Herein lies the uncomfortable paradox. The system based around promoting and nurturing human health is contributing to the one of the biggest public health emergencies of our lifetime. In 2019 Healthcare Without Harm (HCWH) published a landmark paper measuring the carbon footprint of health systems globally. Not including anaesthetic gases it found that the healthcare contributed to 4.4% of global emissions. That is the equivalent to the annual greenhouse gas production of 514 coal fired power stations. Another way of looking at is if global healthcare were a country it would be the 5th largest emitter on the planet.
The top 10 emitters made up 75% of the global healthcare climate footprint (Figure 1). There was also a reasonably strong correlation between healthcare spending and emissions. Those who spent more on healthcare emitted more. HCWH highlight the fact that if we were to couple future health sector growth and investment to an new trajectory to net zero we will significantly be able to reduce our carbon footprint. Health and social care makes up 6% of the carbon footprint in the UK emitting the equivalent of around 25 mega-tonnes of carbon dioxide. The UK government has has set itself the target of being net zero by 2050. The National Health Service (NHS) has surpassed that aiming to reach net zero by 2040 for emissions they control directly (NHS Carbon Footprint) and by 2045 for emissions they influence (NHS Carbon Footprint Plus). To learn more about our Road to Net Zero; click here.
Figure 1:Top ten emitters as percentage of global health care footprint. (HCWH 2019)
"Where on earth is all this carbon coming from?"
To better focus our efforts in reaching the ambitious target of net zero we need to know where the main carbon hotspots are in our health system. Depending on where you are in the world this may well differ. For examples countries with highly carbonised electricity generation will have a higher proportion of their healthcare associated carbon footprint from energy. In general we can divide healthcare associated emissions into scope 1 (emissions from directly controlled sources), scope 2 (indirect emissions from the generation of purchased energy) and scope 3 emissions (all other indirect emissions that occur including supply chain and staff travel).
Figure 2: Greenhouse gas emissions related to the NHS in the UK. (Delivering a Net Zero NHS 2020)
What makes up the great portion of the NHS Carbon Footprint?
Anaesthetic Gases & Inhalers
Waste, Energy & Water
Supply chain, Equipment & Drugs
Staff, Patient & Visitor Travel
62% of the carbon footprint from the NHS comes from medicines, equipment, and the supply chain, 15% from energy, water and waste, 5% from anaesthetic gases and metered dose inhalers, 14% from travel and 4% from commissioned health services outside the NHS.
Figure 3: Sources of carbon emissions by proportion of NHS Carbon Footprint Plus.
Measuring Our Impact
To understand our carbon footprint we need to know how to measure it which is no easy task. When it comes to measuring health sector emissions we rely on wonderful organisations like the UK's Sustainable Development Unit (SDU). The SDU select a set or core indicators that can be used by various settings to report data, such energy and resource use. To learn more about the complexities of measuring and monitoring on a large scale take the SDU Module: An Integrated Approach to Metrics.
In order to measure large swathes of information such as the carbon footprint of entire supply chains Environmentally Extended Input-Output models (EEIO) are used. They essentially link carbon footprint to amount spent, as this accounts for the fact that, on the whole, resource (carbon) intensive products/sectors are more costly. The cost spent and amount used will be multiplied by an emissions factor. These can be found on the IPCC Emissions Calculator Database.
If we are to look at the carbon footprint associated with specific items, we rely on data from Life Cycle Assessments (LCA). Put simply LCAs analyse the environmental footprint of an item (eg cotton swab), or a drug (eg Propofol), taking into account natural resource extraction, manufacturing, packaging, transport, use/reuse, and recycling/waste disposal. This information can be presented in terms of its effect of global warming (often measured in the equivalent weight of carbon dioxide (CO2e)), or in other ways such its effects on water or soil.
Jodi Sherman, Associate Professor of Anesthesiology and Epidemiology in Environmental Health Sciences at Yale, and her teams have produced much of the LCA data we use within anaesthesia. GASP are very excited to be currently collaborating with her team and our colleagues in Australia TRA2SH, on a LCA of IV and PO Paracetamol.
Now lets breakdown our carbon footprint and take a look in more detail:
Click on the boxes below to see how certain areas of our health system impact our climate.
Too much reading? Well don't fear, sit back, relax watch our lecture below to learn about the impact of anaesthesia on the environment.
Disclaimer: The above presentation was delivered prior to NHS Net Zero, our targets are now much more ambitious. We feel much more hopeful!