The investment case for embedding sustainability in public health is twofold. One, doing something now is better than doing something later—building resilient and low-carbon healthcare systems today will be less costly and allow us to meet future challenges. Two, some parts of the world, such as the Middle East with its abundance of solar energy, have the ability to transition to a different formula for energy access, storage and distribution while also becoming leaders in this field.
Making healthcare systems more sustainable is important to reaching national net-zero goals and supporting the wellbeing of populations. Healthcare systems around the world are facing a critical challenge: how to expand services to meet the growing health needs of populations while aligning with net-zero and sustainability targets.
Funding alternative models of care
Prevention is better than cure: To manage the growing demand for healthcare in a low-carbon and resilient way, we need to look at alternative models of care and how to fund these, emphasising prevention and delivering health within communities so that people don't have to go to a hospital.
The most low-carbon and resilient hospital is the one that doesn't exist, because you don't need it. While we need the hospitals we've got today to deliver the things that hospitals do best (specialised care and advanced medical diagnosis and treatment), much of healthcare can be provided in the home or community environment. Singapore, for example, is adopting a population health model, where hospitals and primary and community care systems are vertically integrated within a geographical area. This means that the hospital only gets used when needed, and most care happens at home or virtually through digital health and telemedicine solutions.1 If we could develop this approach in different parts of the world, and the Middle East is well positioned for this, we would create a much more robust system that could manage growing demand while improving health in communities.
Yet, when looking at the Middle East, we must consider how we can deliver better healthcare and universal access for all. There are large disparities in the resources within countries. Countries such as the UAE and Qatar are very well-resourced, while other parts of the region struggle to develop their healthcare system.
Embracing digital solutions: The covid-19 pandemic taught us that rapid change at scale is possible when required. The pandemic accelerated the adoption of telehealth and telemedicine in a way that we would never have seen otherwise. While telemedicine will never take away from the role of the healthcare professional, and there are circumstances where a face-to-face visit is necessary, many consultations are more accessible and convenient when conducted virtually, especially for patients living in rural or remote areas. The adoption of telemedicine has a measurable impact on the carbon footprint of healthcare. When we calculate the carbon footprint of telemedicine, we often focus on the reduction in travel; however, we are also saving valuable resources in the hospital. In the quest for digital adoption, we must ensure that ageing populations and populations without internet access are not left behind. Governments must be genuinely committed to ensuring everybody has access to education, health and other public services through access to the internet.
Building climate resilience: As seen during the covid-19 pandemic, infectious diseases cross borders. We need to strengthen surveillance mechanisms to know how the changing climate impacts disease transmission and respond to the increased risk of infectious diseases such as malaria and dengue. Access to water and energy are important public health issues. There is an incredible dependency across people and communities to ensure we manage our natural resources as best as possible.
Building resilient health systems requires global and regional collaboration. Initiatives such as twinning partnerships, where hospitals in very different parts of the world learn from each other's diverse environments, help support cross-border collaboration to contain, spread and manage climate events.2
In this together
Joint accountability: Improving the sustainability of the healthcare sector is a joint responsibility. Over 70% of the healthcare sector's carbon emissions arise in the supply chain.3 Therefore, engaging with suppliers is critical. We have some great examples from the UK National Health Service (NHS) where it is adapting the tendering process, requiring suppliers to publish a Carbon Reduction Plan, and holding them accountable to demonstrate change. The NHS is also working with suppliers through initiatives like the Evergreen Sustainable Supplier Assessment, to identify opportunities for decarbonisation and align on NHS net-zero ambitions.4
Expanding the role of healthcare professionals: All health professionals, whether hospital managers, public health professionals, community health workers, surgeons or occupational therapists, must embrace the challenge of balancing the growing demand for healthcare with sustainability targets. We all must apply a sustainability lens to our own practice, our way of doing things and, ultimately, every decision we make.
With every decision we make, we must reflect on two things: one—is it necessary? And two—does it improve the quality of care? For instance, with single-use items, we need to question whether we really need to use them as single-use items. Can they be designed for reuse? The same goes for prescribing. We know that some medicines don't add a huge amount of value. For many patients, it may be better to get more exercise or improve their diet. This shift in thinking will also require changing how we educate our healthcare professionals so that asking questions about lower-carbon alternatives and best practices becomes fundamental. We also need to embed sustainability into research initiatives.
Engaging Patients: Patients are a critical stakeholder group, often left out of the sustainability discussion. We need to actively engage patients in treatment and care decisions to understand what they would like and what they would find sustainable. Let's take patients with diabetes as an example. Many who take regular insulin injections and undergo ongoing monitoring feel guilty about the amount of consumption and waste produced and are asking if we can find something that will be better for the environment.
Moving forward
Measuring what matters: At the Geneva Sustainability Center, we've just developed the Sustainability Accelerator Tool (SAT), a benchmarking tool to support hospital and healthcare leaders in driving sustainable, low-carbon, equitable and resilient healthcare. The SAT measures typical environmental elements that apply to all sectors, such as buildings, transport, food and supply chain, but also elements specific to healthcare, like anaesthetic gases, medicines, infection control, single-use items and how we deal with waste. It's essential that, as healthcare professionals, we take accountability for these health-specific elements, because if the healthcare sector doesn't take action, nobody else will.5
A common sense of urgency: The bottom line is that the climate crisis is a health crisis. Now is the time for the healthcare sector to step up, because climate change is impacting the health of populations in every country and in every community. We need to start embracing sustainability and integrate it into everything we do. Everyone in the sector, from policymakers to healthcare workers and suppliers, has a role to play. Everyone involved needs to think about what this means in their area of influence and what they can do differently to contribute to a better climate.
1 Nurjono, M., Shrestha, P., Ang, I.Y.H. et al. Shifting care from hospital to community, a strategy to integrate care in Singapore: process evaluation of implementation fidelity. BMC Health Serv Res 20, 452 (2020). https://doi.org/10.1186/s12913-020-05263-w
2 WHO. Initiatives. Twinning Partnerships for Improvement. Available from https://www.who.int/initiatives/twinning-partnerships-for-improvement
3 Health Care without Harm. Health care’s climate footprint: How the health sector contributes to the global climate crisis and opportunities for action. 2019.
4 NHS UK. A Net Zero Supply Chain and Suppliers. National Health Service. Available from https://www.supplychain.nhs.uk/sustainability/net-zero-supply-chain-and-suppliers/
5 International Hospital Federation (IDF). Toolbox. Available from https://ihf-fih.org/what-we-do/geneva-sustainability-centre/sustainability-toolbox/
A guest blog from Sonia Roschnik, executive director, Geneva Sustainability Centre
Visit The longevity equation: climate resilience for health in the Middle East to learn more
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the views of Economist Impact or any other member of The Economist Group. The Economist Group cannot accept any responsibility or liability for reliance by any person on this article or any of the information, opinions or conclusions set out in the article.
