Hospitals, MedCity Influencers

How to address healthcare’s climate emergency

The healthcare industry is responsible for 4.4% of global net emissions, or over 2 gigatons of carbon dioxide (CO2). The need to address this fact is so pressing that the World Health Organization (WHO) recently put out a comprehensive set of climate guidelines for healthcare facilities across the world.

Is sustainability in healthcare the missing piece in the climate jigsaw? While the focus over the last few years has been on the corporate sector going green, have we all missed the opportunities that are emerging as the global healthcare community confronts the size of its carbon footprint?

The healthcare industry is responsible for 4.4% of global net emissions, or over 2 gigatons of carbon dioxide (CO2). The need to address this fact is so pressing that the World Health Organization (WHO) recently put out a comprehensive set of climate guidelines for healthcare facilities across the world. These guidelines stressed that the healthcare sector needs to be more cognizant not only of the human health risks inherent in a changing climate but of the direct contributions of the sector’s usage of resources such as water and energy, and of its release of hazardous materials. This will be an immense challenge but there is a compelling case to be made that healthcare start-ups and investors alike can take advantage of this urgent transition.

In the United Kingdom, the National Health Service is a pioneer of such adaptive strategies. It has adopted two major targets – a net zero Carbon Footprint by 2040 and, for the emissions the NHS can influence (its so-called NHS Carbon Footprint Plus), a target of net zero by 2045. This transformation is happening as I write: metered-dose inhalers account for 25% of primary care’s carbon footprint, and there is now widespread guidance to switch to dry powder inhalers. Meanwhile, the NHS announced the world’s first zero emission ambulance capable of traveling up to 300 miles before recharging. Electronic prescriptions are replacing paper ones. Patients are getting texts, not letters. At my practice, we are discovering the potential of social prescribing — a health intervention focused on lifestyle shifts, rather than yet more packaged medication. And at hospitals the changes can be equally dramatic: in just two years, the staff at University Hospitals Bristol have reduced use of the carbon-intensive anesthetic desflurane, saving the equivalent of 30,000kg of CO2 per month.

In the U.S., healthcare has been responsible for approximately 8.5% of domestic greenhouse gas emissions. In response, The National Academy of Medicine (NAM) is launching an Action Collaborative on Decarbonizing the U.S. Health Sector with the stated goal of identifying opportunities for linking performance on sustainability outcomes to value-based payments, and reimbursement for educating health professionals on climate change.

Healthcare companies are also grasping the urgency and opportunity inherent in our climate crisis. In 2021, Kaiser Permanente became the first health care system in the U.S. to achieve carbon neutral status, achieving this through both energy efficiency (such as installing on-site solar power) and carbon offsetting. Like the NHS, Kaiser is also working on reducing the emissions it can influence, for instance, by reducing corporate travel. The company, which serves 12 million Americans, has reduced greenhouse gas emissions by 29% while increasing its member base by 20%. They are not the only ones saving money while saving the environment. By installing a system that adjusts the air exchanges based on whether operating rooms are in use and, exchanging only as much air as is necessary, the Cleveland Clinic has reduced its energy costs by $2 million a year. Partners HealthCare is facilitating the construction of a new large wind farm in New Hampshire, an endeavor which should cut costs and emissions. But there are still many more opportunities for innovation that remain and startups will have a key role to play.

Of course, all of these challenges and opportunities are present not only in the U.K. and U.S., but across the world. What happens anywhere on the planet can potentially affect everyone on the planet. As I write, here in London, a dust cloud from the Saharan desert has descended, turning the sky a shade of yellow. We used to say no man is an island, now it seems no island is even an island. What we need are global targets for reducing healthcare climate emissions.

Healthcare systems around the world, both public and private, should be actively collaborating to share best practices so that the global healthcare sector can be part of the solution to the climate emergency. Take sustainable waste management. If it had been more of a priority before the pandemic, then the flood of plastic waste generated by the need for Personal Protective Equipment (PPE) could have been better managed. Over the past two and a half years, over 8 million tons of pandemic-associated plastic waste have been produced globally, of which over 25,000 tons have entered the global ocean. As the WHO put it recently, ‘Covid-19 showed that the world was unprepared to cope with a surge in medical waste — but that through innovation and collaboration, we can fix a problem that has huge implications for mitigating climate change, fighting pollution, and creating resilient health systems.’ Healthcare companies are sensing the urgency too: Pfizer and Novartis have, even as the Covid-19 pandemic surged, become members of RE100, a global renewable energy initiative that brings together corporations committed to becoming 100% renewable.

For founders of startups who want to be part of the solution, funding is available through venture capital and government grants. In the U.S., venture capital funds such as Obvious Ventures based in San Francisco raised $271.8 million in 2020 to invest in sustainable companies including healthcare-focused startups, while in the U.K., the National Institute for Health Research (NIHR) announced £20 million in funding for research to support the delivery of a net zero health and social care system. The NHS is investing in early-stage companies building innovative products or clinical pathways that deliver benefits to patients, whilst reducing carbon emissions through a new £1M net zero SBRI Healthcare competition. Dozens of startup accelerators are now prioritizing sustainability, from Y Combinator and Plug and Play, to Techstars to Google for Startups.

Climate change is a human healthcare crisis as well as a crisis caused, in part, by healthcare. The WHO estimates the direct cost of climate change to health will reach $2-4 billion a year by 2030. Expect a rise in preventable conditions: from dehydration and malnutrition to skin cancers. We have an unmissable opportunity to prevent millions of deaths: Nature, one of the world’s leading science journals, has published an estimate that 74 million deaths could be prevented by optimizing climate policy over the next 80 years.

Both investors and startups have a key role to play. Investors can do more to support founders building sustainable startups. Climate and sustainability needs to become part of the diligence process in the decision to invest in a healthcare company. Startups need mentorship and communities to support them in building sustainable companies and they need to embrace the measuring and reporting of their own carbon footprint. In the same way that we might soon be available to make informed decisions about the carbon footprint of what we buy in the supermarket, investors should now be factoring in emissions that sustainability-focused start-ups are saving: startups like YewMaker, that has designed an evidence-based tool to support low-carbon decision-making in the procurement and prescription of medicine. If healthcare is that missing piece in the climate jigsaw, then startups like YewMaker, savvy investors that factor in emission-reductions and global collaboration on best practice in healthcare are at the cutting edge of that piece.


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Dr. Namrata Rastogi

Namrata is an MD, Family Medicine Physician, with an MS in Management from Stanford GSB. She has over 14 years of experience in healthcare executive and advisory roles: including VC, Product advisor to startups, Partner of a primary care clinic and Digital Transformation leader for a health system. She currently serves on the Health Advisory Board at Palantir and as a Board Advisor at Medwise.ai.

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