In a survey of hospital doctors and nurses in France, Germany and the UK, many agreed they need to better prepare patients and adapt their healthcare systems to be more sustainable.

Executive summary

Healthcare professionals (HCPs) are actively treating an increasing number of patients affected by climate change factors. But healthcare facilities, activities and supply chains are a large contributor to climate change, unintentionally reinforcing the very problems they aim to solve. In total, healthcare represents 4-5% of total global carbon emissions.

Fortunately, the healthcare sector is starting to understand the significant role it can play in decarbonisation efforts to better protect patients and the planet from climate change. How then, can healthcare move forwards in the best interests of its patients and the planet?

This topic is gaining traction across Europe, and globally. At COP26 in Glasgow in 2021, the Health Programme was extensive. Proposals to build climate resilient and low-carbon, sustainable health systems were presented. Initiatives were raised around research for healthcare adaptation and inclusion of health priorities in Nationally Determined Contributions. Raising the voice of HCPs as climate change advocates was also highlighted.

To bring new insight to this conversation and help decision-makers navigate the big issues, Economist Impact, with sponsorship from Johnson & Johnson, spoke with subject experts and surveyed hospital doctors and nurses in three major carbon-emitting countries in Europe—France, Germany and the UK. They shared their perspectives on how healthcare systems and professionals can play a role in decarbonisation and better support patients.

The results highlight a passionate reaction from HCPs, who are deeply concerned about the growing impact of climate change and eager to see sustainability rise on the agenda in their workplace and at a national level. Additionally, interviews with senior experts shed light on priority issues, and how healthcare bodies can better overcome common roadblocks.

Notable findings include:

• HCPs say they want to educate patients about climate change—but first, they need more education themselves. When asked what personal responsibility they’d like to take around sustainability, most selected the role of educator to patients around sustainable lifestyles (33%) and various climate risk factors (25%). However, sustainability education is not part of HCP’s core responsibility, so it is unsurprising that others expressed that they lacked the time and resources (12%) and education (9%) to do this effectively. Most (74%) said that thus far they have not been supported in green literacy efforts.
• HCPs might be more proactive if they had more support and incentives. On the theme of personal responsibility, following educating patients, HCPs gave a moderate response to taking proactive personal responsibility. For example, 18% said they would like to help redesign clinical pathways to be more sustainable. This is disappointing, as HCPs can be a powerful force in addressing the climate footprint of their practice across all emission areas. To change this, particularly in areas where national plans are absent, incentives and a greater sense of empowerment and support will be needed, ideally coming from their employers.
• Small changes add up, and the healthcare ecosystem will transform. To reach zero carbon emissions (net zero) across the value chain of hospitals, change needs to happen at every level. Several experts we spoke with are calling on HCPs to push for sustainable changes in clinical pathways, models of care, the types of prescriptions they give patients and beyond. To reach ambitious sustainability goals, the system will be much different than it is today—and nobody is quite sure what that outcome will look like.
• Healthcare systems protect patients but are also major producers of carbon. In our survey, hospital doctors and nurses confirmed that they are already seeing patients impacted by climate change factors, and they expect to see a rise in those visits in the decade ahead. Yet the European region’s healthcare system produces nearly 5% of the region’s carbon footprint. Making healthcare systems more sustainable is now paramount to reaching national net-zero goals and to the wellbeing of populations.
• Emissions need to be addressed across healthcare’s entire value chain. There is a collective rise in consciousness around the issue of sustainability in healthcare, but much of the attention is landing on Scope 1 and Scope 2 areas (direct emissions and indirect energy). When asked to identify priority sustainability areas in their practise, only about a third (31%) of healthcare professionals in our survey name Scope 3 (medical supply chain). However, Scope 3 is where the bulk of emissions come from. Education is needed to raise collective awareness of all emission sources and how they can be jointly reduced.
• National plans to address the system’s sustainability vary across Europe. Of the three countries studied for this report, only the UK has a detailed plan for reaching net zero in the healthcare sector. Germany and France lack commitments and roadmaps for this. Even so, grassroots actions may be under way, as many (63%) HCPs surveyed are aware of some form of sustainability plan in place or soon to be in place at their hospital. Still, HCPs are sensitive to direction from above, and the absence of national plans (other than in the UK) is likely delaying progress.

Conclusion

Big, systematic change is time-consuming and often slow. And health services are already resource constrained. But there is no time to wait. The climate emergency is only worsening. 

Our survey confirms that HCPs are already aware of the impact of climate change on the health of the populations they serve. However, they would benefit from:

• More information and more support at all stages of their educational and employment journey to better understand the risks to their patients.
• Help and support in putting advocacy into practice in their healthcare institutions or clinical settings.
• Support for proposed changes to clinical pathways that can help reduce any unnecessary medical production and waste in patient treatment and long-term care.

From a clinical perspective, further evaluation to support mitigation and adaptation initiatives is required. This includes:

• Establishing an evidence base to support any changes to clinical activities and ensure that there is no ambiguity that doing the right thing for the climate is also the best thing for the patient.
• Understanding how clinical practices could change to help patients and especially target vulnerable groups (eg, elderly and chronically ill people) adapt to climate risk. 

Out of the three European countries assessed (France, Germany and the UK), only the UK is showing leadership in measuring healthcare emissions and setting targets. For further effectiveness, healthcare systems need to:

• Measure their emissions on a regular and systematic basis (including indirect Scope 3 emissions from the supply chain, a major contributor).
• Bring in well-thought-out activation plans with key roles specified for HCPs, consider resourcing changes with local healthcare sustainability leaders, and transforming industry production lines and supply chains.

Methodology

This research was undertaken in three phases, starting with a literature review of how healthcare systems in France, Germany and the UK are responding to climate change and the role of healthcare professionals (HCPs), followed by a survey of 75 doctors and 75 nurses working in hospitals in France, Germany and the UK in February and March 2022. We also interviewed experts from government, hospitals, medical professional associations and NGOs to build on the research and shed light on our survey findings.