Net Zero Healthcare

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1 in 20 tons of carbon dioxide is emitted by health care
1 in 20 tons of carbon dioxide is emitted by health care

Healthcare is saving lives. But at the same time, it contributes to the climate crisis, accounting for nearly 5% of global CO2 net emissions. That’s twice as much as the aviation industry. How do we shift to green, climate-friendly healthcare?

  • The path to net zero healthcare leads through the radical transformation of healthcare: reducing the number of hospitals, favoring prevention over treatment, shifting towards value-based medicine
  • Our health and climate crisis are interconnected. With every 1°C  increase in global temperature, mortality risk increases by up to 5.5 %
  • During the COVID-19 pandemic, the CO2 emissions per consultation significantly decreased due to the rise of teleconsultations
  • In a panel discussion on Net Zero Healthcare co-organized by DayOne – Healthcare Innovation, experts representing big pharma, startups, and hospitals agreed that we have to reduce inefficiencies in healthcare and invest in sustainable business.

What is the link between climate and health?

Hospitals consume 2.1 times more energy per square meter than commercial buildings per bed and day; they use up to 568 liters of water and generate up to 1.5 kg of biomedical waste. Chemicals for disinfection, medicines, disposable medical and laboratory materials, patient and staff transport, waste management, food, and catering add to the negative impact on our climate. The magnitude of the problem is enormous: the healthcare sector in the United States releases pollutants that cause a loss of 388,000 disability-adjusted life years annually.

Of course, no one is suggesting hospitals should put greenhouse emissions first when health is at stake. However, it’s different to call the health and pharma industry out for their scale and inefficiencies. For example, about 10% of hospital admissions are unnecessary. People overconsume medicines or—the opposite—do not adhere to treatment plans, leading to avoidable emergency department visits. Or think about the patients who must drive long distances to a healthcare facility to get a prescription for medicine they have taken regularly for years. 

Following Humana and the University of Pittsburgh School of Medicine study, 25-30% of healthcare spending is wasted due to failure of care delivery, care coordination, overtreatment, low-value care, and administrative complexity.

The harm healthcare does to the climate falls back on us—the environment and healthcare are one interconnected ecosystem. Researchers estimate that the climate crisis could worsen 58% of human infectious diseases, from common waterborne viruses to deadly diseases like plague. According to McKinsey, in a 2.0°C warming scenario, more than 50% of the world’s population could be exposed to at least one climate hazard, including heat stress. Data from European Environment Agency suggest that the mortality risk increases by between 0.2 and 5.5% for every 1°C  increase in temperature above a location-specific threshold.

How healthcare and pharma can move towards zero emissions

Healthcare can achieve zero emissions by 2050 only if everybody—decision-makers, healthcare facilities and professionals, the pharma industry, businesses, and citizens—contributes to building patient-friendly, waste-free, sustainable healthcare.

Nevertheless, it is imperative to realize that net zero healthcare goes far beyond carbon-free energy sources for hospitals, like photovoltaics. The concept also includes a new approach to healthcare delivery, low carbon prescribing, a shift toward less environmentally-burdensome primary care, digitalization, healthy eating in hospitals or medical device reprocessing.

It all starts with solid leadership that prioritizes planetary health. The first actions are already in place. Under the COP26 Health Programme, established by WHO during the 2021 United Nations Climate Change Conference, over 50 countries committed to building climate resilient and low carbon health systems. Fourteen countries have set a target date to reach net zero carbon emissions in their health system by 2050.

In 2020, NHS launched Delivering a ‘Net Zero’ National Health Service strategy, the first national paper of its kind. It assumes net zero by 2040 for the emissions the NHS controls directly and by 2045 for the emissions the NHS has the ability to influence.

Reinventing the supply chain for medicine

The Global Green and Healthy Hospitals—a network of health organizations aiming to reduce their environmental footprint—has over 1,600 members in 78 countries. Green hospitals implement climate-friendly energy policies, reduce water consumption, optimize transportation, support healthy hospital design and construction, use purchasing procedures that favor sustainable products and materials, and implement waste management.

The first countries are launching their programs to foster transitions in healthcare. For example, KLIK green project empowers 250 German hospitals and rehabilitation clinics to support climate protection. The goal is to eliminate 100,000 tons of CO2–equivalents within three years by extensively and sustainably reducing the consumption of energy, materials, and resources.

Climate-oriented measures also arise in the pharma industry. 4.5 trillion medicines are made annually, but hundreds of billions are never used. Sustainable Medicines Partnership launched by YewMaker intends to change it. This private-public collaboration of 30 organizations, including pharma companies, generic and retail medicine manufacturers, packagers, distributors, hospitals, researchers, academia, policy, and patient groups, work together to reinvent the supply chain. Companies like ten23 health help the pharmaceutical industry and biotech startups develop sustainable strategies for inventing and manufacturing medicines.

Telemedicine is beneficial for the environment and patients

Digital transformation is another driving power for net zero healthcare. Electronic health records that have already saved thousands of trees are just a start.

According to the study, Does telemedicine reduce the carbon footprint of healthcare? A systematic review, telemedicine does reduce the carbon footprint of healthcare, primarily by reduction in transport-associated emissions—the carbon footprint savings range between 0.70–372 kg CO2 per consultation.

Another example: CommonSpirit—a US health network with 1,100 outpatient facilities in 21 states—calculated that 1.5 million virtual visits conducted during the COVID-19 pandemic between 8th March 2020 and 2nd April 2021 prevented the use of 6,354,848 liters of fuel and the emission of 15,092 tons of CO2. Patients also benefited directly by saving nearly $11 million in commuting.

Yet another study published in late 2019 analyzed 12,000 telemedicine visits made between January 2018 and January 2019 by primary care centers in the central region of Catalonia, Spain. The conclusion: 192,682 fewer kilometers driven, 11,754 liters of fuel saved, and a reduction of 29.4 tons of carbon dioxide and 36.6 tons of carbon monoxide.

While telemedicine and telemonitoring reduce unnecessary commuting, the positive impact of digitalization on climate-friendly healthcare has many faces. First, better care delivery coordination can lead to better resource management and, second, moving some health and care services from hospitals to local, less resource-intensive facilities. Third, patient apps can support disease management, reduce or optimize drug consumption and help patients to make beneficial health and environmentally conscious decisions, from healthy plant-based eating to physical activity when a bicycle replaces a car.

Besides, digitization, combined with smart devices, can lead to a stronger focus on prevention, reducing the overall demand for medical services. Finally, by measuring outcomes, we can make a shift toward value-based medicine focusing on treatment outcomes, i.e., quality, rather than favoring the quantity of medical services (fee-for-service model) as is currently the case.

DayOne puts net zero healthcare on the public agenda

There is still a gap in awareness of the harmful effects of healthcare on the environment. Therefore, Switzerland Innovation Park Basel Area, in collaboration with DayOne – Healthcare Innovation, organized a panel discussion on net zero healthcare within the Open Mic Next in Health series in July 2022 in Basel.

The panelists discussed what to do to move from words to action. The moderator, Rob Scott, Global Head of Product & Network Novartis Biome,  put on boxing gloves to emphasize the battle for our future.

The common understanding of the panelists was that we are all in this boxing ring together. We must fight for our future and take steps to drive change in the industry. Here are the key takeaways from the debate:

  • Let’s replace “net zero” with “net positive.” According to Hanns-Christian Mahler, CEO of ten23 health, sustainability must be at the center of all actions for the healthcare business to thrive. “We should do business in a sustainable way because it is the best way to do business.”
  • Taking climate action by individuals needs incentivization. Leaders in the healthcare and pharma industry are those who can motivate and inspire individuals to change their behavior. When the net zero approaches become the DNA of every healthcare organization, people will get engaged. If not, even the best policies won’t help.
  • Healthcare needs a profound shift to become more transparent. Lack of data and monitoring of processes hinder eco-friendly actions. For example, if the net emission in the delivery chain is not measured, it’s impossible to make climate-friendly decisions.
  • It’s about creating a new culture and awareness. We must build sustainable, efficient, waste-free healthcare to achieve the net zero goals. This needs rethinking how we deliver healthcare across the value chain.
  • There is no time to wait. We need radical innovation. Some advancements in terms of better efficiency should be adopted from other industries. “We need a cultural transformation. We need quality indicators, cost-effectiveness that favors value-based medicine,” said Christian Abshagen, Head of Sustainability at University Hospital Basel. If we focus on value, not volume, healthcare will become more sustainable.
  • We must reduce waste in healthcare to address inequality. 2 billion people don’t have access to primary healthcare services. “At the same time, billions of medicines are thrown away for different reasons. So the system doesn’t work and we have to fix the supply chain,” remarked Nazneen Rahman, Founder & CEO YewMaker.

“Our health depends on our planet, and there are huge co-benefits between health and environment that we can leverage together,” concluded Christian Abshagen.

Have you missed the Open Mic Next in Health series – Net Zero Healthcare? Watch it here:

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