Decarbonizing health care — lessons from COP29

At climate conference COP29, a valuable but somewhat overlooked aspect of climate action took center stage: The need to decarbonize health systems. Responsible for an estimated 5% of global greenhouse gas emissions, the health care sector is a surprising yet significant contributor to the climate crisis — and therefore both indirectly, and directly, to a range of communicable and noncommunicable, or NCD, diseases.

Health impacts of climate change include worsened NCD outcomes such as heart disease and diabetes, increased respiratory illnesses due to poor air quality and wildfires, rising heat-related deaths, and mental health challenges such as eco-anxiety. Climate shifts also expand the reach of vector-borne diseases such as malaria and dengue, and reduce water availability.

With climate change threatening global health security, health care systems are facing mounting pressure to reconcile care delivery with environmental sustainability. Against this backdrop, the NGO Health Care Without Harm, or HCWH, Europe convened a COP29 session titled “Healthcare Emissions and Net Zero Roadmaps: Methodology and Lessons Learnt from Health Leaders.” Held at the World Health Organization’s Health Pavilion, the session brought together experts and policymakers to explore actionable strategies for reducing health care’s carbon footprint.

Ultimately, the message was clear: Start with what’s feasible — whether that’s greening a supply chain or piloting renewable energy projects — and scale from there. It’s less about focusing on achieving net zero, but rather near zero, according to Agnes Björn, sustainability strategist at Region Stockholm in Sweden.

“It’s something that doesn’t happen overnight. … When you start, the expectation needs to be that you won’t get perfection right away. The reality is that … you will either be missing data or there [won’t] be precision in the information that you get and you will likely have to work with estimates … and we have to be okay with that,” said Diana Picon Manyari, international climate director at HCWH.

Tackling NCDs

NCDs, such as diabetes, cardiovascular diseases, and cancers are among the leading causes of death globally. Decarbonizing health care systems could have benefits for NCD prevention and management.

Speaking to Devex, HCWH’s Picon referenced the Lancet Countdown’s 2023 report, which calculated that health care-associated pollution from ozone and fine particulates — which can increase the risks of heart disease, asthma, and low birth weight — contribute to about 4 million years of healthy life lost per year.

Picon mentioned metered-dose inhalers as a key example of something commonly used in health care that contributes to NCDs. Inhalers release hydrofluorocarbon propellants, which are greenhouse gases that can contribute to climate change and air pollution. “As a user of inhalers during my childhood living in Lima, Peru, this really spoke to me. … The fact that the medicine we use to treat a respiratory condition negatively affects our respiratory health — it is just wrong.”

She said health systems in the global north are already transitioning to more environmentally friendly inhaler options, and low- and middle-income countries could adopt similar practices. However, she noted that discussions around decarbonization in health care often focus too heavily on resource constraints. “I think we get really stuck in the conversation about resources — in fact, many health systems, including those in LMICs, have found that decarbonization measures can be cost-saving.”

She added that while some initiatives require upfront investment, such as solar panels, they often deliver significant returns over time. For instance, Sierra Leone has replaced diesel generators with solar panels in some health facilities — which has reduced costs, improved rural health care access, extended clinic hours, created jobs, and strengthened community ties, Picon shared.

Another key misconception in climate and health discussions is the tendency to view climate resilience in health care as separate from efforts to reduce carbon emissions, she said. This siloed thinking prevents health systems from preparing for the impacts of climate change and addressing its root causes. “Resilience should not equal adaptation, but rather, it is a state that could be achieved by both adaptation and mitigation actions.”

Belgium: Data as a catalyst for action

Three years ago at COP26, Belgium — alongside 50 other nations — committed to creating a low-carbon, climate-resilient health care system. After the summit, a working group was established as part of the country ministries’ National Environment and Health Action Plan framework.

Among its initiatives was a project with HCWH Europe and sustainable development consultancy Arup on Operation Zero to measure emissions. The study provided a breakdown of the carbon footprint of Belgium’s health care sector, which amounted to 9,901 kilotons of CO2 emissions as of 2022, shared Bram Lefever, NEHAP coordinator, during the session.

Lefever reported significant data gaps in measuring emissions; however, the research suggested that the supply chain accounts for the majority of emissions. Within the health care supply chain, pharmaceuticals, with 31%; medical equipment/instruments, with 14%; and food/catering, with 8%, were the leading contributors. The study also found that hospitals accounted for nearly 55% of health care emissions — with 90% of those emissions stemming from the supply chain.

Using this data, Belgium plans to map current efforts across institutions to replicate successful practices. This will be followed by “test-running” initiatives such as the 2023 collaboration with the University Hospital of Ghent, which evaluated the sustainability of common hospital products.

The UK’s National Health Service: Setting an example

U.K.’s National Health Service’s ambitious Delivering a Net Zero plan is setting a global benchmark for decarbonizing health care systems. Comprising 5% of the country’s emissions, and nearly 40% of the U.K. government’s public sector emissions, NHS aims to achieve net zero by 2040 for the emissions it directly controls — and by 2045 for the broader emissions it influences.

Hiten Patel, head of strategy at Greener NHS, went over some of the components of the strategy, including transitioning to a zero-emission fleet by 2035, excluding ambulances — which comprises about 20,000 vehicles. “Roughly 3 in 100 cars at any one time are to do with the NHS, that might be patients [or] staff,” he said.

Medicines make up about 25% of NHS’s emissions, with 5% of direct emissions coming from inhalers, nitrous oxide, and anesthetic gases. Moving forward, Patel said there will be a shift to alternatives with lower global warming potential, such as Total Intravenous Anesthesia, known as TIVA, which is a general anesthetic technique that does not involve inhalation.

Sustainable procurement policies are another focus. NHS will leverage its buying power, requiring carbon reduction plans and annual emission disclosures for contracts over £5 million (about $6.3 million).

Last but not least is a switch to renewable energy. Since 2020, around £1 billion has been invested in heat decarbonization and energy efficiency measures, said Patel. Hospitals across the U.K. are presenting renewable energy sources such as heat pumps, solar panels, and solar farms.

Spain: Early steps toward greener health care

Spain’s health care system, while less advanced in decarbonization efforts, is making incremental progress toward its 2050 carbon-neutral goal. Initiatives under “Sanidad #PorElClima”, or health for the climate, include a carbon footprint calculation tool that is used by nearly half of its almost 600 hospitals, Philippine Ménager, Sanidad #PorElClima project officer shared during the session. However, implementation remains fragmented — and a challenge — across the country’s 17 autonomous regions, she said, adding that a cohesive national strategy is needed to accelerate progress.

Policy implications from Region Stockholm

Björn spoke about several policy implications in Region Stockholm, Sweden. Among recent learnings in the region was better-integrated sustainability — moving away from separate environmental, social, and economic sustainability policies. Another key lesson, Björn explained, is “we need to get away from overconsumption”, particularly in health care, where unnecessary tests, treatments, and procedures contribute to emissions. Third, rather than focusing solely on achieving “net zero,” Region Stockholm is shifting toward a “near-zero” mindset, focusing on the reduction of emissions wherever possible and actionable steps, Björn said.

Moving forward: Starting small, thinking big

Looking ahead, Picon called for more research to explore how adaptation and mitigation actions can complement each other and result in further resilience. “It would completely change the conversation, particularly in low-resource settings,” she said.

Picon also emphasized a number of takeaways, including that decarbonizing health care isn’t about perfection, it’s about progress. She also highlighted the broader scope of sustainability beyond simply reducing emissions. While emissions reduction is often the primary focus in climate discussions, waste reduction and improving efficiency within health systems are equally important but tend to be overlooked.

Lastly, Picon emphasized the need for collective action, noting that no single country or system can tackle this challenge alone. She advocated for knowledge-sharing and urged civil society and the private sector to consider how they can better support governments in these efforts.

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