On average across OECD countries, some 4.4% of overall greenhouse gas emissions were linked to the health sector in 2018. Yet until recently, relatively little attention has been given to health systems as a driver of greenhouse gas emissions. Looking closely at what sectors and processes within health systems contribute most to greenhouse gas emissions can help countries committed to take action to reduce their carbon footprint make more informed decisions.
Nearly nine in ten OECD countries report having taken action to decarbonise healthcare and the structures that deliver it. In most cases, the primary focus of these policies has been to harness opportunities that reflect broader governmental strategies towards decarbonisation, such as shifting towards renewable energies and developing lower-emission, environmentally friendly building standards.
At the same time, there remain significant opportunities for countries to reduce the environmental impact of their health systems by taking steps that are specific to the health sector, such as by addressing how, where and when care itself is delivered. In this report, total health sector emissions were estimated and further disaggregated based on three separate frameworks – looking at the type of provider, emission “scopes” and country of origin of emissions. These approaches provide different perspectives on the drivers of health sector emissions, by disaggregating the same overall footprint into different categories. Analysis developed for this report found that highly resource intensive care settings, notably hospitals, contribute disproportionately to the emissions of the health sector. On average across OECD countries, hospitals represent an estimated 30% of emissions associated with the healthcare sector. Shifting care away from intensive settings such as hospitals towards outpatient care, and strengthening primary care to help reduce avoidable and preventable care, are already key priorities of health systems that wish to deliver high quality outcomes while reducing costs.
Reducing inappropriate care and waste and the time spent in hospitals, for example, could contribute to reducing the emissions associated with hospital care by as much as a quarter on average across OECD countries. Prioritising policies that promote appropriate care and reduce low-value care and waste in the health system have not only health and financial benefits, but also environmental ones. Recognising the potential environmental benefits of low-value care further strengthens the arguments for efforts to promote appropriate care.
Increasingly, medicines and other healthcare inputs are being scrutinised at the product level for their potential environmental impact. In several cases, clinical products, including anaesthetic gases and respiratory inhalers, have lower-emission substitutes readily available and largely clinically indistinguishable, pointing to opportunities for clinicians and care organisations to make adjustments to their practices that contribute to decarbonisation efforts in the healthcare sector. However, the range of healthcare products that have been environmentally screened, let alone identified as having a lower environmental-impact substitute, remains comparatively small. Significant gaps in data availability – as well as challenges related to the comparability of data across methods and countries – mean that healthcare policymakers, clinicians and administrators are often faced with making decisions with limited high-quality data.
The report further underscores the extent to which the complex, global medical supply chains contribute to the greenhouse gas emissions of the health sector. Analysing overall emissions using the framework of scope (classifying company emissions based on direct and indirect emissions, including across companies’ value chains) and country of origin, this report finds that the majority of health sector emissions can be traced back to health sector supply chains. Moreover, half of health sector emissions on average were found to originate from sources outside the country in which healthcare was delivered – meaning that even conscious efforts to reduce emissions in the delivery of care may be insufficient to successfully decarbonising health systems.
The enormous complexity and difficulty of rapidly shifting away from long-established and interconnected health supply chains was underscored during the recent COVID‑19 pandemic. Yet the high environmental costs associated with existing supply chains in the health sector drives home the need to look not only at what products and services are used in healthcare, but at how these are produced and delivered. Many countries and health companies, including in the pharmaceutical and health technology sectors, have increasingly recognised the important role of supply chains in driving emissions and are taking steps to address them. Policy options include the development of health-specific green procurement policies and of multi-country guidance and standards, enabling companies to benefit from greater clarity in the market and economies of scale that can help to shift behaviour.
Promoting public health policies that improve population health by reducing risk factors for chronic diseases such as cancer and cardiovascular diseases offer the opportunity for policymakers to achieve wins across multiple domains. Many of the risk factors that contribute to the development of highly prevalent chronic diseases also contribute to significant greenhouse gas emissions, the use of cars in urban areas or large‑scale factory farming of unhealthy foods. Scaling up policies that promote the adoption of healthier behaviours, such as reducing pollution exposure and increasing physical activity through the promotion of active transportation initiatives, can lead to both improved health outcomes and lower greenhouse gas emissions. Modelled OECD estimates suggest that shifting towards sustainably-produced plant-based diets could help to reduce greenhouse gas emissions by 304 MtCO2 equivalent – similar to removing 72 million cars from the road for a year – and reduce premature deaths from cancer by 27 000 deaths a year across OECD countries.
Health systems are not immune to the consequences of emissions put into the air. Indeed, many are already contending with addressing growing health needs related to rising temperatures and extreme weather events. By presenting novel estimates and thorough policy analysis, this report demonstrates how many of the policies that can help to mitigate greenhouse gas emissions already align with many of the key objectives of health systems – to delivering high-quality care while making populations healthier.