The recent Lancet Countdown report on Climate Change highlighted the impact of the healthcare sector in global emissions. The report indicates that the total emissions footprint of the global health sector is 5.2 per cent or 2.7 GtCO2e of the total global emissions, while contributing to 10 per cent of global GDP. As per Health Care Without Harm, the Indian health sector’s contribution of the country’s total emissions is approximately 2 per cent. While this may seem like a small contribution towards the total, the fact that it continues to increase at a rate of approximately 5 per cent every year is a cause for concern. Additionally, the extensive use of anaesthetic gases, single use plastics, generation of biomedical waste and a poor substitution uptake of renewables makes the issue more germane. Given that India has committed to a net-zero target by 2070, and international health systems like the NHS and the US’ Health and Human Services department given clear reduction and net zero targets, the need for concerted action on decarbonisation by the Indian healthcare sector has become an imperative.
As we begin this journey of decarbonisation, it is important to understand the key contributors to the emissions inventory in a typical hospital. Studies by the UK’s NHS indicate that 24 per cent of emissions are through delivery of care, which includes energy use, procurement of pharmaceuticals and chemicals, use of medical equipment and materials like anaesthetic gases and metered dose inhalers. Add to that another 10 per cent of emissions are contributed by patient and visitor travel to hospitals and through staff commutes. Most of the emissions however, come from the supply chain, averaging at 62 per cent of the total carbon footprint. Of this, pharmaceuticals, chemicals, and medical devices make the majority of the emissions inventory, with non-medical equipment, food and catering and business services like indemnity insurance bringing up the rear.
Indian healthcare offers slight variations but is broadly in line with global peers. As per a 2019 report by Health Care Without Harm and ARUP, on an average 8 per cent of total emissions in Indian healthcare is attributable to direct emissions, i.e. those generated through operational emissions. A further 11 per cent of emissions come from indirect emissions of those from purchased energy sources for a hospital or health centre. 81 per cent of emissions are through the supply chain which includes emissions on account of manufacturing, transport and storage of pharmaceuticals, medical devices and chemicals, transport and business services. As Indian healthcare becomes more mature in the years ahead, it may start to mirror the emissions inventory of the rest of the world, but the skew towards a majority of emissions coming from the supply chain are likely to remain.
As with any data sets, it is easy to postulate and take positions. It can be argued that till the supply chain emissions, largely beyond the scope of healthcare providers, are not reduced, any meaningful progress towards decarbonisation will remain futile. Others could argue that the onus remains on the decarbonisation efforts by power generators and equipment manufacturers to ensure the health sector meets its carbon neutrality and net zero ambitions. The merits of these arguments aside, the onus remains on the sector to implementing measures to that impact direct and indirect emissions. Not only does this make economic and ecological sense, it is critical in order to reduce the climate related disease burden that one is witnessing over the past decade.
First, the health sector needs to conduct an analysis of their actual carbon footprint. An emissions inventory framework for all hospitals and health institutions needs to find priority in amongst policymakers and health administers. Only with real and credible data can the sector make targets and affirm to actions that are measurable and impactful. Multiple solutions based on the UN’s Greenhouse Gas (GHG) Protocol are available for ready use by healthcare institutes. Second, the sector needs to create emission and consumption reduction targets that look at fossil fuel consumption, waste generation and water consumption and effluents generated. This is a critical step towards the sector making consequential progress towards reducing its carbon footprint with eventual attainment of net zero ambitions. Third, the need to move en-masse to renewable sources of energy is the need of the hour. The marketplace mechanism of power purchase in many jurisdictions allows for judicious decisions to be taken on sourcing of energy for the health sector. This move towards cleaner fuels should have adjuncts including increasing self-generation through solar energy and exploring new technologies like renewables-based power back-ups and enhanced battery storage to meet critical operational needs of a hospital. Fourth, the generation of biomedical waste has seen an exponential rise in the Covid years. While unavoidable, the levels of biomedical waste generation needs to see a commensurate reduction as we emerge in the post-Covid clinical world. This will only be possible with a significant reduction in the use of masks, gloves and single use plastics for clinical procedures that do not require these. Keep in mind, as Indian healthcare becomes more specialised and tertiary care facilities grow across India, the commensurate generation of biomedical waste is expected to rise. The sector, therefore, needs a clear roadmap on defining the appropriate, safe and required use of masks, gloves and single use plastics that ensure harmonisation between high quality care, staff safety and the carbon footprint. Given that net zero to landfill for biomedical waste is a challenge, given the health risks and toxicity of this type of waste, local and state governments needs to prioritise increased capacity waste to energy units that are aligned towards biomedical waste.
In addition to the above, the healthcare build will need to be aligned with principles of carbon neutrality and energy efficiencies. Building energy efficiency certifications like LEED go a long way in ensuring lowering of the carbon footprint and should be taken up in a concerted manner within the broader health sector. Also, the introduction of new low embodied carbon materials and greater use of smart building technologies that lower the footprint need prioritisation. These measures can help the sector make progress on carbon neutrality, but it will continue to depend on the broader ecosystem to help attain net zero status. The decarbonisation of the supply chain needs partnerships, incentives, and regulatory measures. While the health sector must use its purchasing power, the lack of alternatives or fiscal and regulatory motivations for manufacturers to decarbonise will impede progress. Therefore, industry participation in developing alternatives and embarking on a net-zero journey will need to go hand-in-hand as the sector decarbonises.
Governments and regulatory agencies too will need to play their part in this journey. Healthcare accrediting bodies need to have measurable standards on consumption, waste reduction targets and decarbonisation in place to provide regulatory nudges. Similarly, access to funding and incentives that aligns with progress on healthcare decarbonisation needs broader deliberation. The use of carbon offsets finds discussion within healthcare decarbonisation, given that involuntary and unavoidable residual emissions will continue to persist even in the most decarbonised systems. However, just like with any other sector, offsets should be the port of last call, rather than the first off-the-shelf approach. And given the tortuous history of offsets currently, the health sector would be best advised to pursue other strategies more vigorously.
The Covid-19 pandemic reaffirmed the role of the health sector in forefronting a national cause and response. It builds on the tremendous work done by the sector previously as India made admirable progress on various health indicators and continues to do so. And therefore, the onus on facing the perpetual pandemic that is climate change requires the same fervent response from the sector to decarbonise. The route to the planet getting back to the pink of health is through greener healthcare.