How Australia’s medical colleges can lead our health care sector to net zero

Specialist colleges and societies have a critical role in guiding the health care sector’s transition to a lower emissions future.

As climate change and associated extreme weather events continue to affect Australia’s health care system, it is imperative that every doctor and health service is aware of, and upskilled in, managing the changing clinical demands. Further, the health care sector has a responsibility to limit its own greenhouse gas emissions, and colleges can play a key role.

First, let’s provide a bit of context. If the global health care sector were a nation, it would be the fifth largest emitter, responsible for over 4% of global greenhouse gas emissions. Australia’s health care sector is one of the largest per capita emitters (alongside the United States, Canada and Switzerland), contributing to an estimated 35.8 million tonnes of carbon emissions annually, equivalent to over 7% of Australia’s total carbon emissions.

Clinicians are responding to the challenge and leading positive change. For example, the Royal Melbourne Hospital (RMH) ran an environmental sustainability competition in 2022, resulting in 14 clinical and non-clinical entries with significant financial and carbon savings. One of these projects was led by the RMH’s emergency department Choosing Wisely team and reduced unnecessary arterial blood gases and coagulation testing, saving $250 000 annually.

There have been significant steps forward at national and state levels over the past 12 months to enable the health sector to urgently address its contribution to the climate crisis. It is pleasing to see both state and federal governments step up their efforts to support clinicians to decarbonise the health sector. The National Health Sustainability and Climate Unit was formed in 2023 in the federal Department of Health and Aged care, and state-based health and climate units have now been formed in Western Australia, New South Wales, Queensland and Victoria.

In December 2023, Australia’s first National Health and Climate Strategy was released, highlighting a whole-of-government plan to address the health and wellbeing impacts of climate change and our health system’s carbon emissions. The Australian Commission on Safety and Quality in Health Care (ACSQHC) has also released a draft Environmental sustainability and climate resilience healthcare module, that includes health services educating and supporting sustainable health care initiatives, and an increased focus on value-based care. This is an important step towards embedding environmental sustainability as part of business-as-usual for health care delivery rather than an optional add-on.

In 2023, the Australian Medical Council (AMC) released updates to the training standards for medical schools and teaching hospitals, recognising the health impacts of climate change and the need for environmentally sustainable health care delivery. Specialist colleges’ standards will also soon be required to align to new training standards.

Advocacy group Doctors for the Environment (DEA) and the Australian Medical Association (AMA) have been working together for several years to advocate for a net zero Australian health care sector. After their first conjoint DEA/AMA annual webinar “Climate change and sustainability: leadership and action from Australian doctors”, they developed the GreenCollege guidelines in recognition that, although some colleges were engaged in efforts to improve sustainability in the healthcare sector, there were inconsistent approaches, gaps in what was being addressed, and an appetite for guidance on how environmental sustainability could be best embedded into college activities. Colleges and societies that have since endorsed the guidelines include the Royal College of Surgeons, who were the first. The National Health and Climate Strategy has also recognised the GreenCollege guidelines as a driver of action to reduce greenhouse gas emissions from the delivery of care.

Importantly, the majority of health sector emissions are derived from clinical care pathways. Colleges and societies can play a critical role in:

• leading the development of specialty-specific low carbon care pathways;
• reducing low value care;
• providing specialty-specific education; and
• demonstrating leadership by decarbonising their own activities, such as reducing emissions from annual scientific conferences, which have a significant carbon footprint.

The release of the National Health and Climate Strategy, the updated AMC education standards and the ACSQHC Environmental sustainability and climate resilience healthcare module make it clear that environmental sustainability in health care is no longer an add-on activity. If colleges and societies are to remain relevant leaders of the medical profession, they need to act now to urgently reduce the environmental impact of the health care sector, while preparing our workforce for the increasing health impacts caused and exacerbated by climate change.

Furthermore, it is the responsibility of all medical, nursing, allied health and interprofessional health bodies to advocate for net zero health care by 2040 and adopt actions, such as those outlined in the GreenCollege guidelines, to identify and help reduce the environmental impact of their own activities, as well as the broader health sector, and prepare their members for the health impacts of climate change that are already being seen in Australia and internationally. The time is now.

Dr Sonia Chanchlani is a Sustainability, Climate and Health Senior Fellow in at the University of Melbourne and a Board Director for Doctors for the Environment Australia.

Dr Ben Dunne is a specialist thoracic surgeon at Royal Melbourne Hospital and a co-chair 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 necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated. 

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