Climate change has rapidly become a critical driver of global morbidity and mortality. The World Bank estimates that climate change could exacerbate existing health inequities by putting more than 100 million people back into extreme poverty by 2030.6 Another recent study conservatively estimates that climate change will increase mortality by 35/100 000 or 3.9 million lives a year by 2099, with a much heavier toll on low income regions.7
Although many countries have not done an extensive assessment of their health sectors’ contributions to climate change, the NHS estimates that the health sector represents 39% of all public sector greenhouse gas emissions in England.3 In the US, healthcare contributes 9% of overall greenhouse gas emissions.2
Pollution and toxic waste rank alongside climate change as major threats to health and sustainability, particularly for low income communities. The World Bank estimates that 23% of child deaths among residents of India could be attributed to pollution, which means that about 350 000 children aged under 5 years die every year as a result of bad air, contaminated water, or similar problems.8 Unfortunately, healthcare is an important contributor to morbidity and mortality from pollution. One study estimated that the indirect health burdens caused by emissions from the healthcare sector are commensurate with the health burden caused by preventable medical errors.9
Increasingly, healthcare organisations of all sizes are implementing strategies to limit their harmful environmental effects (box 1). By switching to renewable energy and reducing healthcare waste, healthcare organisations can reduce greenhouse gas emissions and pollution, contribute to growth in renewable energy employment, and realise large financial savings.10
Reducing greenhouse gas emissions
Gundersen Health System11
This non-profit healthcare organisation based in Wisconsin, US, was 100% dependent on coal for electricity and 100% dependent on natural gas to heat its facilities in 2006. It recognised that reliance on fossil fuels added to local respiratory health problems and had a negative effect on the local economy as well as increasing the cost of delivering care. Gundersen set a goal to become the first health system in the US to be heated, cooled, and powered by renewable energy that it owned.
Over the next few years, it co-invested in a variety of community based clean energy projects. Guided by audits conducted by a local air conditioning company, Gundersen invested $2m (£1.6m; €1.8m) in efforts to reduce energy use and saved $1.2m every year thereafter. Regional partners co-investing in two wind sites included a large private construction company and an organic farm cooperative.
As a collaborating partner, the local county government contributed gas from the local landfill, which Gundersen used to heat, power, and cool an outpatient campus with 1200 staff. It purchased previously unused hardwood chips from several local lumber mills to fuel a high tech biomass boiler providing heat, power, and sterilisation capability. Gundersen decreased its particulate and greenhouse gas emissions by over 90%, saved money, and boosted the local economy. Each year the system has many days of energy independence and also provides a backstop for extreme weather events when the grid may fail.
These efforts also more deeply connected Gundersen with its community partners in the shared purpose of improving health and economic wellbeing, and serve as a model in the healthcare sector for addressing climate change.
A local health authority that is also one of Europe’s largest healthcare providers, Region Stockholm has led several initiatives to tackle climate change and harmful healthcare waste. In 2004 it installed a pilot facility at Karolinska University Hospital that splits nitrous oxide—a commonly used gas in medicine that has 300 times the global warming impact of carbon dioxide and contributes to ozone depletion—into harmless nitrogen and oxygen. The facility was the first of its kind in the world, and the programme has since been extended to all hospitals within the region.
The region also works to reduce the emissions of active substances from the production of pharmaceuticals by requiring that its suppliers have implemented procedures to monitor and control harmful discharge and emissions. Additionally, the council has incorporated data on the environmental effect of pharmaceuticals into the development of a drug formulary known as the Wise List, which has had the added benefit of reducing healthcare costs. The Wise List is primarily used by primary care providers in the Stockholm region, and adherence to the drug formulary is high.12
Healthy Families New Zealand13
Healthy Families was established by the New Zealand Ministry of Health to prevent chronic disease through a comprehensive and coordinated approach rooted in leadership of community residents. In Auckland, an urban area with about 1.6 million people, a collaborative initiative with the Sikh community to use waste land for food production and to create a food forest found that it is customary in the Sikh community to dispose of fabric used in religious rituals in incinerators, creating air pollution and greenhouse gas emissions.
In partnership with Healthy Families and others, they developed a programme to share the fabric with communities who could reuse it. Since December 2017, women from Samoan, Tongan, Maori, and Cook Islands communities, together with other community based organisations in Auckland, have been creating upcycled products that provide additional income and the associated health benefits to hundreds of families. In addition to the community economic benefit, avoiding incineration or disposal in landfill prevents the equivalent of 3.6 tonnes of CO2 emissions a year, which is the equivalent of taking 2.5 cars off the road in Auckland.13
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