Roadmap to sustainable health care

THE climate crisis is a health emergency contributing to trauma, illness and death, as the summer of 2019–20 starkly demonstrated with hundreds of deaths and thousands of hospital admissions from unprecedented bushfire smoke.

Yet the health care sector is part of the problem, contributing to an estimated 4–6% of global greenhouse gas emissions and 7% of Australia’s total carbon footprint. This global carbon footprint is equivalent to the emissions from over 500 coal-fired power plants, or if the sector were a nation, it would be the 5th largest emitter.

Health care, which exists to maintain and improve health, has an imperative to change its practices and be part of the solution.

The Australian Medical Association (AMA) and Doctors for the Environment Australia (DEA) have recognised the sector’s leadership role and, in March 2021, they called for the Australian health care sector to reduce its significant emissions – 80% by 2030 and net zero emissions by 2040 – in line with meeting the 1.5°C Paris Agreement target.

More recently, Health Care Without Harm (HCWH) released a comprehensive tool to assist the health sector to address its large footprint. Their Global Road Map for Health Care Decarbonisation highlights how every country and every sector will be required to do their part in protecting health from climate change, and how the health sector must become climate-smart, by “charting a course toward zero emissions that is inextricably linked with building resilience and meeting global health goals”.

Specifically, countries with the highest per capita health care emissions have an added responsibility to address their emissions the most quickly and comprehensively. Australia (along with Canada, Switzerland and the US) fits into this category.

Three overlapping decarbonisation pathways and seven high impact actions are identified in the HCWH Road Map.

The Decarbonise Pathways require:

1. decarbonisation of health care delivery, facilities and operations;
2. decarbonisation of health care’s supply chain; and
3. accelerated decarbonisation of the wider economy and society.

In practice, the first pathway means ensuring all new and refurbished health care facilities are net zero emissions, such as the planned Canberra Hospital extension, which will be all electric and powered by renewable energy.

The second pathway is about influencing supply chains across the sector. Scope 3 emissions that result from the supply chain of goods and services that are not owned or directly controlled by an organisation are a significant part of health care’s carbon footprint (consistently over 60% of emissions) and need to be included in emission reduction targets.

For example, England’s National Health Service (NHS), with over 80 000 suppliers, is using its purchasing power by announcing that before the end of the decade they will no longer purchase from suppliers that do not meet or exceed their net zero commitment, and AstraZeneca has committed to becoming “carbon neutral” across its entire value chain by 2030.

The third pathway focuses on the importance of decarbonising society and the energy sector. As fossil fuel combustion is estimated to contribute to 84% of global health care’s emissions, health care cannot meet net zero emissions without a transition to a decarbonised economy.

The seven high impact actions in the HCWH Road Map are similar to those recommended in DEA’s Net zero carbon emissions: responsibilities, pathways and opportunities for Australia’s healthcare sector report, which was launched in December 2020:

• power health care with 100% clean, renewable electricity;
• invest in zero emissions buildings and infrastructure;
• transition to zero emissions, sustainable travel and transport;
• provide healthy, sustainably grown food;
• incentivise and produce low carbon pharmaceuticals;
• implement circular health care and sustainable waste management; and
• establish greater health system effectiveness.

Sectorial action alone is not enough to address the health care sector’s sizeable emissions. The HCWH Road Map also calls for governments to develop national and subnational road maps and action plans for health care decarbonisation.

Although several health services are taking the lead in Australia, such as Uniting Care Queensland and New England and Hunter Local Healthcare District, Australia has at any government level to lead and coordinate metrics, innovation, improvement initiatives and collaboration.

Establishing an Australian Sustainable Healthcare Unit is necessary to advancing standardised and consistent measurement of health sector emissions (it’s hard to change what is not being measured), mapping evidence-based approaches to emissions reductions, and achieving nationwide health sector outcomes. The AMA, the Royal Australasian College of Physicians, the Climate and Health Alliance, DEA and the Climate Health WA Inquiry have all proposed such a unit.

As health professionals there is not only a duty of care but also an opportunity to lead and embrace the necessary changes to protect health and “help the sector chart a course to reinventing itself and providing societal leadership in the age of climate change” (page 26). Charting a low carbon pathway for health care provides many opportunities within the sector for improved quality of care (promoting effective care pathways), financial benefits (greater efficiency of resources) and maximising the co-benefits that low carbon, energy, transport and dietary pathways can deliver (health benefits from decreased air pollution, increased physical activity and increased plant-based diets).

The time to act is now. With global health care’s footprint estimated to triple by 2050 without appropriate action, business as usual is not an option. We need to get our “own house in order”.

Dr Eugenie Kayak is an anaesthetist and the convenor of Doctors for the Environment Australia’s Sustainable Healthcare special interest group.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.