Climate change has been declared a public health emergency in the 21st century. Hospitals, healthcare centres and health services are responsible for protecting health, treating patients, and saving lives from the effects of climate change. However, health care systems, particularly those of high-income countries, are driving up carbon emissions while delivering care, and procuring products and services. Therefore, healthcare systems are facing a dual challenge of dealing with health impacts of climate change and reducing their own emissions.
The direct, indirect and social impacts of climate change result in a number of human diseases. As the disease burden increases there will be more pressure will be placed on health systems to provide a greater number of services. Ultimately causing the health systems to consume more energy and resources resulting in more emissions impacting the changing climate. To put things in perspective, if the entire global health system were a country, it would be the fifth largest polluter on Earth. And if nothing is done about it the healthcare emissions could triple between now and 2050.
All countries will experience significant and growing climate change impacts. However, Australia faces greater impact of climate change than many other parts of the world. Therefore, despite being a developed country, Australia is at most risk from a range of adverse climate change impacts. Health systems contribute to climate change through greenhouse gases. And ‘scopes’ help us categorise these emissions on basis of their source.
Scope 1 emissions include all the fossil fuels burned on site this is e.g., the gas in company cars or fuel to power the equipment. Scope 2 emissions are associated with purchased electricity, steam for heating and cooling purposes. It’s indirect because the energy is generated offsite. These two categories of emissions are easy relatively easy to control by – transitioning to renewable energy. However, the biggest hurdle is, Scope 3 emissions. These include all other emissions in the company’s supply chain. There are about 15 categories of scope 3 emissions, they are difficult to measure, and they constitute about >70% of healthcare’s share of emissions.
In Australia, the healthcare sector produces approximately 7% of national carbon emissions with public and private hospitals being the highest contributors. Healthcare can reduce its footprint by reducing carbon dioxide and eventually eliminating them through the process of decarbonisation.
At present in Australia and Victoria there is increased focus on transitioning to renewable energy, energy reduction and efficiency initiatives, this largely addresses Scope 1 and 2 emissions, which is only ~30% of the health sector footprint. More than 70% of the problem that is scope 3 emissions yet remains.
We conducted a desktop review and found out that while previous research studies have been done on action areas to reduce scope 1 and 2 emissions such as transitioning to renewable energy, there is now increasing recognition of this transition on scope 3 action areas. My PhD research focuses on identifying the scope 3 co-benefits of renewable energy when a hospital transitions to being renewably powered.
To reduce Scope 3 emissions, we need to consider health system as a whole as they are highly complex and diverse organisations. Implementing sustainability related changes such as reduction of scope 3 opportunities is a complex problem because multiple factors are involved and these factors are not directly related. This research will adopt a systems dynamic approach to help us to identify interconnections between these factors.
Some of the potential solutions identified from literature are summarised in the table below.
An example is to reduce emissions from Scope 3 action such as medical equipment is – In Renewably powered health services there could shift from single use to reusable instruments by some infrastructural changes such as using large washers for sterilisation purposes. This could have multiple benefits in terms of costs and environmental outcomes. This can also have flow on advantages for waste reduction – another scope 3 opportunity.
Another opportunity to reduce emissions from staff and patient travel another scope 3 action area is increase EV charging stations in renewably powered health services – this can promote staff uptake of EV.
|Scope 3 Reduction Opportunities||Example actions to reduce scope 3 emissions in Renewably Powered Health Services|
|Medical Equipment||Relevant Peer Reviewed Literature & Documents|
|Infrastructural changes for sterilization
Optimising decontamination of reusable equipment through large washers (Rizan et al., 2021)
|Staff and Patient Commute||Health Service Plans|
|EV charging stations at hospital sites
Increased EV charging stations within renewably powered health services to reduce scope 3 emissions associated with staff and patient travel. (NHS Berkshire Healthcare., 2022)
|Waste||Policy and Planning Frameworks|
|Waste reduction – flow on advantage of renewable energy
Shift from single use to reusable instruments with flow on advantages for waste reduction (Doctors for Environment, 2022)
Dr Nick Watts, the first sustainability officer employed by the UK’s National Health Service says, “the problem seems so enormous that it’s disempowering. And what can individuals do? In truth, individuals can make all the difference.”
Transformational change often does not occur in a linear manner. Rather, it happens rapidly and with little warning. We are living under this looming shadow in the form of an accelerating climate emergency, which in itself is the biggest public health opportunity of the 21st century. It is a race against time and a race against us. We must urgently take unprecedented action along with research for healthy people on a healthy planet. As a health professional I pledged to do no harm and improving sustainability in healthcare services is going beyond doing no harm and doing good. Thus, the health sector must help lead the way – and this is what I believe, is the key to future focused sustainability.
Decarbonising our healthcare, a prescription for action
In this episode of IHT’s Healing Health podcast, Urvi’s PhD supervisor Dr Rebecca Patrick is joined by Dr Mike Forrester to discuss sustainability in healthcare.