The global health sector contributes considerably to greenhouse gas emissions. This article explores how the Indian healthcare sector has responded to the challenges of climate change by detailing actions taken at the policy level, the community level, and at the level of the individual healthcare facility.
Climate change is, by now, a reality that has hit many countries hard, more so in recent years. India is one among them, having been ravaged by lethal heatwaves, forest fires, flooding, droughts, dust storms and cyclones, all against the background of a deadly pandemic. As the most populous country in the world, the consequences of these climate disasters have been significant, with vulnerable groups bearing the brunt of the impact. In addition to the disaster-related injuries, there have been climate-induced changes in disease patterns, with an increase in respiratory diseases, cardiovascular disease, non-communicable disease and heat stress. As has been reiterated repeatedly on the local, regional and global scale, there needs to be concerted action at every level in order to combat climate change.
Studies have begun to establish what the health sector can do to reduce its climate footprint while itself remaining resilient to the impact of climate change. The global health sector contributes significantly to greenhouse gas emissions, and according to a 2019 study by Health Care Without Harm and Arup, would be the fifth-largest emitter on the planet if it were a country, thereby contributing to the disease burden of the community that it is meant to protect. These considerable emissions come from the sector’s significant consumption of water and energy from running 24 hours a day, 365 days a year, catering to millions of patients, healthcare employees and visitors, using carbon-intensive supply chains for daily operations, and creating huge amounts of waste, both hazardous and non-hazardous, that need to be disposed of. Any reduction in these emissions will necessarily have to come from every individual healthcare facility adopting sustainable climate-smart changes to decrease its individual climate footprint in order to reduce the overall impact by the health sector.
This article explores how the Indian healthcare sector has responded to the challenges of climate change by detailing “climate-smart” actions taken at the policy level, the community level, and at the level of the individual healthcare facility.
India is a signatory to the Paris Agreement and has committed to decrease its emission intensity of GDP by 33-35 per cent of 2005 levels. India’s climate change policy enshrined in the National Action Plan on Climate Change has one mission under ‘Health’ and it is implemented by the National Centre of Disease Control under the Ministry of Health and Family Welfare (MoHFW). Acceding to calls that healthcare policy and climate policy be integrated, the Indian Government has instituted a National Expert Group of Climate Change and Human Health with experts from both arenas. These bodies deal specifically with the healthrelated impacts of climate change.
For climate resilience of health facilities however, the National Disaster Management Authority (NDMA) is the nodal authority that supports the National Programme on Climate Change and Human Health, which incorporates the concepts of Green and Climate Resilient healthcare principals in revising the Indian Public Health Service guidelines according to which all government hospitals in the country operate. It also aims to bring about awareness and capacity building of healthcare professionals on the issues related to climate change.
There is significant advocacy ongoing from the private health sector as well, which in India delivers the majority of healthcare to the population. The Health and Environmental Leadership Platform (HELP) which has over 7300 healthcare institutions (both government and private), is one platform to share best practices and showcase leadership in the adoption of climate-smart strategies. The Association of Healthcare Providers – India (AHPI) and the Centre for Environmental Health (CEH), a centre of excellence set up by the Public Health Foundation of India (PHFI), organised the National Health Conclave 2019, which gathered experts from academia, healthcare providers, policy makers and civil society to discuss climate concerns and make recommendations on climate preparedness for the Indian health sector that were presented to the Ministry of Health and Family Welfare, Govt. of India. The Ministry is in the process of facilitating the inclusion of climate change and health into the undergraduate, post-graduate medical, nursing and allied health curricula.
Due to their profession, doctors, nurses and allied health workers are often considered “thought leaders” in their community. This gives their voices added value when messages about the impact of climate change are directed towards the general public, the media, and even policymakers. Hence, as first responders to the impact of the climate crises as well as thought leaders, health workers should use their position to educate their patients and their communities, who in turn should pressure their local leaders to take action. This is another reason for the importance of training and capacitybuilding of healthcare workers.
Similarly, the position held by a hospital or healthcare facility in the community can be used to set an example to the rest of the community. When healthcare centres start using clean, renewable energy and implement conservation strategies, they become a model of leadership for ideas that can spread quickly into the wider economy. As major energy consumers and highly respected anchor institutions in their communities, health systems have a unique opportunity to bring about change and contribute to green local economies.
The World Health Organization (WHO) explains a climate-smart health system as one that can anticipate, respond to, cope with and recover from climaterelated shocks and stresses, bringing about sustained improvements in population health, thus linking together decarbonisation and health equity. Climate-smart measures in a healthcare facility focus on decarbonisation of healthcare delivery, facilities and operations while building resilience to climate change. Every operational aspect of a healthcare facility can be targeted to reduce its climate footprint, beginning with green infrastructure and the effective management of water, energy, waste and transportation. The following suggestions have been summarised from Climate Change and the Health Sector: Healing the World (Thomas et al, 2021).
A green hospital can be described as one that reduces its environmental impact and ultimately eliminates its contribution to the burden of disease, is ideally made from environment-friendly and locally-sourced materials, and is designed to optimise available resources such as sunlight, water, ventilation and energy, and should be hazard-resilient and functional during a crisis. A hospital with no access to back-up energy sources during a natural disaster will have no role to play in delivering healthcare or saving lives. Kohinoor Hospital, in Mumbai, Maharashtra, is Asia’s first LEEDPlatinum certified hospital. It was built mostly using construction materials available locally or regionally, and used recycled material in its infrastructure. The façade and orientation of the building were designed around the solar path to ensure a cool yet naturallylit environment. Waste was recycled where possible, with the overhead tank foundation being constructed with scrap steel. Urinal sensors, low flow fixtures and grey water management features were installed for water efficiency, solar panels on the roof heat most of the hospital’s water requirements, and a windmill generates 90 per cent of the hospital’s energy needs. The hospital’s sewage treatment plant treats all the waste water, and the gardens require no irrigation. (Case study from page 133 of Climate Change and the Health Sector: Healing the World)1.
Water is one of the most essential commodities used in a hospital (sterilisation, sanitation, infection prevention, patient care, laundry, food preparation, etc.). Water conservation strategies can include rainwater harvesting, waste water treatment for recycling, and developing adequate storage facilities. The National Institute of Ophthalmology in Pune, Maharashtra, is a super-speciality eye hospital that implemented sustainable interventions onsite to reduce their water, energy and carbon footprints. The strategies used to save water on the premises included measures such as training their staff on water management (in accordance with their green policy and standards), putting up posters and visual reminders to use water carefully, installing water meters to measure consumption, checking plumbing regularly for leakages, and re-using non-infected water for cleaning purposes. (Case study taken from the Center for Environmental Health, https://www.ceh.org.in/resources/casestudies/).
As over half of the health sector’s carbon footprint comes from its energy use, replacing expensive and unsustainable equipment with renewable energy sources and energy-effective equipment can significantly reduce the environmental impact. Solar power, wind energy, bio-energy and hydropower are possible sources of renewable energy that increase self-sufficiency and lead to significant financial savings. A public-private partnership with the Government of Assam launched boat clinics as a mobile health service in areas where the construction of permanent health infrastructure was challenging; initially powered by loud and expensive generators that ran on fossil fuels, the boat clinics now use clean energy generated by rooftop solar photovoltaic modules that are also more reliable and cost-effective.
Healthcare facilities expend huge amounts of energy on waste treatment and disposal. While it may seem that the easiest option is to incinerate all waste, it is essential for healthcare organisations to follow segregation, storage and treatment policies. This decreases the amount of waste that goes for incineration, thus reducing both energy use and environmental impact. For non-hazardous waste, biomethanation and composting can be conducted on-site. The Dr. RN Cooper Municipal General Hospital, in Mumbai, Maharashtra, implemented a sustainable intervention in food waste management to reduce the amount of food waste being dumped and creating pressure on landfill sites. In collaboration with the BMC and a local non-profit, one vermi-compost pit and four bricklined compost pits were built on the hospital premises, saving 60 MT of waste from being dumped at the landfill and 200 kg of manure was generated from vermi-composting, saving on the cost of purchasing manure2.
Healthcare premises see a large number of vehicles every day, whether they are ambulances, vehicles for daily operations and supply chain deliveries, medical equipment and products, or vehicles used for commuting by hospital employees, patients and visitors. Hospital management can encourage a shift to public transport and consider the use of modified hospital vehicles to reduce air pollution. Narayana Health City in Bengaluru, Karnataka, has a fleet of electric vehicles for their daily operations. The four buggies, with a capacity of 2.6 KW each, as well as reducing fossil fuel use, have resulted in a saving of about 22 lakh INR as compared to using diesel vehicles for the same operations3. Other hospitals can reduce their vehicle use by encouraging carpooling between employees, promoting cycling or walking by making appropriate changes to the campus landscape, regular maintenance checks for hospital vehicles, and instituting a committee to specifically monitor and advocate for these initiatives.
This article has provided an overview of the actions taken by the Indian health sector to combat climate change, become climate-smart and develop resilience in preparation for the increased burden of disease. It outlines some of the actions implemented at the policy/sectoral level, the community level and the individual healthcare facilities on the ground.
References:
1 Case study taken from the Center for Environmental Health, https://www.ceh.org.in/resources/case-studies/
2 Case study taken from the Center for Environmental Health, https://www.ceh.org.in/resources/case-studies/
3 Case study taken from page 179 of Climate Change and the Health Sector: Healing the World
