The sustainability challenge in healthcare

23 January 2023

The challenge of providing infrastructure that responds to and mitigates the impact of our changing climate is a key focus for future healthcare delivery. Helen Pickering, global head of healthcare, and Adam Mactavish, global sustainability lead discuss the issues and practical solutions.

Climate change is the most important issue of our age. It is, according to the World Health Organisation (WHO), the biggest single threat facing humanityⁱ.

The health consequences of the growing climate emergency are both broad and profound. Heat, cold, flooding and other implications of climate change have both direct and indirect effects, including impacts on disease and availability of essential resources such as food and water.

Linkages between climate and health are particularly noticeable in the Middle East and Africa. A recent study led by Saudi Arabia into the impacts of climate on health in the Gulf Cooperation Council (GCC) area identified some of the effectsⁱⁱ.

This report makes for stark reading. Between 1979 and 2019, the region experienced an increase in temperature of more than 0.5 degrees centigrade each decade - over twice the global average.

Human health implications in the GCC region are widespread and significant. They include an increase in the number of dangerously hot days and subsequent heat related stress, through to impacts on air quality and on communicable disease as well as on maternal, reproductive and mental health.

The impact of the healthcare sector on climate change is substantial, it is responsible for almost 5% of global greenhouse gas emissions and has a carbon footprint equivalent to 514 coal-fired power plants. If the sector were a country, it would be the fifth largest polluter on Earthⁱⁱⁱ.

The sector therefore has to deal with two issues. Firstly, it needs to minimise its own effect on the climate by aiming for, and working proactively towards, net zero emissions; and secondly, it must prepare to meet the changing needs of populations that are experiencing a wind range of climate induced stresses.

The carbon generated by healthcare can be attributed to a number of sources. Probably the most visible is the physical infrastructure, acute hospitals are some of the most energy intensive buildings in the world.

However, there are other less obvious activities that result in high carbon emissions. Travel, by patients, visitors, staff and the healthcare providers themselves; medicines, chemicals and inhalers; and, perhaps surprisingly, diagnostic equipment such as MRI’s, anaesthetic gases and metered dose inhalers.

“Decarbonisation of the healthcare sector and its infrastructure is a complex business, requiring input from different teams working in disciplines such as clinical, strategy, planning as well as in the built environment.”

Helen Pickering, global head of healthcare

Delivering ambitious goals

There is, however, a strong determination to succeed. In the UK Currie & Brown are working with leading healthcare institutions, such as the internationally renowned Great Ormond Street Children’s Hospital, who have declared Climate and Health Emergencies with ambitious targets for decarbonising their activities.

They have begun actively assessing options for radically improving energy efficiency and reducing, and ultimately removing, fossil fuel combustion across their facilities together with a wide range of other measures aimed at reducing resource consumption, improving local environmental quality and the wellbeing of patients and staff.

In another visionary project where Currie & Brown are Lead Advisor, plans are being put in place as part of the Monklands Hospital Replacement Project in Scotland to eliminate fossil fuel use by creating an all-electric new hospital.

Currie & Brown is a leader in sustainable healthcare, working with providers who are dealing with the technical, commercial and operational challenges of bringing net zero carbon status to a number of new acute hospital projects, as well as helping existing hospitals and systems to develop their decarbonisation strategies. In existing hospitals, the focus is on managing the transition from legacy services to more efficient, modern and sustainable systems while factoring in both existing operating environments and budgets.

“The building of new healthcare infrastructure creates its own challenges. The construction process releases embodied carbon - along with use of materials, it can emit more than a tonne of carbon per square metre - and decreasing the overall footprint is a key consideration.”Adam Mactavish, global sustainability lead

Practical solutions

The use of digital healthcare, delivering care closer to home and smart buildings are all innovations that will help to minimise carbon emissions by reducing the amount of space needed and travel, leading to more efficient delivery of care and improved patient experience.

Using lower carbon materials in construction can also play an important role in increasing sustainability. For instance, part of the cement content of concrete mixes can be replaced or recycled steel used.

Although some lower carbon options are more expensive than using traditional materials and methods, there are also occasions when they may be less costly. It may be, for example, that energy efficient products such as brick or rendered cladding work out cheaper than higher carbon alternatives such as metal panelling.

For existing buildings, savings can be made by better understanding how the existing infrastructure operates and by introducing energy saving controls. High efficiency and performance lighting, ventilation and cooling systems and careful procurement of new imaging and diagnostic equipment can also play a big part in reducing power demand.

Removing fossil fuel use from heating and power systems plays a critical role in decarbonisation. In recent decades, combined heat and power systems have been installed, though in the long term they can be a block to decarbonisation if the grid itself is rapidly becoming a source of low carbon power.

All healthcare providers should be thinking about how their local climate will continue to change in the coming decades and take steps to ensure resilience under a range of future climate scenarios. Healthcare is at the forefront of helping mitigate emissions. These initiatives will have a material impact on national emission reduction goals but importantly will also help to deliver operational efficiencies and improved patient wellbeing.

ⁱ Climate Change and Health – Key Facts - World Health Organisation, October 2021 

ⁱⁱ The State of Climate and Health Research in GCC - Aeon Collective X Community Jameel, March 2022

ⁱⁱⁱ The nexus between climate change and healthcare – The Health Policy Partnership, January 2022

^iv Delivering a ‘Net Zero’ National Health Service – NHS England, July 2022