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.

Climate change is one of the most complex threats to the health of our people and our planet. The Middle East is among the geographic areas most vulnerable to rising temperatures, air pollution, food and water insecurity and adverse weather events. Without considerable mitigation and adaptation efforts, the health and longevity of current and future generations will be severely impacted.

COP28 will be the first to feature a “Health Day”, evidence of the growing realisation that the climate crisis is also a health crisis and an opportunity for the region to play a leading role in driving international co-operation on climate mitigation and public health.

The longevity equation: climate resilience for health in the Middle East is an Economic Impact report supported by PureHealth. Our report explores the consequences of the climate crisis for the health and wellbeing of populations in the Middle East and aims to stimulate discussion on the urgency for accelerated climate action in the region and the priorities for governments, health systems and all sectors.

We have identified a number of common priorities under three key pillars: knowledge empowerment, climate-smart health systems and multisector action. These can help guide regional stakeholders in mitigating and adapting to the impacts of climate change while also supporting the health and longevity of the region’s populations.

Knowledge empowerment:

Build awareness, education and accountability of the climate risk factors and their potential impact on human health across all stakeholder groups and levels of society

Improve surveillance, data collection and monitoring of the region’s climate change risk factors and their direct and indirect impact on human health

Support ongoing research to quantify the health impacts of climate change to raise the alarm and build an investment case for climate mitigation and adaptation efforts

​Climate-smart health systems:

Develop national health adaptation plans (NAPs) that consider the unique country dynamics and health systems across the region

Strengthen the capacity of health systems to prevent, prepare and respond to climate change through robust surveillance and early warning systems and a trained workforce

Adopt initiatives to reduce emissions and unnecessary waste from regional health systems and hold suppliers accountable for their climate commitments

Multisector action:

Integrate health into national climate mitigation and adaptation strategies and support cross-sectoral collaboration and accountability 

Consider the co-benefits of public health action and environmental sustainability in current and future urban development

Expand the scope of climate mitigation and adaptation beyond national borders through regional data sharing, resource sharing and collaboration

Infographic

In December 2023, 49 health ministers and over 60 ministers from other ministries gathered in Dubai for the first inter-ministerial meeting on climate and health held at the annual United Nations climate change conference, COP. While long overdue, the adoption of a dedicated health day at COP28 was not a surprise, as the health impacts of climate change have never been as visible as they are today.

Much of the political discourse on climate change is around emissions, finance and technology, yet the impacts of climate change affect the health of everyone. This is evident in the global impact felt in 2023, the hottest year on record, during which increased death and disability from extreme temperatures were recorded across almost all regions.1 Last Summer, wildfires in Canada and Hawaii underscored the severity of climate-related events, leading to smoke-covered cities in North America and significant casualties in Hawaii. As I write, wildfires in Chile, exacerbated by the current heatwave, have already caused more than 100 deaths.  Globally, flooding and superstorms are increasing the risk of disease outbreaks, while climate change-driven drought, impacting food production, exacerbates hunger and famine. In the Middle East, rising exposure to dust storms and water stress are growing concerns, highlighting the urgent need for climate action.

Health at COP28: a small step in the right direction

COP28 achieved notable health successes, including the Declaration on Climate and Health, advancements in the Global Goal on Adaptation (GGA), and consensus on establishing a Loss and Damage Fund to provide compensation for climate-vulnerable countries.

The Declaration on Climate and Health, formulated with input from governments in the months leading up to COP28, has garnered signatures from 149 countries to date. This widespread support signals acknowledgment of the crucial link between climate change and health, and the urgent need for action, along with emphasising the importance of preparing and strengthening health systems. The declaration also recognises that many sectors determine health. Clean air, water, sanitation, and access to nutritious food, play pivotal roles in safeguarding people's health.

Established under the Paris Agreement, the GGA aims to establish collective commitments and funding for national adaptation needs. Agreed upon for the first time at COP28, it includes language addressing the necessity to strengthen health systems, especially in vulnerable regions. Though the wording requires further strengthening with measurable targets, indicators, and clear accountability, and badly needs to be underpinned by appropriate levels of funding, this represents a positive step forward.

Countries that contribute the least to driving climate change are often those experiencing the worst impacts, but lack the time and resources to adapt and protect themselves. In some cases, the climate impacts are so extreme that adaptation isn't feasible. Developing nations have long called for funding to respond to the impacts from climate change that they haven’t been able to adapt to, and at COP28, we finally saw the operationalisation of the Loss and Damage Fund. While a crucial step in compensating vulnerable nations, the current pledge of US$700 million from wealthy nations only covers 0.2% of the projected annual need of US$400 billion.2

These measures signal recognition among countries of the link between climate change and health, and their readiness for action, however the negotiated outcomes from COP28 fall far short of the urgency and ambition required for effective climate response. Notably, fossil fuels were explicitly mentioned for the first time, with a commitment to transition away from them in the energy sector. However, it is far from a firm commitment to a full and just phase-out of fossil fuels, containing language that leaves loopholes and potential room for expanding oil and gas use.3

Maintaining momentum beyond COP28

A louder health voice in climate policy As the damaging impacts of climate change on health become increasingly evident, involving the health community in climate negotiations, and placing health at the heart of decision-making, is vital. 

Approaching climate change through a health lens results in distinct policy decisions that directly benefit the health and wellbeing of people, locally and in the near term. Among the best examples is cutting air pollution and fossil fuel use. Even if technologies like carbon capture and storage could help control greenhouse gas emissions (this has not yet been demonstrated), they don't mitigate the harmful air pollution impacts of fossil fuel use. Air pollution currently kills around 7m people a year, and 99% of people on the planet breathe air that exceeds the World Health Organisation’s air quality guidelines.4 Eliminating fossil fuel use would both mitigate climate change and make a substantial difference to the impacts of air pollution. Similarly, transitioning to electric vehicles, alone, reduces greenhouse gas emissions but falls short of the extensive health benefits associated with active transport. Safe bikeways, sidewalks, and walking to public transportation, offer opportunities for physical activity and contribute to substantial health gains, as well as influencing mental and social well-being.

Despite record health-sector participation at COP28, with around 1,900 health professionals present, the fossil fuel sector had over 2,400 representatives.5 To ensure the health voice prevails, a well-organised and informed health community is essential. Integrating climate change into health training and advocating for health ministries to actively participate in shaping national commitments and policies that address climate change is crucial. We look forward to seeing an even greater, and increasingly well-informed, health presence at future COPs.

Investment in health systems Strengthening our health systems is imperative to respond to the challenges of a changing climate. All health professionals need necessary training, and hospitals and clinics require proper infrastructure for effective response to weather events.

Historically, public health relied on past weather patterns for planning interventions and requirements. We're now in a time when the past is not an indicator of what's happening in the future. Adapting to future changes necessitates a shift from traditional approaches. Public health systems need real-time data and modelling, and early warning systems to let them know what is coming, whether a heat wave, a storm or period of poor air quality, so they can then take action that protects people as well as possible.

We also need to acknowledge the scale of the challenge we are facing. We're currently on a trajectory towards a world that would see nearly 3°C of global warming over the pre-industrial era.6

All the disasters and health impacts we're seeing are at 1.5°C or less. We cannot adapt to a 3°C world. Strengthening health systems alone won't suffice; addressing emissions in energy, transportation, and food systems is essential to protect public health.

A necessary equitable pursuit Many people in the world lack access to basic primary healthcare. Healthier populations are more resilient to climate threats, which means we must invest in universal health coverage worldwide.

Solutions like renewable energy, solar power and wind power, can improve healthcare in remote or low-income areas. Solar power, for instance, provides an independent energy source for hospitals and clinics without a formal grid, enhancing healthcare accessibility.

For low-income and developing countries, scalable solutions are crucial. Wealthy nations, especially those contributing significantly to the climate crisis, have a responsibility to support vulnerable nations. While this is a moral imperative and necessary to ensure global health equity, it is also in every nation’s self-interest. The climate crisis transcends borders, and affects all of us. We must all step up and make a united global effort to ensure the well-being, and indeed survival, of us all.

References

1 United Nations. Hottest July ever signals ‘era of global boiling has arrived’ says UN chief. July 2023. Available from https://news.un.org/en/story/2023/07/1139162.2 Green Central Banking. ECB warns climate laggard banks of penalty escalation. December 2023. Available from https://greencentralbanking.com/2023/12/13/ecb-warns-climate-laggard-banks-of-penalty-escalation/3 Wise, Jacqui. COP28 decision to “transition away” from fossil fuels is hailed as milestone but loopholes are decried. BMJ 2023;383:p2941.4 WHO. Billions of people still breathe unhealthy air: new WHO data. April 2022. Available from https://www.who.int/news/item/04-04-2022-billions-of-people-still-breathe-unhealthy-air-new-who-data5 NPR. A record number of fossil fuel representatives are at this year's COP28 climate talks. December 2023. Available from https://www.wamc.org/2023-12-07/a-record-number-of-fossil-fuel-representatives-are-at-this-years-cop28-climate-talks6 SEI, Climate Analytics, E3G, IISD, and UNEP. (2023). The Production Gap: Phasing down or phasing up? Top fossil fuel producers plan even more extraction despite climate promises. Stockholm Environment Institute, Climate Analytics, E3G, International Institute for Sustainable Development and United Nations Environment Programme. https://doi.org/10.51414/sei2023.050

A guest blog from Jeni Miller, executive director, Global Climate and Health Alliance

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.