Greener healthcare - a shared challenge

This November, Glasgow will host the international COP26 UN climate summit. UK Government has a strong ambition to use its Presidency to drive global commitment to net zero targets. Pressure is on companies of all sectors and sizes to join Race to Zero, the campaign to rally support from global businesses, cities, and investors for a healthy, resilient, zero-carbon recovery. The green economy is fundamental within the UK narrative of Build Back Better – and the economic and social benefits of decarbonised and more efficient healthcare systems are critical to this.

The interaction between health and climate change is well documented – the World Health Organization (WHO) predicts that it will have an “overwhelmingly negative” impact on the world’s health. ^[1] The last year also served as a sharp reminder that climate and health inequalities often go hand in hand. More than 50 million people were hit by both climate-related disasters (floods, droughts and storms) and the COVID-19 pandemic, resulting in worsened food insecurity and compounding risk to evacuation and relief operations.^[2]

At present, many solutions to climate impacts on health have an emissions cost. Analysis has suggested that combined CO2 emissions from hospitals, health services and medical supply chains across the OECD group of market economies plus China and India comprise 4% of total global emissions footprint – greater than aviation or shipping. In England alone, the NHS footprint equated to 5.4% of the country’s carbon emissions for 2019.^[3]

For the wider healthcare system, opportunities for change lie in areas such as building efficiency and waste reduction – where potentially recyclable high-quality waste products in operating theatres are largely labelled as infectious clinical waste and incinerated at high financial and environmental cost.

Hospitals have also been exploring retrofitting heat recovery technology to dialysis machines, and switching operating room anaesthetics (which account for almost a third of the UK’s health and social care sector emissions) to less-polluting gas. In England there are also plans for delivery of London’s first prototype hydrogen fuel cell ambulance later this year, in addition to rollout of electric ambulances in other regions. Meanwhile the introduction of a new Chief Sustainability Officer’s Clinical Fellow Scheme aims to  embed green innovation from within the system.

This NHS momentum is underpinned by ambition to reach net zero for its direct emissions by 2040 set in October 2020, making it the first healthcare system in the world to set a net zero target. Accompanying this is a net zero target for supply chains (NHS Carbon Footprint Plus) by 2045 – with an 80% reduction pathway for 2036-39. This will encompass everything from medical devices, medicines, and manufacturing (including chemicals and gases).

The message from the Greener NHS report is clear: suppliers must meet or exceed their commitment on net zero emissions before the end of the decade. The potential for this thinking to permeate into other markets is strong – particularly with the Green Deal driving thinking across the EU –and could have wide ranging implications for access criteria for new medical devices and medicines.

Strong cross-industry effort will be needed. In 2015 the global pharmaceutical industry produced 55% more CO2 than the automotive industry.^[4] A huge amount of work has been undertaken since then to decarbonise manufacturing and product design – from reusable, propellant-free inhalers to exploration of biotechnology in medicine production processes. Yet so much of the pharmaceutical sector’s ability to deliver rests upon driving change in its own wider supply chains.

Three core approaches will help support this shift:

1. Pharmaceutical companies taking still greater responsibility for their own suppliers via procurement processes - upping renewable energy, pressing greater reduction of water consumption, or facilitating circular economy thinking on plastics.
2. Holding governments to account around supporting longer-term infrastructure: for example, hydrogen for powering manufacturing plants and forgreen steel for healthcare products.
3. Ensuring health system innovation is future-proofed: such as tackling the data centre emissions challenge of digital health.

There are many reasons to be optimistic about meeting the ambitious targets. Trends have shown that focused efforts can deliver on decarbonisation, while crucially maintaining economic growth and expansion of service. In the NHS emissions from health and social care were cut by 18.5% between 2007 and 2017, despite clinical activity rising by over a quarter over the same period. ^[5]

While the climate challenge may be international, the reputational risk for companies is much more local. There is an increasing imperative for companies to forge a UK corporate story on net zero and to adopt initiatives that show clear action at a market level, rather than just within global teams. Working on low carbon energy within government, I have seen first-hand that seismic shifts in decarbonisation occur when industry holds suppliers to account and partner with wider sectors. Now is the time for the pharmaceutical industry to take its place in vocal leadership to green its future and communicate to the NHS and others that it is part of the solution.

^[1] Who.int. (2019). Climate change and health. https://www.who.int/en/news-room/fact-sheets/detail/climate-change-and-health [Accessed 5 May 2021].

^[2] IFRC World Disasters Report 2020 (Accessed 5 May 2021)  https://media.ifrc.org/ifrc/wp-content/uploads/2020/11/20201116_WorldDisasters_Full.pdf

^[3] Figure 2 from: NHS England and NHS Improvement. Delivering a Net Zero National Health Service. 2020. (accessed 1 May 2021] https://www.england.nhs.uk/greenernhs/publication/delivering-a-net-zero-national-health-service/

^[4] International comparison of health care carbon footprints: Peter-Paul Pichler, Ingram S Jaccard, Ulli Weisz and Helga Weisz, Published 24 May 2019 (Accessed  4 May 2021) https://iopscience.iop.org/article/10.1088/1748-9326/ab19e1

^[5] NHS Long Term Plan (Accessed 4 May 2021) https://www.longtermplan.nhs.uk/online-version/appendix/health-and-the-environment/