The ‘win win’ pathway to net zero for the health sector

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The Australian health sector is embarking on a period of rapid innovation and reform, driven by the disruptive innovation arising from the COVID-19 pandemic. This reform should include keeping pace with the transition to ESG-driven strategies and operating models we see globally. The health impacts of climate change are increasingly evident and immediate. They have the potential to dwarf the impact of COVID-19. Addressing the sector’s own contribution to climate change is the first step the sector can take to reducing the impact of climate change on citizen health in Australia and around the world.

Understanding the impact of climate change on health outcomes

As recent weather events attest, Australia’s climate is changing, and it is doing so in ways that impact our health.The 2020 Australian Royal Commission into National Natural Disaster Arrangements identified climate change as the cause of more frequent and intense extreme weather events, with further global warming “inevitable”¹. A special report by the Medical Journal of Australia and the Lancet identified that the 2019-20 bushfires resulted in 450 deaths, including 33 directly from the fires and 417 from smoke exposure, over 1,300 asthma emergency department presentations and over 3,150 hospital admissions for cardiovascular and respiratory conditions².

Beyond severe weather events, the changing climate also impacts our health in subtler ways. Rising air temperature and changes in its composition increase the risk of skin cancer and the development of respiratory conditions. Changes in rainfall and temperature patterns alter the activity of insects and the prevalence of infectious diseases they carry³. Increasingly, the broad and varied health impacts of climate change, now and in the future, are being recognised and discussed as governments and businesses take action to limit the extent of climate change and mitigate its effects.

The health benefits of addressing health sector emissions

The public health benefits of addressing climate change are clear, and we have a “win-win” opportunity to begin tackling this issue now.

As a first step, the sector should seek a rapid transition to net zero emissions so it aligns with the hippocratic oath taken by healthcare practitioners - primum non nocere - first, do no harm. While broader action is taken across economies to rapidly decarbonise, the health sector can lead by example, reaping the benefits from improved health outcomes. This will, in turn, help ease the growing pressure on health systems of ageing populations and chronic disease burden.

Given the scale of emissions from the sector, as outlined below, the health impact on communities can be material. One US study found the healthcare sector’s emissions had an impact on the health of the population comparable to the 44,000–98,000 people who die in hospitals each year in the U.S. as a result of preventable medical errors⁴. Moreover, research by PwC’s Health Research Institute into the social determinants of health demonstrates that the environment is responsible for 10% of an individual’s health outcomes.

As GPs and hospitals are increasingly responding to the effects of climate change, including responding to natural disasters, heat stress and infectious diseases, there are both immediate and long term benefits for the sector in taking a preventative approach to climate change related health issues - starting with emissions within their control.

The contribution of the health sector to climate change

At a global level, the health sector is responsible for an estimated 4.4% of greenhouse gas emissions⁵. For context, this is more than double the greenhouse gas emissions of the aviation industry (1.9%).⁶

This varies by country: healthcare in Australia contributes 7% of emissions and 10% in the USA, compared to 3% in the UK⁷. In fact, if the US healthcare sector was a country, it would be the world’s 13th largest emitter⁸.

The causes of these emissions vary between providers across the sector, based on the nature of their business, location and services. The largest category for emissions is in the supply chain, where over 70% of emissions are embedded (known as ‘Scope 3’ emissions). This includes the supply chain emissions of personal protective equipment (PPE), medicines and other purchased consumables, plus agriculture for catering or cotton, and the shipment of goods. Twenty-eight per cent of emissions result from the energy used to manufacture products used in the health sector⁹.

Table 1: Definitions and examples of greenhouse gases

Scope	Contribution to health sector emissions	Definition	Health sector examples
1	17%	Direct emissions from sources controlled by the organisation	Hospital/care facility emissions Vehicle emissions
2	12%	Indirect emissions resulting from energy consumption	Purchased electricity, steam, heating and cooling
3	71%	Indirect emissions from sources not directly controlled by the organisation (eg, supply chain), but directly related to its activities, including upstream and downstream	Consumables manufacture and transport Agriculture for meals/clothing Pharmaceuticals and chemical products

^{Source: Overview of GHG Protocol scopes and emissions across the value chain, Greenhouse Gas Protocol}

Guided by the data on the sources of emissions, health sector leaders can take action to reduce emissions for their organisations in the areas of greatest impact.

Six ‘win win’ actions the health sector can take towards net zero emissions

There are six actions the sector can take now which will deliver reduced greenhouse gas emissions, near-term health benefits for patients and long-term population-wide health benefits through a reduction in the effects of climate change. These cover actions on energy consumption, transport, supply chain and virtual health, among others.

Delivering on these actions will require buy-in and support from across the sector, based on different healthcare models and responsibilities around Australia. For example, centralised procurement agencies would play a role sourcing sustainable food and adopting circular supply chains. Support and incentives (or disincentives) from commonwealth, state and territory governments may also be required. These would enable public and private healthcare providers to make capital investments and changes such as transitioning to virtual models of care (for example by tying sustainability metrics to health district performance assessments). Working with a wide range of stakeholders will enable ambitious change to be realised at pace across the sector.

As these initiatives are implemented, clinicians and consumers will have visibility of some key actions, allowing them to take part in the transition directly. These include the shift to virtual models of care, positive changes to food and nutrition patients receive, and improved experiences accessing healthcare facilities through better integrated public and patient transport and upgraded building design.

Action		Environmental Impact Rating	Near-term population health benefits
Switch to renewable energy and reduce overall consumption	Make the switch to renewables through power purchase agreements (PPAs) or rooftop solar or wind generation on site. Reduce consumption through energy efficient construction and behaviour change. (Scope 1 & 2 emissions)	Very high	Improved air quality reduces the risk of cardiovascular and respiratory disease.
Support domestic production by sourcing locally and reduce waste through circular supply chains	Reduce freight emissions by using local suppliers, and engage with suppliers on their sustainability and emissions. Seek circular supply chains to reduce waste, particularly with regard to plastics and textiles, and adopt efficient practices to reduce consumables and pharmaceuticals. (Scope 3 emissions)	Very high	Support job creation, employment and income are a key social determinant of health. Reduction in plastic waste which can have carcinogenic, developmental, or endocrine-disrupting impacts.
Transition to virtual care models which reduce patient travel and the need for physical space	Embrace virtual models of care to provide patient care in the community, including virtual monitoring and telehealth, reducing the need for patients to travel to facilities and reducing the energy demand on physical facilities. (Scope 1, 2 and 3 emissions)	High	Improved air quality reduces the risk of cardiovascular and respiratory disease.
Transition to an electric vehicle (EV) fleet and promote green transport options for patients, staff and providers	Switch to EVs when procuring new vehicles, including ambulances and patient transport. Partner to provide charging stations for patient, visitor and staff parking and integrate with public transport networks. (Scope 1 and 3 emissions)	High	Improved air quality reduces the risk of cardiovascular and respiratory disease.
Provide and promote healthy diets from sustainable food systems	Significantly reduce consumption of unhealthy (and carbon-intensive) foods, such as red meat and sugar, and increase consumption of healthy foods, such as nuts, fruits, vegetables, and legumes. Source from suppliers with sustainable agricultural practices. (Scope 3 emissions)	Medium	Improved diet can lower the rate of obesity, cardiovascular disease and diabetes.
Advocate for active lifestyles enabled by the built environment	Reduce traffic and air pollution with smart urban development which enables walking, cycling and running, including in healthcare facility design and location. (Scope 1 and 3 emissions)	Medium	Physical activity promotes mental health and lowers the risk of obesity and diabetes.

Harness innovation to improve health outcomes and accelerate Australia’s journey to net zero emissions

In addition to improving health outcomes and reducing environmental harm, many of these initiatives also align to existing health priority agendas including embracing virtual models of care, supply chain transformation, modernising health infrastructure, post-COVID-19 cost management, and national resilience in preparation for future health emergencies.

For organisations within the health sector that want to take action, we suggest the following immediate steps:

Understand the current emissions profile and key drivers, today and into the future, for your organisation (including your own operations and supply chain)
Identify quick-win measures which can be taken today and longer-term activities to plan for, using the six win-win actions as a starting point
Integrate a net zero transition into business strategy and embed sustainability into future growth and transformation plans

As health services plan their recovery from COVID-19 and transition to the new normal throughout 2021 and beyond, leaders would be wise to use this year of disruption as a catalyst to start to transition to net zero emissions, reducing the harm done to the environment and improving the health outcomes for the communities they serve.

Sources

^{1. Royal Commission into National Natural Disaster Arrangements, Overview - The 2019-2020 disaster season, 2020

2. The Medical Journal of Australia, The 2020 special report of the MJA–Lancet Countdown on health and climate change: lessons learnt from Australia’s “Black Summer”, 3 December 2020

3. The New England Journal of Medicine, The Climate Crisis - Health and Care Delivery, 22 August 2019

4. PLOS One, Environmental Impacts of the U.S. Health Care System and Effects on Public Health, 9 June 2016

5. Arup & Health Care Without Harm, Health Care’s Climate Footprint: How the health sector contributes to the global climate crisis and opportunities for action, September 2019

6. Our World in Data, Climate change and flying: what share of global CO2 emissions come from aviation? 22 October 2020

7. The Lancet - Planetary Health, The carbon footprint of Australian health care, January 2018

8. YaleNews, Environmental and health impacts of U.S. healthcare system, 9 June 2016

9. Arup & Health Care Without Harm, Health Care’s Climate Footprint: How the health sector contributes to the global climate crisis and opportunities for action, September 2019}