 81% of the emissions are through the supply chain which includes emissions on account of manufacturing, transport and storage of pharmaceuticals, medical devices and chemicals, transport, and business services. As Indian healthcare becomes more mature in the years ahead, it may start to mirror the emissions inventory of the rest of the world, but the skew towards most emissions coming from the supply chain is likely to remain unchanged.

These figures offer invaluable insights for the sector to create high-impact strategies towards decarbonisation and sustainability. Technology will – and is – playing a critical role in this mission. Many hospitals in the United States have made a concerted shift towards attaining net-zero trajectories over the past decade. Health systems such as Kaiser Permanente, Harvard University, and the University of California Health have clear net-zero targets which blend the use of technology along with reduced consumption to achieve their stated goals. The use of concrete with low embodied carbon, mass timber, and optimising passive performance through design techniques that reduce thermal mass have been used in hospital builds over the past decade. Similarly, the use of waste processing by converting to energy has been used across multiple hospitals in the UK and Europe. Additionally, the increased use of renewables and electrification or de-fossilisation of the energy grid and consumption has become standard practice for hospitals in the US and the UK. With purchased electricity and fuel consumption driving emissions in healthcare, these measures have been critical in making meaningful progress on decarbonisation.

Technological interventions for decarbonisation – both incremental and exponential – are making their way into Indian healthcare. Starting from the switch to LED lighting to more sophisticated automated Building Management Systems (BMS), Indian healthcare is witnessing a move towards efficiencies. Mandatory building design codes are also shaping the manner and adoption of technologies such as solar panels, rain water harvesting, and effluent treatment for waste water, which are being increasingly seen in hospitals. Similarly, Indian healthcare is moving towards green building design and LEED certification in order to ensure the appropriate and efficient use of material and resources. Apart from the building environment, the use of energy efficient technologies such as reusing of water for horticulture and in the HVAC system, motion detectors for lighting, waste processing on site, and procurement of low-carbon intensive materials are all underway. As stated above, purchased electricity through the grid constitutes a major portion of the emissions in any healthcare setting. The government’s move to decentralise power purchase and the introduction of power markets has ensured an increasing trend in the purchase of energy generated through renewables.

Apart from engineering and design solutions, many technologies to adequately capture the emissions and carbon footprint have made their way across health systems. SaaS-based software that can tabulate and assess various emissions and waste generation is increasingly being used by hospitals. Some of these tools are being made available to low- and middle-income countries through the World Health Organisation (WHO), in partnership with organizations such as the Aga Khan Health Services (AKDN). These tools will be invaluable as health systems take initial steps on decarbonisation.

An area that requires major focus in the years ahead will be that of providing adequate and appropriate product substitutes used in clinical care. Lack of standardisation or unavailable safety profiles of many low-carbon consumables and medical devices has led to their slow pace of uptake across health systems. Add to this is the spectre of greenwashing, and the felt need for regulation and standards for healthcare supplies does not seem unreasonable. Only when progress on this is attained, will clinicians and healthcare workers embrace the newer products that are made available to them.

As with sustainability and decarbonisation the world over, the need for deep partnerships and collaboration between healthcare providers, suppliers, climate scientists, medical device and pharmaceutical manufacturers, and policymakers and administrators is required. Climate change knows no boundaries, and the artificial silos that a sector creates within its own spectrum will impede progress. Slow progress is a luxury that no health system or country can enjoy.

Dr. Karan Thakur – Vice President, Sustainability & Public Affairs – Apollo Hospitals