The healthcare sector has been under enormous strain over the last 18 months, with COVID-19 contributing to over 4 million deaths.

The impacts have been significant across the world, but particularly in lower-income countries where vaccine distribution has highlighted the inequality in healthcare. In high-income countries one in four people have been vaccinated, but the ratio drops precipitously to one in 500 in poorer countries.

But it’s not just COVID that healthcare is battling. It must also urgently confront the challenges of climate change. Not only is the sector responsible for 4.4% of global emissions but it is significantly exposed to climate change: 9.4% of all deaths over the last 20 years have been attributed to it.

If the sector takes no additional action, sector emissions will triple by 2050 and WHO predicts 250,000 additional deaths a year between 2030 and 2050 will be attributable to climate change. The impacts of climate change will be felt by everyone, but children living in poor countries and countries with weak health infrastructure are particularly vulnerable. The climate risk index, for example, shows that 70% of the ten countries most impacted by extreme weather events are among the least developed.

Healthcare climate mitigation strategy

In light of the sector’s emissions (if it were a country it would be the fifth highest emitter) decarbonizing will be critical to reaching net zero by 2050 at the latest. We believe the following actions can aid the sector on this journey:

Make bold commitments: setting and committing to bold targets creates the grounds for developing a decarbonization roadmap for health systems. The NHS’ commitment to becoming net zero by 2045, including its global supply chain, is one of the most ambitious commitments to date in the sector. Further countries and healthcare systems are following suit, including the PSG institute of Medical Sciences and Research in India and the Western Cape Government Health organisation in South Africa, both making science-based net zero commitments.

Leverage private – public collaboration: as the sector has major state and non state actors, collaboration is key to delivering climate mitigation. Effective collaboration has been demonstrated with the COVID vaccination rollout across the globe, epitomized by Bhutan vaccinating 93% of its adult population in just 16 days. Similar coordination and alignment of priorities can be leveraged in tackling the healthcare emissions, especially given high rates of state involvement.

Mobilize cross sector system changes: given the scale and cross-cutting nature of the sector, decarbonization requires engagement with multiple industries such as agriculture, power, and gas. By leveraging healthcare’s large buying power, the sector can promote sustainable production and innovation across their supply chain. Colombia has demonstrated this through recent shifts towards reusable gowns reducing a hospital’s CO₂ emissions by 5.43 tonnes/CO₂e per month and saving $82,700 per month.

Improve sector efficiencies: large disparities in expenditure exist between countries with relatively similar coverage. For example, Chile has less than half of Cuba’s Expenditure PPP but more Universal Health Coverage (UHC). This signals opportunity for efficiency gains to reduce emissions while improving coverage. To improve efficiencies, we can focus on two principal ways: (1) preventing avoidable demand, (2) innovating supply (3) enhancing effective health promoting models of care. An example of the latter would be Chile, where in response to COVID they ramped up telemedicine to provide more than 6,000 remote services, reducing transport needs which are responsible for 4.5% of global healthcare emissions.

Establishing a resilient global healthcare sector

A climate resilient healthcare system is one which can continue to improve the effective provision of healthcare even as impacts of climate change increase. The Global Souths’ recent difficulties in responding to the pandemic has highlighted its potential exposure to severe climate risks. This disparity requires healthcare systems to adapt to protect the most vulnerable communities.

To become resilient to these risks, WHO outlines four key areas to improve:

1. Equip healthcare workforce for climate resilience: Ensuring adequate numbers of skilled human resources with decent working conditions are empowered and informed to respond to these environmental challenges. WHO has developed guidance to aid health care systems to identify a national strategy and roadmap to ensure climate resilience
2. Establish water, sanitation, hygiene & healthcare waste management: Incorporating sustainable and safe management of water, sanitation and health care waste services. Nepal has demonstrated smart waste management via waste segregation, autoclave treatments and recycling initiative. In addition to reducing emissions, hospitals with these systems could continue treating waste after a 7.8 Gorkha earthquake in 2015.
3. Utilize renewable energy: Establishing a reliable supply of sustainable energy that is used efficiently with limited environmental impact. Solar4health is an organization aligned with this mission, providing solar electrification of 34 remote primary healthcare centres in Nigeria, benefiting 25,000 people and producing over 1.75MWp of clean energy.
4. Develop infrastructure, technologies & products: Adopting climate resilient and low impact infrastructure, technologies, products, and processes. Somerset hospital, South Africa, implemented a system that recovered energy from autoclaves which saves 5000 litres of water per day and produced electricity savings of $15,000 per year.

Call to action

All actors in the healthcare sector have a role to play in mitigating and adapting to risks of climate change. They can do this by:

1. Measuring emissions: healthcare systems can begin their journey by establishing an emissions baseline. This can be done through Health Care Without Harm and Global Green and Healthy Hospitals’ Climate Impact Checkup tool.
2. Understanding the status: to take into account geographical and socio-economic differences, use the tool to benchmark the footprint to similar facilities.
3. Establishing the north star: join the Race to Zero through Health Care Without Harm and make a bold commitment to halving emissions by 2030 and becoming net zero by 2050 at the latest, in line with the Paris Agreement’s 1.5 degree pathway.
4. Developing a plan and start actioning collaboratively: create a plan to get to the north star, and start implementing as soon as possible. Work with the wider network of over 3,000 hospitals and 40 healthcare institutions already in the Race to bring the whole sector to net zero.

Acknowledging country differences

In Health Care Without Harm’s decarbonization road map, the climate action strategies outlined differ depending on the country due to varying responsibilities and capabilities. They outline the following differences for decarbonizing healthcare systems:

• High-income countries whose health systems are most responsible for global health care emissions (per capita and historically), need to act most quickly and take the greatest responsibility for addressing the climate crisis.
• Middle-income countries must invest in health system development that takes them on a pathway to zero emissions and avoids replicating the carbon-intensive health delivery model of wealthier countries.
• Low-income countries need to deploy low-carbon and zero emissions technology that enhances their ability to develop their health systems and provide health access and services to all.

Climate change is a humanitarian crisis inextricably linked with healthcare and it is vital that governments, and health actors across the industry, take the necessary steps to ensure climate mitigation and resilience.

Gail Sucharitakul is Health Sector Lead, Climate Champions. Jamie Hardy is Health Sector Support, Climate Champions.