A growing awareness and understanding of climate change and the planet’s increasing vulnerability has led to a necessary onus on humankind to reduce its negative impacts on the Earth. As such, targets have been set and a focus on environmental sustainability has moved into prominence. Healthcare contributes to climate change in a substantial way. In The environmental footprint of healthcare: a global assessment report, researchers examined the ‘environmental footprint of healthcare provision, which includes a wide variety of air, water, and soil pollutants’ and ‘also has an unintended and negative impact on health’. The study highlighted: “Healthcare causes global environmental impacts that, depending on which indicator is considered, range between one and five per cent of total global impacts, and are more than five per cent for some national impacts.” There is no denying that the healthcare sector significantly contributes to environmental damage, but is there enough awareness of this, and can more be done?

ITIJ spoke with Emma Hoban, Policy Analyst and Kylie Woolcock, Policy Director, both from the Australian Healthcare & Hospitals Association, who pointed out that: “‘First, do no harm’ is considered one of the defining ethical principles underpinning the provision of healthcare and yet globally, the health sector contributes to 4.4 per cent of net global carbon emissions, an amount equivalent to the fifth-largest carbon emitter on the planet.” There is a certain irony associated with an industry that is designed to promote health and healing having such a detrimental impact on the health of our planet.

Jon Utech, Senior Director of Sustainability Strategy, Cleveland Clinic, agrees: “Healthcare professionals have a moral imperative to do no harm and prioritise the health and wellbeing of patients and communities. The health of our planet and public health are intrinsically linked, and we know that exposure to environmental pollutants and chemicals of concern harm human health. The healthcare sector has a significant environmental footprint, and many healthcare organisations are anchor institutions in their communities. To this end, the healthcare sector has an important and influential role in modelling and advocating for environmental health,” he articulated.

Climate change vs health outcomes

Alex Perry, CEO of Bupa UK Insurance, provided a vivid insight into the concerning relationship between climate change and human health. “Climate change is rapidly shaping the environment around us, with the world seeing rising temperatures and extreme weather events. Human health and planet health are inextricably linked, so the impact of climate change on health outcomes is undeniable. For example, as our air quality declines, respiratory illnesses will increase. As our planet warms, infectious diseases will rise. And the more we destroy habitats and damage biodiversity, the greater the risk to our own health,” he told ITIJ. “Health insurers and healthcare providers need to understand this relationship to better support their customers, manage related costs and mitigate risks. We can’t undo the damage that has already been done, but we can play our part in making the future healthier for humans and all life on our planet.”

What actions are members of the healthcare sector taking to ensure that they are playing their part and contributing to this important shared goal? Perry believes it’s vital that the sector collaborates with a sense of urgency to address the climate crisis. He provided an insight into the actions that Bupa UK Insurance is taking to this end: “Bupa Insurance has been carbon neutral in our direct operations since 2019, and we’re working with our clinical partners to help them achieve the same. Human health is dependent on the planet’s health which makes it all the more important for our industry to get to net zero as fast as possible.”

ITIJ also spoke with Charlie Campbell, the Association of British Insurers’ (ABI) Manager of Health and Protection. The ABI is also implementing positive impactful measures: “Ensuring our operations and supply chains are sustainable sits at the heart of our recently launched Climate Change Roadmap, which sets out the significant role the insurance and long-term savings industry has to play,” he stated. “Alongside targets to fully decarbonise by 2050, including reaching net zero within directly controlled emissions by 2025, the ABI and our members will be working with the independent healthcare sector to explore the potential for safe alternatives to single-use plastic and other unsustainable items in hospitals and healthcare. Developing the commitments in the Roadmap will continue to be a priority for our members over the coming months and years.”

Searching for innovative sustainability measures

Cigna is another health insurer striving for a better tomorrow and making meaningful moves to achieve this. Arjan Toor, CEO of Cigna Europe, shared some of the important ways that this is being done: “Sustainability is extremely important to our customers, even more so as a result of the pandemic, and we have introduced a variety of innovative measures across the business to help reduce our carbon footprint, to identify new efficiencies and make strategic investments that reduce our environmental impacts and our operating costs.” The measures that Cigna has implemented include a sustainability performance plan that outlines how it can reduce its carbon footprint, eliminate operational inefficiencies, and significantly improve its energy efficiency, and the health insurer is already making impressive headway, as Toor outlines: “We exceeded our 2020 environmental targets in water, energy, and greenhouse gas emissions, and we have set new, ambitious targets for 2030, including 100-per-cent renewable energy and significant water consumption reduction targets.”

It is encouraging that hospitals and health insurers alike are taking strides into the world of sustainability that will lead to a brighter future, but is there room for improvement? Hoban and Woolcock believe that health systems and services should commit to net zero emission targets and articulate interim targets consistent with the Paris Agreement. “Strategies and plans must then be developed, embedded into core business, and continuously monitored to facilitate collective decarbonisation action,” they explained. They pointed out that healthcare providers and professionals are trusted public authorities, and this is something that has been heightened by the Covid-19 pandemic: “The sector has an opportunity to use its trusted leadership position to demonstrate environmental action, educate populations and raise awareness of the links between climate, the environment and health outcomes.” Hoban and Woolcock also pointed out that another way that healthcare bodies can have positive impacts is by contributing to relevant research: “It is important that the industry supports and participates in ethically and environmentally designed research projects to better understand the health and welfare impacts of the changing climate and environment.”

Utech said that hospitals can advocate for environmental stewardship within their organisation by tapping into the creativity, expertise and passion of their caregivers. He provided some tangible examples of this: “Cleveland Clinic has green teams and committees that champion resource efficiency at their facilities and in their functional areas, such as our Greening the Operating Room Committee. This committee worked across departments to implement air exchange setbacks in our operating rooms, resulting in significant energy savings. Our green teams also promote recycling and waste reduction, water conservation, and the expansion of green space by planting and maintaining gardens on site. Other ways hospitals can become more energy efficient is by adopting green building standards, switching to LED bulbs, and engaging caregivers in turning off lights and non-essential electronics when not in use.”

Collaborating against climate change

There are also initiatives and commitments that organisations can join, enabling hospitals and health insurers to work towards shared goals in achievable and measurable ways. “Healthcare organisations can become more energy efficient through commitments such as the Department of Energy’s Better Building Challenge. In 2010, Cleveland Clinic joined the Better Buildings Challenge and committed to reducing its energy use per square foot by 20 per cent by 2020,” Utech highlighted. “To date, Cleveland Clinic has reduced its energy use by 26 per cent from our 2010 baseline. As a result, we have saved tens of millions of dollars that we can redirect to enhancing patient care, and reduced emissions from energy use, which has a public health benefit.” This demonstrates that the benefits of environmental sustainability are far reaching and that it is a win-win situation, so to speak: reducing energy use leads to cost savings that can then be devoted to improving patient care.

Bupa also recognises the power of joining initiatives, as Perry reveals: “This year, Bupa has committed to the Science-Based Targets initiative (SBTi) joining companies worldwide in following science-led actions to reduce carbon emissions. We are proud to be one of the first large healthcare organisations to join the initiative,” he told ITIJ. Perry also said that health insurers have an important role to play in informing their employees and customers about the link between the environment and health, as well as working with business partners to make changes. Indeed, education and awareness play a critical role in stepping away from environmentally detrimental practices and embracing sustainability. Hoban and Woolcock effectively emphasise this point: “Understanding the complexity of climate change and environmental health issues, and the systems challenges they present, is essential for the healthcare sector to function,” they articulated.

Digital transformation can have a direct impact on carbon footprints

Another important aspect of the sustainability journey is digital technology, which is something that holds great potential, as Perry highlights: “Health insurers can help support sustainable healthcare through investing in digital technology. By providing digital GP appointments and health assessments where feasible, our customers access healthcare from their own homes, reducing travel and lowering carbon emissions. Our digital membership portal provides online access to all health cover documents and reports, which both improves our customer experience and reduces paper documentation being sent to customers, which also reduces our carbon footprint.” 

Indeed, digital and other innovations mean new sustainable solutions are emerging all the time, helping to expedite the transition to greener healthcare. “Innovation is being driven by huge investments in digital technology, which is having a direct impact on carbon footprint,” Perry confirms. “At Bupa, our digital appointments and a digital membership portal have supported our commitment to reduce carbon emissions.”

For Utech, innovations of note involve making use of local suppliers and fruitful partnerships: “Healthcare organisations have increasingly committed to sourcing products and services from local and diverse suppliers, which not only supports local economies and promotes equity, but also reduces the energy use associated with transportation, for example. There are also a lot of innovative examples of healthcare organisations working with local organisations to recycle items, such as surgical blue wrap, which has been used to create items such as sleeping bags for the homeless, and reusable masks and bags.”

Recognising the impact of climate change

Hospitals and health insurers are not only aware of healthcare’s environmental footprint, but they are also implementing measures and innovations and making commitments to work towards a greener future. With these efforts in place, what does the future of sustainability in healthcare look like? For Hoban and Woolcok, recognition and reform are key. “We need to recognise the impact of climate change and the environment on the health of current and future generations, and introduce reforms that promote value and orient care around the needs of people and communities,” they told ITIJ. Another important piece of the puzzle, they said, is ensuring that the healthcare sector capitalises on its important position: “The healthcare sector must use its trusted position in society to demonstrate innovation and leadership through the creation of a sustainable healthcare system that respects and protects the environment, while continuing to improve the health and wellbeing of individuals and communities,” they said.

Utech believes that collective work underway is encouraging, and we are heading in the right direction. “Today, the healthcare sector is more broadly embracing sustainability and progress is accelerating. Healthcare’s supply chain is a big area of focus due to its large environmental footprint, and there are active conversations and collaborative efforts taking place among healthcare organisations and group purchasing organisations,” he stated. “There is also sector-wide interest in taking action on climate change, chemicals of concern, and the circular economy, and we expect more collaboration, initiatives and investment in these areas.”

Increasing healthcare sustainability is a win-win opportunity

The healthcare sector is a trusted leader that promises to do no harm and therefore has a duty to fulfil in reducing its environmental footprint. It should be at the forefront of environmental change and ensure it is upholding its responsibilities by championing sustainability to protect health for generations to come. This involves continued, consistent efforts from, and collaboration between, all stakeholders in the sector. Establishing improved understanding is also key, which is why education and awareness need to be at the forefront of the drive towards sustainability in healthcare. What is more, hospitals and health insurers need to educate their patients/customers about the dangers of climate change, the links between environment and health, and actions that can be taken, however small.

Ongoing research is critical to expanding understanding and preserving the planet, and this is something that hospitals can and should support in any way they can. When it comes to being more environmentally friendly, it is a win-win situation for hospitals and health insurers alike as increasing sustainability can reduce operational costs and improve patient outcomes. Thanks to digital technology and innovations, along with campaigns and initiatives, sustainable options and the ability to fight for a greener future are on the rise. Although the planet is in a critical condition, it could be argued that never has there been more awareness and understanding about climate change and sustainability, and all of the links across the healthcare sector are actively advocating for and working towards positive change and a greener tomorrow.