Across OECD countries, health systems are increasingly recognising the environmental impact of the services they deliver. Many are taking steps to mitigate the emissions impact of the health sector. At the same time, health systems are under pressure to deliver high-quality care with limited resources, and many healthcare workers feel burned out by the demands of their work and its administrative burden. This chapter provides an overview of the key findings from the analysis presented in this report, demonstrating how many of the same policies that can help countries to deliver high-value care at lower costs can also help move them towards reducing the environmental impact of their health systems.
Decarbonising Health Systems Across OECD Countries
Abstract
A new OECD analysis indicates that greenhouse gas emissions linked to the health sector made up 4.4% of overall emissions on average in OECD countries in 2018. This is higher than the share of emissions from industries that have received scrutiny for the impact of their emissions, such as the aviation industry. It underscores the important role health systems play not only in improving health outcomes but in helping to deliver services more efficiently and with greater environmental sustainability. New OECD estimates bring insights into the emissions impact of the health sector by providing an overview of the health sector’s greenhouse gas emissions. Total health sector emissions were further disaggregated using three complementary frameworks, focussed on provider type, scope, and domestic versus international origin. Each analysis partitions the same emissions baseline into distinct categories, without changing the overall footprint.
While most carbon emission mitigation efforts in OECD health systems have so far focussed on choices not directly linked to health policy, nearly all responding OECD countries report that they are taking steps towards decarbonising their health sectors. Reducing the carbon footprint of the health sector requires a combination of policies. Some are directly linked to choices about energy use or transportation, which are not directly linked to health policy but nonetheless require action on the part of policymakers in the health sector. Nearly 90% of countries report that initiatives are underway to reduce the emissions associated with energy consumption in the health sector. More than three‑quarters of countries report that energy efficient building standards have been adopted which are applicable to the health sector. A number of countries, including Austria, France, the Netherlands and the United Kingdom, have reported proactive steps towards institutionalising policymaking that takes into account and aims to counteract the emissions impacts of their health sectors.
Health policy can have a direct impact on the carbon intensity of health systems. This report focusses on opportunities for transforming healthcare delivery with an awareness of its emissions and broader environmental impacts. It identifies key levers through which health policy can contribute to reducing emissions of the health sector: transforming healthcare delivery to reduce emissions, including reducing low-value care; decarbonising medical supply chains; substituting high-emissions products for low-emissions alternatives; and strengthening public health policies that encourage healthier choices and healthier cities.
Emissions from supply chains represented nearly four‑fifths (79%) of health sector emissions on average across OECD countries in 2018 (latest available year), which shows the importance of prioritising mitigation efforts in the area. Twelve per cent of emissions relate to direct emissions coming from a health facility, with a further 9% of emissions associated with the electricity purchased by health facilities. These estimates are derived from new OECD analysis using data from environmentally-extended OECD Inter-Country Input-Output tables and System of Health Accounts data. Initiatives to decarbonise supply chains that encourage the transformation of production and products and introduce green procurement standards for healthcare products and services are emerging in OECD countries.
A high share of health systems emissions derived from supply chains and their high level of global integration means that half of emissions associated with the health sector are estimated to originate outside the country where the healthcare is consumed. Some examples of initiatives to develop green procurement guidelines and rules for the health sector have been implemented, such as requirements to include environmental considerations in all procurement for specialist health services and hospitals in Norway. However, with few exceptions, such as a collaboration across Denmark, Iceland, Norway and Sweden to develop joint criteria for sustainable packaging for medical products, green procurement guidelines for the health sector remain in their infancy and have not been scaled up.
When allocating emissions across providers, the new OECD analysis suggests that hospitals account for 30% of emissions on average across countries. Encouraging more carbon neutral pathways of care and lower dependence on hospital activities can help health systems to deliver lower-emissions care. Many of the most resource intensive parts of the health sector are also the most emissions intensive. New estimates suggest that reducing avoidable admissions and the average length of stay in hospital could help health systems to reduce their hospital-based emissions by a quarter across OECD countries. Initiatives such as Denmark’s strategy for sustainable hospitals, launched across all five regions in 2024, are important steps towards developing joint objectives and actions to underpin a shift towards environmental sustainability throughout healthcare delivery.
An important percentage of health systems emissions could be modified by transforming healthcare delivery to reduce emissions in the health system. This includes promoting policies that reduce emissions through reducing low-value care. New OECD calculations find that healthcare delivery and administration-related emissions could be reduced by an equivalent of taking nearly 19 million gasoline‑powered cars off the road for a year by reducing the average length of stay in hospital, reducing avoidable hospital admissions, lowering administrative costs to healthcare, and reducing unnecessary tests and imaging. Furthermore, policies that help to reduce the delivery of low-value care help countries to both reduce the costs associated with healthcare while also reducing the emissions impact of the health system, all while benefiting health outcomes for patients.
Examples are emerging of ways for health systems to substitute high-emissions products for low-emissions alternatives with little clinical or financial impact. While the evidence base around the emissions and other environmental impacts of health products and services is still nascent, there are possibilities to move away from widely used high-emitting products for lower-impact alternatives, such as with the use of specific anaesthetic gases and inhalers. Generally, policy action in this regard has lagged behind, but rapid changes have been seen where concerted efforts have been made to reduce the use of high-emitting products. This is the case of in the United Kingdom (NHS England), shifting away from high-emitting anaesthetic gas (desflurane) for lower-emissions alternatives.
Public health policies that reduce risk factors for non-communicable diseases also have a strong impact on greenhouse gas emissions. A range of policy options are available to promote healthier and more sustainable choices across food, transportation, and household energy. A fundamental shift towards healthy diets that are sustainably produced, consisting of mainly plant-based foods with little to no red and processed meats, may reduce GHG emissions by 304 MtCO2eq, equivalent to emissions of 72 million cars over one year, and 27 000 premature deaths due to cancer annually in OECD countries, according to modelled estimates.
A number of OECD countries have begun integrating climate‑related considerations into key public health domains. In Belgium, for example, environmental sustainability is considered alongside health impacts in the development of dietary guidelines, while in countries including Denmark and the Netherlands, the development of policies and infrastructure to support active mobility options such as cycling superhighways and network help to both reduce car travel and improve health outcomes.
Policymakers continue to lack sufficient data on the emissions impacts of healthcare products and services, limiting their ability to make informed decisions and to monitor the impacts of mitigation actions. National approaches to measuring the carbon footprint have used different methodologies, hindering comparability, while international comparisons have frequently remained at the sectoral level. This has complicated the comparability across countries and challenged the ability to identify areas for policy action. More action to develop more frequent, harmonised and detailed approaches to measuring the impacts of the health system is needed.
Healthcare accounted for 4.4% of greenhouse gas emissions on average across OECD countries in 2018
Over recent years, as the impacts of a changing climate on societies – and on health outcomes – have become increasingly apparent, many health systems have begun to reckon with the impact that climate change will have on the care they provide and the patients they serve. Much of this attention has focussed on the impacts of climate change on health outcomes and on the resilience of health systems itself. But there is also a growing awareness among policymakers, healthcare workers, administrators and others, that health systems themselves also have a role to play in reducing their carbon footprint.
Anthropogenic environmental pollutants encompass a wide array, ranging from greenhouse gases (i.e. carbon dioxide, methane, nitrous oxide, fluorinated gases), air pollutants (i.e. particulate matter, ozone, carbon monoxide, lead, sulphur dioxide, nitrogen dioxide), heavy metals, pesticides (i.e. organochlorine compounds), plastic additives (i.e. phthalates, and bisphenol A) – all of which have varying levels of negative health impacts depending on the level, duration, and mode of exposure.
Greenhouse gas emissions, predominately generated by human activities, serve as the primary driver of climate change, resulting in far-reaching consequences on a global scale. Despite ongoing efforts to curb emissions, global greenhouse gas emissions have surged exponentially since 1750, with a 1.5% increase observed in 2022 (Liu et al., 2023[1]). The urgent need to address greenhouse gas emissions arises from their pivotal role in exacerbating climate change and its increasingly severe and interconnected repercussions including extreme weather events, disruptions to food production, population displacements and migration.
Like all other economic sectors, the health sector plays a role in contributing to climate change via its associated greenhouse gas emissions. While the delivery of healthcare produces broader environmental impacts beyond the generation of greenhouse gas emissions, the focus of this analysis is on the impacts of the health sector on greenhouse gas emissions and the policies that have been adopted to help mitigate this contribution, in line with the recent focus on climate mitigation policies in many OECD countries.
Despite growing attention to the issue, few international comparisons exist that look at both the emissions associated with health systems overall, as well as the emissions impacts of various sub-domains of the health sector. While governments and researchers have begun to develop estimates of the health system’s contribution to greenhouse gas emissions across many OECD countries, the availability of approaches that measure the emissions of health systems across multiple countries has been more restricted, and limited either to whole‑of-sector analyses or one‑off estimates that do not allow for regular updating.
According to new analysis using data from the OECD’s environmentally extended Inter-Country Input-Output database and data from the System of Health Accounts, 4.4% of overall greenhouse gas emissions were associated with activities in the health sector in 2018 on average across OECD countries (Figure 1.1). A brief description of the methodology used to calculate the emissions estimates described in this chapter can be found in Box 1.2. Across the OECD overall, emissions associated with the health sector amounted to nearly 963 million tonnes CO2e in 2018, representing a total level of emissions higher than that of Germany – the third-largest greenhouse gas emitter within the OECD.
Note: Emissions refer to demand-based emissions.
Source: OECD analysis based on environmental extension of OECD Inter-Country Input-Output database and System of Health Accounts data.
Emissions associated with healthcare varied on a per-capita basis even more significantly than as a share of the overall emissions of the country, reflecting among other factors differences in spending, healthcare utilisation, emission intensity in production and the structure of healthcare supply chains. On average across OECD countries, 523 kg of CO2‑equivalent emissions per capita were associated with healthcare demand in 2018 (Figure 1.2).
Source: OECD analysis based on environmental extension of OECD Inter-Country Input-Output database and System of Health Accounts data.
Two broad approaches have typically been adopted to measure greenhouse gas emissions, including for health systems. Top-down approaches to emissions accounting look at the contributions of a sector, such as healthcare, to greenhouse gas emissions at a macro level, and build on environmental extensions of multi-regional economic input-output tables to link the economic transactions that occur within the health sector with the environmental (emissions) impacts of these transactions. Bottom-up approaches use a life‑cycle approach to account for emissions associated with the entire production process, use, and disposal of a specific product.
In the health sector, emissions have been calculated using both approaches, together with a hybrid approach that supplements top-down accounting methods with limited bottom-up data (for example, combining a top-down input-output-based model with the emissions associated with patient transportation).
While a growing number of countries have developed national estimates of their health systems emissions, the methodology underpinning these estimates have varied. Initiatives to develop internationally comparable estimates of health sector emissions have been more limited. Where these have been developed, they have been largely focussed on health sector emissions overall and have not looked at the emissions associated with different sub-sectors within health systems.
The OECD has undertaken new work to develop internationally comparable estimates of the greenhouse gas emissions of the health sector and its various domains. This analysis is based on an environmental extension of the OECD’s Inter-Country Input-Output (ICIO) database, which includes estimates of carbon dioxide, as well as CO2‑equivalents for methane, nitrous oxide, and fluorinated gases (Yamano, Lioussis and Cimper, 2024[2]), and granular health spending data from OECD’s health spending data collection based on the System of Health Accounts (OECD/Eurostat/WHO, 2017[3]) Using annually updated environmentally extended inter-country input-output tables from the OECD, this new approach offers an opportunity for countries to understand the source of their greenhouse gas emissions across the health sector and within specific areas of care and delivery, using a method that is comparable and allows for tracking progress over time.
Results presented in this report are based broadly on a set of parallel analyses of health sector emissions. These three analytical approaches should be seen as complementary but are not additive; each is a distinct analysis of how the totality of health sector emissions can be allocated across the sub-categories within each.
Health sector emissions were estimated at the sub-sectoral level by categorising health spending from the health provider perspective to categorise consumption-based emissions by hospitals, nursing homes, outpatient care, medical goods (including pharmaceuticals), investments, and other (other healthcare providers, including public health providers, administrative agencies, ancillary service providers such as laboratories or patient transportation, providers of informal LTC at home (in care of care allowance) and non-resident health providers). Care should be taken in the interpretation of sub-sectoral breakdowns, as certain methodological assumptions (notably around the identical input structure across hospital and outpatient care and identical emissions intensity) are unlikely to reflect the reality. The basis of the sub-sectoral analysis by health provider further means the level of spending by provider play an outsized role in driving some of the differences between countries. Nonetheless, while there is scope for further refinement of the model, the initial results provide a useful starting point for countries to understand broadly where there is room for action.
Emissions were further categorised according to the “scope” classification defined by the Greenhouse Gas Protocol for emissions measurement within companies. In this categorisation, emissions are allocated based on whether they represent direct GHG emissions (Scope 1, e.g. sources owned or otherwise controlled by the company); whether they represent indirect GHG emissions linked to purchased electricity and consumed by the company (Scope 2); and indirect GHG emissions that are linked to the production and transport of goods and services (Scope 3, e.g. the supply chain).
Lastly, the proportion of emissions that occurred domestically versus in other countries was further investigated. The share of domestic emissions is shaped primarily by two factors: the reliance of the country’s health sector on foreign healthcare products and inputs, and the relative energy intensity of its domestic energy sector.
Associating measures of health systems performance with health sector emissions highlights countries that have delivered relatively good health outcomes at lower emissions. For example, ten countries have achieved higher-than-average life expectancy at lower-than-average health sector emissions intensity (Figure 1.3). While the model’s reliance on health spending means some of these differences may be driven by relative spending levels, this does not explain all of the variation seen across countries. The quadrants represented in Figure 1.3 (and in subsequent Figure 1.4) are set based on the OECD averages of the two variables being compared.
Note: Data for health sector emissions are expressed in per-capita terms and normalised to the OECD average. Data on life expectancy at birth is normalised to the OECD average. Quadrants are centred around the OECD average of the two variables.
Source: OECD analysis based on data from OECD Health Statistics 2025, System of Health Accounts and ICIO data.
Data on avoidable mortality similarly highlights that 11 countries have lower-than average rates of avoidable mortality delivered at a per-capita emissions intensity lower than the OECD average (Figure 1.4).
Note: Data for health sector emissions are expressed in per-capita terms and normalised to the OECD average. Data on avoidable mortality is normalised to the OECD average. Quadrants are centred around the OECD average of the two variables.
Source: OECD analysis based on data from OECD Health Statistics 2025, System of Health Accounts and ICIO data.
Policies to reduce health sector emissions are well aligned with efforts to reduce low-value care
Reducing low-value care in hospitals could reduce hospital emissions by 25%
There is an important role that healthcare delivery and practice can play in reducing the greenhouse gas emissions associated with the health sector. There is particular alignment between policies to reduce low-value care – a key policy objective across many OECD countries – and policies that can support the reduction of greenhouse gas emissions within the health sector. Previous work by the OECD has found that as much as one‑fifth of expenditures on healthcare across OECD countries may be wasted, suggesting that there is considerable scope to reduce ineffective and inappropriate care that drives up financial and emissions costs, while maintaining a neutral or even delivering a positive impact on health outcomes (OECD, 2017[4]).
Moving care that can be delivered effectively out of hospitals into the community, both by scaling up outpatient care and by reducing unnecessary hospital procedures, has been a focus of policies to reduce low-value care for decades. Yet, too much care is still delivered in locations that are more complex and more costly than necessary, with a large body of evidence demonstrating that primary healthcare can help to reduce both hospitalisations and spending on healthcare (OECD, 2020[5]). Patients who visit primary care practitioners regularly have been reported to have both improved health outcomes and lower healthcare costs, while better continuity of care and care management for patients living with chronic conditions, including hypertension and diabetes, have been associated with better health outcomes (Chan et al., 2021[6]; Lee et al., 2021[7]).
Analysing the healthcare emissions associated with different locations of care1 demonstrates that hospitals continue to be the most important driver of health sector emissions by place of location or healthcare domain. Across OECD countries on average, about 30% of health sector emissions were associated with hospital care, much higher than the emissions impact of the outpatient or long-term care sectors.
With an important plurality of health sector emissions taking place in hospitals, reducing care based in hospitals and scaling up lower emissions outpatient care has the potential to both improve health outcomes and reduce costs and to further mitigate the impact of the health sector on the environment. Bringing down the overhead associated with healthcare administration, reducing low-value care in hospitals and pharmaceutical prescribing, scaling up existing low-emissions alternatives in outpatient care and reducing low-value excess services including laboratory tests and medical imaging would play an important part in improving the carbon footprint of the health sector, all while promoting the kinds of policies and strategies that countries have already identified as adding important value.
Reducing low-value care in hospitals would have an impact on mitigating the emissions associated with hospital care. On average across OECD countries and using a top-down approach, hospitals produced an average of nearly 200 kg of CO2‑e emissions per patient bed day in 2018, an intensity much higher than the emissions associated with an outpatient care visit. In addition to decreasing hospital costs, long hospital stays are often an indication of suboptimal care co‑ordination, with patients sometimes staying in hospitals longer than clinically needed because follow-up care, including long-term care beds or outpatient rehabilitation services, are not available or not efficiently arranged. While policies to reduce the length of stay in hospitals must be implemented carefully to ensure patients are not discharged when they are not clinically ready – which could result in complications or readmissions – the variation in average lengths of stay across OECD countries suggests there is some scope to bring down the amount of time many patients stay in hospital.
Source: OECD analysis based on data from OECD Health Statistics 2025, System of Health Accounts and ICIO data.
Reducing avoidable admissions for preventable long-term, chronic conditions would also offer important cost and emissions savings to health systems. Chronic conditions including asthma, congestive heart failure and chronic obstructive pulmonary disease are preventable conditions for which good, primary- and outpatient-care based treatment pathways have been developed. As such, where hospitalisations occur, they are often seen to have been avoidable had better outpatient-based care management been practiced. While extremely low levels of hospital admissions for avoidable conditions may be a sign that access to hospitals is limited – rather than that countries are practicing effective care management in primary care – lower levels of avoidable admissions are generally considered to be a good marker of care quality in health systems. In recent years, countries have already begun to see reductions in avoidable hospital admissions. Between 2011 and 2019, admission rates for asthma and COPD fell by 13% across OECD countries on average and by 6% for congestive heart failure (OECD, 2023[8]).
Reducing the length of an average hospital stay and the rate of avoidable hospital admissions to the OECD average for countries currently above the OECD mean would make an important contribution towards reducing hospital-based health sector emissions. On average, hospital-based emissions across OECD countries could decline by as much as a quarter under a scenario where average lengths of stay were reduced to the level of the best performing quartile of countries, while avoidable admissions were reduced to zero.
Moving care out of hospitals and into the community and improving care management for chronic conditions associated with avoidable hospital admissions serves as one example of how pursuing policies that reduce low value could also help to achieve important environmental benefits. OECD countries currently experience significant differences in hospitalisation rates for avoidable admissions, including hospitalisations related to chronic conditions such as diabetes and asthma (OECD, 2023[8]).
Many of the policies that would help to meaningfully reduce greenhouse gas emissions are the very same policies that health systems should be prioritising anyway, to achieve other core system objectives, including better health outcomes, delivered more efficiently. Policies that help to reduce low-value care, such as reducing unnecessary digital imaging and laboratory tests, or moving avoidable care out of hospitals and into the community can help to both reduce unnecessary healthcare consumption and lower the emissions associated with the health sector.
OECD countries play a central role in both the consumption and production of pharmaceuticals and medical goods globally. Nine of the ten largest exporters and importers of pharmaceuticals and other medical goods are OECD countries. The extreme complexity and global nature of pharmaceutical and other medical goods production means that their supply chains make up a large share of overall health sector emissions. The OECD model not only allows to identify several sub-sectors that are responsible for the overall greenhouse gas emissions in the health sector but can trace back emissions to their industry of origin. This type of analysis is needed when attributing health sector emissions across the “scope” classification as defined by the Greenhouse Gas Protocol.2 Applying this concept on average across OECD countries, emissions not directly generated or consumed by a producer but rather related to its value chain (so-called scope 3 emissions) made up more than three‑quarters of overall emissions in 2018 (Figure 1.6).
All GHG emissions, as allocated based on the Scope concept by the GHGP, 2018, OECD
Note: Data refers to the OECD mean.
Source: OECD analysis based on data from OECD Health Statistics 2025, System of Health Accounts and ICIO data.
Pharmaceutical supply chains are extremely complex. The production process, including both sourcing and supplying raw materials, primary manufacturing (producing the active primary ingredient), secondary manufacturing (finalising the product) and distribution, can involve multiple companies and stakeholders spread out across many locations and countries for the production of a single product (OECD, 2023[9]). In contrast, modelled estimates from the OECD suggest that just about 12% of all GHG emissions associated with final healthcare demand were related to direct emissions that occurred at domestic health facilities3 (e.g. fuel combustion to generate heat in hospitals), while a further 9% related to indirect emissions from domestically purchased electricity by health providers.
Note: Data refers to Scope 3 emissions according to the classification of the Greenhouse Gas (GHG) Protocol and refers to indirect emissions not related to electricity purchased directly by healthcare facilities.
Source: OECD analysis based on data from OECD Health Statistics 2025, System of Health Accounts and ICIO data.
Across OECD countries on average, more than half of countries’ emissions associated with healthcare demand by its residents were generated abroad. Countries with a strong reliance on foreign inputs but a relatively low emissions intensity in domestic production, such as Austria, Iceland, Luxembourg and Switzerland, demonstrate a lower domestic share of emissions. In contrast, countries with a lower reliance on foreign inputs and a higher emissions intensity in domestic production, such as Mexico, Poland and the United States, saw a higher share of emissions generated domestically. the global and interdependent dynamics of the health sector.
Source: OECD analysis based on data from OECD Health Statistics 2025, System of Health Accounts and ICIO data.
The large share of health sector emissions stemming from health sector supply chains and particularly from sources abroad, as in the production of many pharmaceutical products imported from abroad, underscores the reality that policies that facilitate changes in emissions in healthcare delivery domestically can have only a limited impact on emissions in the health sector overall. To deliver reductions in health sector greenhouse gas emissions, practices that promote the reduction of emissions within its supply chains more broadly are likely to deliver a meaningful impact.
Pharmaceuticals and medical goods represent 26% of health sector emissions; substituting away from some high-emission products is already possible
On average across OECD countries, the consumption of medical goods and pharmaceuticals was associated with a quarter of all health sector greenhouse gas emissions in 2018, the second largest cause of GHG emissions in health after hospitals (Figure 1.9).
Source: OECD analysis based on data from OECD Health Statistics 2025, System of Health Accounts and ICIO data.
There is a growing body of evidence around cases where pharmaceutical and medical goods consumption can be substituted or reduced without negative clinical impact, but with notable emissions benefits. For example, commonly used anaesthetic gases, including notably desflurane, sevoflurane and isoflurane, differ greatly in their greenhouse gas emissions and warming potential. In most clinical cases desflurane can be substituted with little clinical impact for sevoflurane, which has been estimated to have a greenhouse gas impact just 5% of that of desflurane (Sherman et al., 2012[10]).
Despite the potential for low-emission and substitutable alternatives to be adopted with relative ease, current data gaps and lack of specific guidance constrain clinicians’ ability to make emissions-informed choices for products such as anaesthetic gases. Across OECD countries, two countries – the United Kingdom (England, Scotland) and Australia (Western Australia) have removed desflurane from use as an anaesthetic gas, with the European Union slated to follow suit in 2026. In Western Australia, for example, removing desflurane has been estimated to have delivered both emissions and cost reductions, reducing an estimated 1800 tons of CO2‑equivalent emissions annually, while driving down costs by 750 000 AUD (Department of Health and Aged Care, 2023[11]). Some medical associations and other clinician-oriented initiatives have further developed guidelines around promoting lower-emission alternatives in specific clinical contexts, such as developing more environmentally-friendly Green Surgery guidance (Brighton and Sussex Medical School, Centre for Sustainable Healthcare and UK Health Alliance on Climate Change, 2023[12]).
Similar alternatives exist for other products outside of the surgical ward. Inhalers, used to support treatment in people with different respiratory conditions, similarly exhibit a significant variation in greenhouse gas emissions with marginal clinical difference for the majority of patients. Metered dose inhalers currently on the market have an emissions impact much higher than other forms of inhalers, such as soft mist or dry powder inhalers, due to the emissions intensity of their propellant. But for many patients, switching to a different type of inhaler can be undertaken without significant clinical impact. For example, researchers have found that asthma patients can be switched from pressurised metered dose inhalers to dry powder inhalers without impacting control of their condition, while cutting inhaler-related emissions by more than half (Woodcock et al., 2022[13]). Across OECD countries who provided data, the share of metered-dose inhalers (the highest emitting inhalers) used as a proportion of all inhalers varied close to two‑fold in 2023 (Figure 1.10). The wide variation in consumption patterns for respiratory inhalers across OECD countries currently underscores that environmental considerations and emissions impacts are not regularly incorporated into clinical decision making currently used by healthcare professionals.
Metered dose inhalers as a share of all prescribed inhalers, 2023
Source: OECD analysis based on data from the 2025 OECD Health and Climate Data Collection on High-Emission Clinical Inputs.
Switching from the high-emitting pressurised metered dose inhalers currently on the market to dry powder or soft mist inhalers could help OECD countries cut the greenhouse gas emissions associated with inhalers significantly. At the same time, new products may be accompanied by higher costs than higher-emitting existing alternatives, as occurred when chlorofluorocarbons were banned, forcing policymakers and clinicians to balance environmental considerations with questions of costs to the health system and implications for access (Jena et al., 2015[14]). A number of major pharmaceutical companies have been working in recent years to reformulate their metered-dose inhalers to reduce their emissions intensity and have begun applying for regulatory approval, with the first metered dose inhaler using a low-emission propellant approved in the United Kingdom in May 2025 (AstraZeneca, 2025[15]).
Reshaping the impact of health systems supply chains
Harnessing public procurement represents an important tool for countries to help shape the environmental impact of their health sectors and of supply chains more broadly. Across OECD countries, public procurement by governments made up more than a quarter of all government expenditures in 2021, representing nearly 13% of GDP on average. Critically, healthcare procurement represents the largest share of government procurement in OECD countries (OECD, 2025[16]).
OECD countries have increasingly developed guidelines and rules related to procurement policy to help achieve their environmental goals – including objectives towards mitigation. Close to four‑fifths of OECD countries report having adopted “green” procurement policies for government procurement. Fewer – about one in six countries – have adopted guidelines for green procurement that relate specifically to the health sector.
The development of joint procurement policies across countries – particularly where markets are small – can help to offer clarity and sufficient market size to incentivise companies and their suppliers to adapt their production processes to meet the desired environmental standards. Such practices have a well-established track record in some regions with small countries, including Nordic countries, while initiatives to develop joint procurement standards for environmental sustainability in healthcare procurement have also more recently been undertaken by a range of larger countries from more disparate parts of the world, though the process is still underway (Sykehusinnkjop, 2023[17]).
Health Technology Assessments (HTA) could offer an opportunity to incorporate environmental considerations into healthcare decision making
In the medium term, health technology assessments (HTAs) may offer the opportunity for health systems to more systematically consider the environmental impacts of new healthcare products and technologies. While countries, including Australia, Canada, Poland, Spain and the United Kingdom, have begun to explore how environmental factors can ultimately be incorporated into HTAs, the actual application of environmental considerations in HTAs remains limited. In Canada, for example, environmental impacts are included as one of the ten domains within the deliberative framework developed by the Canadian Agency for Drugs and Technologies in Health (CADTH) Health Technology Expert Review Panel. However, not all of the domains must undergo a full evaluation during the deliberation process, and while environmental impacts (largely unrelated to emissions) have on occasion been considered in HTA decision making – notably around dental interventions – this is not the norm (Walpole et al., 2023[18]). With countries beginning to explore whether and how to factor in environmental impacts into health technology assessments, it will be important to collect further information on what scope of environmental factors is under consideration, and to assess how different approaches to evaluating environmental impacts could affect existing HTA processes.
A major barrier remains the lack of sufficient high-quality data on the environmental impact – including the greenhouse gas emissions – of different medical technologies and healthcare products. Acting on uncertain or incomplete data could risk complicating well-established assessment practices without delivering clear environmental benefits. This is particularly true in cases where trade‑offs exist between different types of environmental impacts, such as between the impacts of a product on greenhouse gas emissions and its impact on other environmental factors, such as water pollution. For example, while a decision around recommending a new medical device in the United Kingdom in 2022 noted that that while there was a lack of evidence on its impact on greenhouse gas emissions, there was the “potential” that the device could help to reduce greenhouse gas emissions compared to other products (National Institute for Health and Care Excellence, 2023[19]). However, the environmental considerations were neither taken into account as evidence nor cited as a reason the product was recommended (Szawara et al., 2023[20]).
While efforts to reduce the health systems impact on the environment, and on greenhouse gas emissions more specifically, remain fairly new, important policies have already emerged that can help countries deliver environmentally sustainable care, including models of sustainability and circularity in hospitals, targeted guidance to specialists, and the promotion of low-emission products and alternatives that are available with similar clinical outcomes and costs to existing practices. At the same time, the extent of concrete policy options and evidence around the effect of different interventions on changing greenhouse gas emissions is still imperfect and incomplete. This is due primarily to limitations in the availability of data and what is more broadly understood in terms of the environmental impact of different interventions, products, and models of care.
Despite this uncertainty, avenues for health systems to move towards high quality, lower emissions care in ways that contribute to health systems goals exist, including delivering high-quality healthcare that promotes better health outcomes at lower costs. Governments across many OECD countries have scaled up efforts to reshape their economies in a way that promotes growth while accelerating efforts to decarbonise their societies. Health systems have been no exception to this. Strategies to decarbonise the health sector in OECD countries have been led by Ministries of Health, who in many cases have shared the responsibility for mitigation policies with Ministries of the Environment and others responsible for broader decarbonisation efforts in the country. In the Netherlands, for example, the Ministry of Health, together with other stakeholders and relevant ministries, committed to a Green Deal on Sustainable Healthcare in 2022. The Green Deal sets out a range of actions that signatories undertake to commit to improve the environmental sustainability of healthcare, including moving towards carbon neutrality by 2050, scaling up circular practices and reducing waste, reducing the environmental impact of pharmaceutical products, improving knowledge and awareness around the environmental impacts of the health sector, and promoting public health interventions (Ministry of Health, Welfare and Sport, 2022[21]).
While policymakers responsible for the health sector have given increased attention to promoting policies to reduce greenhouse gases associated with the production and consumption of healthcare services, most OECD countries report that mitigation efforts have not been significantly staffed or funded, with just over one‑third of 23 responding countries reporting that a team or division focussed on mitigation policies has been developed. Only three responding countries – Australia, Austria and the Netherlands – reported that they had both teams and funding allocated for mitigation efforts within the health sector. Nearly four in five responding countries (18 of 23) reported that there was no funding allocated within the health budget to emissions reduction efforts.
Note: 23 OECD countries responded to the survey.
Source: OECD (2024[22]), OECD Policy Survey on Climate Change and Health 2024.
The vast majority of OECD countries have developed policies and regulations aimed at helping to reduce the greenhouse gas emissions from energy use inside healthcare facilities. For example, nine in ten surveyed OECD countries reported having policies to support upgrading the energy efficiency of buildings, such as energy efficiency standards and requirements in the construction of new healthcare facilities. These rules and standards reflect broader energy efficiency measures in the construction sector, rather than being tailored for the healthcare sector specifically. Two in three OECD countries have further developed policies to help healthcare facilities strengthen their response to climate change events, including through vulnerability assessments at the facility level and support for upgrades that support resiliency.
Many of the policies that have been put in place to help improve environmental sustainability reflect wider economy-wide approaches that have been adopted by countries to facilitate mitigation, rather than targeting the health sector specifically. While more than three‑quarters of responding OECD countries (17 of 22) report having energy efficiency standards and requirements applicable to the construction of new healthcare facilities, for example, just 3 of the 17 countries that reported such standards were in place reported that they had been developed specifically for healthcare facilities. Where healthcare specific initiatives have been adopted, they have often been the result of bottom-up momentum from healthcare practitioners and administrators. In some cases, efforts to promote sustainability that began at a more local level have expanded to encompass a broader set of institutions. In Denmark, for example, the five Danish regions published a joint strategy for hospital sustainability in 2024 with shared sustainability objectives (e.g. 50% reduction in emissions by 2035) and initiatives covering hospitals across the country (Healthcare Denmark, 2024[23]).
Where such healthcare‑focussed initiatives have emerged, they have been met by strong demand. In Austria, for example, a programme to support mitigation in healthcare facilities was expanded due to high demand, with more than 30% of Austrian hospitals participating in the initiative (Lichtenecker, 2024[24]).
The potential contribution of public health policy to climate change mitigation extends far beyond the remit of healthcare systems alone. Many of the most effective mitigation measures – such as those related to urban design, transportation, food systems and energy — lie outside the traditional health sector. Public health interventions that influence these areas, including policies that promote active mobility, reduce air pollution and support healthy and sustainable diets, can achieve important emissions reductions while delivering substantial health co-benefits. Recognising and integrating these health gains into climate policy can strengthen the rationale for mitigation measures.
Note: Outliers at the tail end of 2.5% (beyond the 97.5th percentile on the upper-end and 2.5% percentile on the lower-end are removed).
Source: Whitmee, S. et al. (2024[25]), “Pathways to a healthy net-zero future: report of the Lancet Pathfinder Commission”, https://doi.org/10.1016/s0140-6736(23)02466-2.
The rise of many non-communicable diseases and the acceleration of climate change share many drivers. The potential to develop win-win policies that help to improve both health outcomes and reduce greenhouse gas emissions is underscored by the fact that the burden of non-communicable disease and climate change share many of the same drivers, including the use of fossil fuels, the development of highly industrialised food systems that promote unhealthy diets, and the development of transportation systems that leave populations overwhelmingly dependent on cars for travel. Many of the policies that promote good health, inversely, can also have beneficial impacts to mitigating climate change (Figure 1.13).
Source: Adapted from Whitmee, S. et al. (2024[25]), “Pathways to a healthy net-zero future: report of the Lancet Pathfinder Commission”, https://doi.org/10.1016/s0140-6736(23)02466-2 and Gao, J. et al. (2018[26]), “Public health co-benefits of greenhouse gas emissions reduction: A systematic review”, https://doi.org/10.1016/j.scitotenv.2018.01.193.
Across OECD countries, health conditions amenable to climate mitigation policies represented more than 8% of DALYs and 14% of deaths in 2022. Many public health policies have already been identified that could drive important benefits to health outcomes while also reducing greenhouse gas emissions by levels far above what can be achieved within direct health systems-related emissions alone. This section focusses on three key sectors – sustainable and healthy diets, transportation and household energy – where evidence on sector-specific mitigation policies have shown the largest benefits for health outcomes and important benefits for reducing emissions (Whitmee et al., 2024[25]). It looks at the policy options available to address the dual challenges of climate change and public health and considers the role of Ministries of Health in promoting the health benefits of mitigation actions in policies that lie beyond their area of responsibility.
Reducing unhealthy diet’s impact on health and the environment
There are opportunities across OECD countries to harness healthier and sustainable dietary consumption patterns to realise win-win outcomes for both public health and environmental sustainability. Policies and approaches that reduce food waste, reduce the consumption of animal products, and move towards seasonal eating patterns can provide multiple co-benefits for health and the environment.
Some countries, including Czechia, Estonia, Greece, Lithuania and Poland, have both high burdens of diseases related to obesity and high emissions from their food and agriculture systems, suggesting that there are good opportunities to simultaneously tackle both challenges. Consumption-based policies that shift the focus from how food is produced to how it is consumed can help to can help to directly impact challenges such as unhealthy diets and food waste in ways that promote public health and sustainability.
Modelling from the OECD suggests that scaling up the adoption of more nutritionally balanced, plant-based diets in line with national dietary guidelines would reduce premature deaths from cancer by 27 000 deaths annually across OECD countries, and could reduce greenhouse gas emissions by 304 MtCO2eq, equivalent to removing all the cars from the roads of France and Spain for a year.
Change in total GHG emissions, Mt of CO2‑eq per year, average over 2023‑2050
Source: OECD (2024[27]), Tackling the Impact of Cancer on Health, the Economy and Society, https://doi.org/10.1787/85e7c3ba-en.
Policies to influence the price of foods can impact the behaviour of consumers, including encouraging them to shift towards healthier and more environmentally sustainable options. A number of OECD countries, including Finland, Germany, Poland and Portugal, have focussed on reducing taxes on foods considered to be healthy or environmentally sustainable, including fruits and vegetables. Zoning regulations which discourage or prohibit the establishment of fast-food restaurants have been adopted in Canada and Ireland to promote healthier food environments and discourage unhealthy consumption. Lastly, some countries, including Austria, have begun to explore the potential to use public procurement to encourage healthier and more environmentally sustainable food options.
Promoting active transportation
The transportation sector accounted for approximately a quarter of global emissions in 2019, and represents the fastest growing source of emissions in OECD countries. Passenger transportation itself accounts for two‑fifths of transportation emissions, including emissions related to the use of private cars and vehicles. While some areas in the OECD have seen a reductio in the number of vehicles per capita, many countries – including Australia, Canada, Mexico and Türkiye, as well as a number of countries in Central and Eastern Europe, have high rates of car ownership, even in urban areas with public transportation alternatives.
Strategies and policies that promote environmentally sustainable transportation alternatives can help to encourage healthier choices to be made. Scaling up safe, high-quality infrastructure for cycling has helped to shift commuters towards cycling, for example, including in countries like Denmark and the Netherlands, which have successfully moved away from car-centric models in the mid‑1970s towards more environmentally sustainable alternatives today.
Financial incentives that encourage the uptake of public transportation has also helped to increase ridership. In Luxembourg, public transportation was made free for all in 2020 to encourage an increase in ridership, while reductions in the cost of public transportation in Germany led to dramatic increases in ridership, along with reductions in levels of air pollution. Other financial incentives have included policies related to congestion pricing, as implemented in Italy (Milan), Sweden (Stockholm) and the United Kingdom (London).
Countries have also adopted many policies to encourage fuel efficiency in vehicles, including by developing vehicle emissions standards, feebates and green procurement policies to encourage a switch towards lower emission vehicles.
Promoting cleaner energy use in residential settings
In recent years, there has been significant progress made towards scaling up renewable energy sources in OECD countries. Yet many residential homes continue to remain highly dependent on oil and natural gas for their heating systems. While in some countries, including Canada, Japan, Korea and Luxembourg, high-polluting energy sources represent less than 5% of residential energy consumptions, others, including Czechia, Estonia, Poland and Slovenia, report rates higher than 40%.
Such a dependence on high-polluting sources of energy can impact not only emissions but also public health. Estonia, Hungary and Poland all continue to experience high emissions within the residential energy sector and a high burden of diseases related to indoor air pollution. Developing policies that support cleaner energy alternatives in the residential sector can help to tackle both the health impacts of indoor air pollution and reduce emissions. A number of countries have taken important steps to shift away from polluting energy sources. In Norway, for example, oil- and paraffin-based heating has been phased out since 2016, with a full ban on new and renovated residences enacted as of 2020. Other countries, including Austria, Belgium, Denmark, Germany and Ireland, have similarly adopted restrictions on the use of fossil fuel-based heating options in new and renovated residences.
Public health policies to achieve win-wins for health and climate rely heavily on information-based approaches
The majority of public health policies impacting the food, transportation and household energy domains adopted by OECD countries have focussed on “information-based” approaches, including labelling initiatives, consumer guidelines, and awareness campaigns, with the goal of improving information and public knowledge. Regulations and government investment have been less frequently applied. There have been fewer applications of financial incentives in the food and nutrition sectors compared with the transportation and energy sectors.
Percentage of countries implementing “win-win” policies, by sector and policy instrument
Note:17 OECD Countries have responded to this survey.
Source: OECD Health and Climate Policy Survey.
Policymakers have increasingly understood the importance of complementing supply-side policies that have been the focus on decarbonisation efforts with interventions that aim to change behaviour, through the adoption of demand-side interventions. The Sixth Assessment Report from the IPCC estimates that strengthening demand-side responses which support lifestyle changes could help to reduce emissions by up to 40‑70% globally by 2050 (Calvin et al., 2023[28]).
References
[28] Arias, P. et al. (eds.) (2023), IPCC, 2023: Climate Change 2023: Synthesis Report. Contribution of Working Groups I, II and III to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change [Core Writing Team, H. Lee and J. Romero (eds.)]. IPCC, Geneva, Switzerland., Intergovernmental Panel on Climate Change (IPCC), https://doi.org/10.59327/ipcc/ar6-9789291691647.
[15] AstraZeneca (2025), Trixeo Aerosphere approved in the UK as first inhaled respiratory medicine using next-generation propellant with near-zero Global Warming Potential, https://www.astrazeneca.com/media-centre/press-releases/2025/trixeo-aerosphere-approved-in-the-uk-as-first-inhaled-respiratory-medicine-using-next-generation-propellant-with-near-zero-global-warming-potential.html.
[12] Brighton and Sussex Medical School, Centre for Sustainable Healthcare and UK Health Alliance on Climate Change (2023), Green surgery: Reducing the environmental impact of surgical care, https://ukhealthalliance.org/sustainable-healthcare/green-surgery-report/.
[6] Chan, K. et al. (2021), “Effects of continuity of care on health outcomes among patients with diabetes mellitus and/or hypertension: a systematic review”, BMC Family Practice, Vol. 22/1, https://doi.org/10.1186/s12875-021-01493-x.
[11] Department of Health and Aged Care (2023), Natinoal Health and Climate Strategy, https://www.health.gov.au/sites/default/files/2023-12/national-health-and-climate-strategy.pdf.
[26] Gao, J. et al. (2018), “Public health co-benefits of greenhouse gas emissions reduction: A systematic review”, Science of The Total Environment, Vol. 627, pp. 388-402, https://doi.org/10.1016/j.scitotenv.2018.01.193.
[23] Healthcare Denmark (2024), The Danish regions’ strategy for sustainable hospitals, https://healthcaredenmark.dk/national-strongholds/sustainability/.
[14] Jena, A. et al. (2015), “The Impact of the US Food and Drug Administration Chlorofluorocarbon Ban on Out-of-pocket Costs and Use of Albuterol Inhalers Among Individuals With Asthma”, JAMA Internal Medicine, Vol. 175/7, p. 1171, https://doi.org/10.1001/jamainternmed.2015.1665.
[7] Lee, J. et al. (2021), “Assessment of Interprofessional Collaborative Practices and Outcomes in Adults With Diabetes and Hypertension in Primary Care”, JAMA Network Open, Vol. 4/2, p. e2036725, https://doi.org/10.1001/jamanetworkopen.2020.36725.
[24] Lichtenecker, R. (2024), The Austrian Strategy Towards a Net Zero Healthcare System, https://www.gov.si/assets/ministrstva/MOPE/Podnebje/Samo1planet/Zdravstvo-po-zeleni-poti/03-dr.-Ruperta-Lichtenecker-The-Austrian-Strategy-Towards-a-Net-Zero-Healhcare-System.pdf.
[1] Liu, Z. et al. (2023), “Monitoring global carbon emissions in 2022”, Nature Reviews Earth & Environment, Vol. 4/4, pp. 205-206, https://doi.org/10.1038/s43017-023-00406-z.
[21] Ministry of Health, Welfare and Sport (2022), More sustainability in the health and care sector, https://www.government.nl/topics/sustainable-healthcare/more-sustainability-in-the-care-sector#:~:text=To%20be%20carbon%2Dneutral%20by,2018%20as%20its%20reference%20year.
[19] National Institute for Health and Care Excellence (2023), Sedaconda ACD-S for sedation with volatile anaesthetics in intensive care: Medical technologies guidance, https://www.nice.org.uk/guidance/mtg65/resources/sedaconda-acds-for-sedation-with-volatile-anaesthetics-in-intensive-care-pdf-64372178389957.
[16] OECD (2025), Policy Issues: Public Procurement, https://www.oecd.org/en/topics/policy-issues/public-procurement.html.
[22] OECD (2024), OECD Policy Survey on Climate Change and Health.
[27] OECD (2024), Tackling the Impact of Cancer on Health, the Economy and Society, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/85e7c3ba-en.
[8] OECD (2023), Health at a Glance 2023: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/7a7afb35-en.
[9] OECD (2023), Ready for the Next Crisis? Investing in Health System Resilience, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/1e53cf80-en.
[5] OECD (2020), Realising the Potential of Primary Health Care, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/a92adee4-en.
[4] OECD (2017), Tackling Wasteful Spending on Health, OECD Publishing, Paris, https://doi.org/10.1787/9789264266414-en.
[3] OECD/Eurostat/WHO (2017), A System of Health Accounts 2011: Revised edition, OECD Publishing, Paris, https://doi.org/10.1787/9789264270985-en.
[10] Sherman, J. et al. (2012), “Life Cycle Greenhouse Gas Emissions of Anesthetic Drugs”, Anesthesia & Analgesia, Vol. 114/5, pp. 1086-1090, https://doi.org/10.1213/ane.0b013e31824f6940.
[17] Sykehusinnkjop (2023), New environmental criteria for the procurement of pharmaceuticals, https://www.sykehusinnkjop.no/en/nyheter/nyheter-2019/new-environmental-criteria-for-the-procurement-of-pharmaceuticals/.
[20] Szawara, P. et al. (2023), Environmental sustainability in HTA: Are HTA bodies applying environmental criteria in their decision-making?, https://www.ispor.org/docs/default-source/euro2023/isporeurope23wagnerhta290poster132526-pdf.pdf?sfvrsn=fdefc172_0.
[18] Walpole, S. et al. (2023), “How can environmental impacts be incorporated in health technology assessment, and how impactful would this be?”, Expert Review of Pharmacoeconomics & Outcomes Research, Vol. 23/9, pp. 975-980, https://doi.org/10.1080/14737167.2023.2248389.
[25] Whitmee, S. et al. (2024), “Pathways to a healthy net-zero future: report of the Lancet Pathfinder Commission”, The Lancet, Vol. 403/10421, pp. 67-110, https://doi.org/10.1016/s0140-6736(23)02466-2.
[29] WHO (2023), The Diet Impact Assessment model: a tool for analysing the health, environmental and affordability implications of dietary change, World Health Organization Regional Office for Europe, https://iris.who.int/handle/10665/373835.
[13] Woodcock, A. et al. (2022), “Effects of switching from a metered dose inhaler to a dry powder inhaler on climate emissions and asthma control: post-hoc analysis”, Thorax, Vol. 77/12, pp. 1187-1192, https://doi.org/10.1136/thoraxjnl-2021-218088.
[2] Yamano, N., M. Lioussis and A. Cimper (2024), “Measuring greenhouse gas footprints in global production networks: New perspectives on emissions embodied in production chains and final demand patterns”, OECD Science, Technology and Industry Working Papers, No. 2024/12, OECD Publishing, Paris, https://doi.org/10.1787/fc426ab9-en.
← 1. The analysis carried out distinguished between six subsectors in health: Hospitals, nursing homes, outpatient providers (such as offices of GPs or specialists, outpatient clinics and other ambulatory health providers), medical goods, other health providers (such as public health institutes, health administration, imaging centres, laboratories, patient transportation), and investment goods.
← 2. The allocation across Scopes 1, 2 and 3 allocates all health sector emissions across direct and indirect (purchased electricity / other indirect) emissions. It provides complementary information to the allocation of GHG emissions by healthcare subsector presented earlier in the chapter. The approaches are not additive, as both allocate the same amount of total emissions, but according to different categorisations.
← 3. Also includes domestic manufacturers, transport and trade.