THE PROBLEM

Healthcare accounts for 4–5% of global greenhouse gas emissions (7% in Australia). Around 40% of the footprint of healthcare comes from buildings (including energy, water and waste, catering and non-medical equipment). Greening hospitals by using renewable energy is vital, but alone will be insufficient as 60% of the footprint of healthcare is due to clinical care itself i.e. the tests and treatments that result from clinical decisions in relation to each individual patient. The UK leads the world in decarbonising healthcare; the NHS has cut its footprint by 26% compared to 1990 emissions. Almost all of that gain, however, has been achieved by less reliance on fossil fuels and decarbonising the UK electricity grid. Changing clinical care itself is the next, critically important challenge as further carbon footprint reductions will not be achieved without it.

Environmental sustainability is often described as a hierarchy of waste reduction: reduce (or recycle), reuse, and replace, with most attention to date being focused on reuse (or recycle) strategies. In some areas of healthcare, opportunities for reuse are limited (e.g. by infection control requirements) and replacement with lower carbon options is currently limited and will rely on future technical innovation. A major opportunity for reduction, therefore, lies in avoiding or reducing unnecessary or low value care.

Low value care confers little or no benefit and risks iatrogenic harm. As a result, it generates carbon emissions without improving health. CI Glasziou et al have shown that ~30% of healthcare is low value and 10% is harmful. CIs Barratt, Bell, Semsarian, Glasziou and AI Morton have shown low value care is widespread in cancer and heart disease. CI Buchbinder and AI Harris have found the same in the musculoskeletal (MSK) field. Research by CIs on this team is leading to practice change. Accelerating this change can significantly reduce healthcare’s carbon footprint without negatively impacting quality of care.

We work in partnership with government and researchers to find and inform solutions to healthcare sustainability.

These partners, include:

• National Health, Sustainability and Climate Unit

• Healthy Environments And Lives (HEAL) Network

• NSW Health - Climate risk and net zero

• Healthcare Carbon Lab

• North Sydney Local Health District

OUR RESPONSE SO FAR…

Measure the carbon emissions from common medical goods and services

To drive change, clinicians need evidence on the carbon footprint of the things they do, and the things they use every day. This information enables comparison and choice between low and high carbon healthcare goods and services. Yet this vital information is almost completely lacking.

• The carbon footprint of pathology testing (2020)

• Hospital steam sterilizer usage: could we switch off to save electricity and water? (2016)

• Steam sterilisation’s energy and water footprint (2016)

• The Environmental footprint of morphine: a life cycle assessment from opium poppy farming to the packaged drug (2016)

• The carbon footprint of Australian health care (2018)

• A survey of the choice of general anaesthetic agents in Australia and New Zealand (2019)

• Health Care Sustainability Metrics: Building A Safer, Low-Carbon Health System (2020)

• Optimising a targeted test reduction intervention for patients admitted to the intensive care unit: The Targeted Intensive Care Test Ordering Cluster Trial intervention (2021)

• Recovery of Sevoflurane Anaesthetic Gas Using an Organosilica Membrane in Conjunction with a Scavenging System (2021)

• Renewable energy use in Australian public hospitals (2021)

• The carbon footprint of treating patients with septic shock in the intensive care unit (2018)

• Carbon Footprint of General, Regional, and Combined Anaesthesia for Total Knee Replacements (2021)

• Health, financial and environmental impacts of unnecessary vitamin D testing: a triple bottom line assessment adapted for healthcare (2022)

• The environmental impact of health care for musculoskeletal conditions: A scoping review (2022)

• Exploring the Integration of Environmental Impacts in the Cost Analysis of the Pilot MEL-SELF Trial of Patient-Led Melanoma Surveillance (2023)

• Survey of intensive care unit staff views on a newly introduced reusable isolation gown (2022)

• A randomised noninferiority trial to compare enteral to parenteral phosphate replacement on biochemistry, waste, and environmental impact and healthcare cost in critically ill patients with mild to moderate hypophosphatemia* (2024)

• Single-use synthetic plastic and natural fibre anaesthetic drug trays: a comparative life cycle assessment of environmental impacts (2024)

• How many carbon emissions are saved by doing one less MRI? (2024)

• The carbon footprint of total knee replacements (2024)

Advocating for sustainable healthcare

As this field grows, and as global awareness about the need for climate action in general, and in healthcare specifically, grows, work is needed to build the case within healthcare, policy and research settings. To this end, we see our advocacy work as a crucial part of our research agenda.

• Victorian public healthcare Chief Executive Officers’ views on renewable energy supply (2021)

• Planetary health care: a framework for sustainable health systems (2021)

• Environmentally sustainable health care: now is the time for action (2020)

• A sustainable future in health: ensuring as health professionals our own house is in order and leading by example (2020)

• Environmental sustainability in anaesthesia and critical care (2020)

• Overdiagnosis is increasing the carbon footprint of healthcare

• When we truly need single-use equipment, will we have enough? Single-use versus reusable anaesthesia equipment: a qualitative analysis of Western Australian hospitals (2021)

• Why be sustainable? The Australian and New Zealand College of Anaesthetists Professional Document PS64: Statement on Environmental Sustainability in Anaesthesia and Pain Medicine Practice and its accompanying background paper (2019)

• Overdiagnosis is increasing the carbon footprint of healthcare (2021)

• High value health care is low carbon health care (2021)

• Climate responsibilities in intensive care medicine—let’s go green! An introduction to a new series in Intensive Care Medicine (2023)

• Towards zero carbon healthcare: anaesthesia (2022)

• Climate change and child health (2022)

• Environmental sustainability in cardiovascular practice: current challenges and future directions (2024)

• A qualitative exploration of barriers, enablers, and implementation strategies to replace disposable medical devices with reusable alternatives (2024)

• Staff satisfaction with reusable surgical drapes (2024)

Communicating about climate change and health research

Cross-disciplinary research and collaboration on health and climate change must be enhanced and supported to aid decision making for optimal adaptation and mitigation. An improved, shared understanding of the terminology used in the field enhances the capacity for effective collaboration.

• An Australian glossary on Health and Climate Change (2021)