Health care's response to climate change: a carbon footprint assessment of the NHS in England

Abstract

Background Climate change threatens to undermine the past 50 years of gains in public health. In response, the National Health Service (NHS) in England has been working since 2008 to quantify and reduce its carbon footprint. This Article presents the latest update to its greenhouse gas accounting, identifying interventions for mitigation efforts and describing an approach applicable to other health systems across the world. Methods A hybrid model was used to quantify emissions within Scopes 1, 2, and 3 of the Greenhouse Gas Protocol, as well as patient and visitor travel emissions, from 1990 to 2019. This approach complements the broad coverage of top-down economic modelling with the high accuracy of bottom-up data wherever available. Available data were backcasted or forecasted to cover all years. To enable the identification of measures to reduce carbon emissions, results were disaggregated by organisation type. Findings In 2019, the health service's emissions totalled 25 megatonnes of carbon dioxide equivalent, a reduction of 26% since 1990, and a decrease of 64% in the emissions per inpatient finished admission episode. Of the 2019 footprint, 62% came from the supply chain, 24% from the direct delivery of care, 10% from staff commute and patient and visitor travel, and 4% from private health and care services commissioned by the NHS. Interpretation This work represents the longest and most comprehensive accounting of national health-care emissions globally, and underscores the importance of incorporating bottom-up data to improve the accuracy of top-down modelling and enabling detailed monitoring of progress as health systems act to reduce emissions. Funding Wellcome Trust.

Accelerating climate action: the role of health professionals

“…15 In the NHS, 62% of these emissions are from its supply chains and 24% from delivery of care. 16 Health professionals can be institutional leaders who drive decarbonisation in hospitals through reducing overdiagnosis and overtreatment in healthcare, 17 eliminating waste, streamlining services, 18 and better managing suppliers and procurement. 19 All of these efforts will bring us closer to making healthcare more sustainable.…”

Switching to the Dry-Powder Inhaler Easyhaler®: A Narrative Review of the Evidence

“…These propellants are powerful greenhouse gases (from 1500 to 3000 times greater global warming potential than CO 2 [ 28 ]), and so have a disproportionate impact on the carbon footprint of treatment. In the UK for instance, MDIs contribute 13% of the core carbon footprint of the National Health Service (NHS) related to delivery of care, and 3% of the “carbon footprint plus” emissions which the NHS can influence [ 29 ].…”

“…In a non-randomized, open-label, post-authorization efficacy study in Poland conducted among 2200 adult (mean age, 49.8 ± 17.9 years) outpatients with asthma, delivery of budesonide/formoterol fumarate via an Easyhaler for 8–12 weeks was associated with an increase in the proportion of patients with well-controlled asthma or total control of asthma (Asthma Control Test [ACT] score 20–25 points) from 46.6 to 90.8% ( p < 0.001), and with a marked reduction in the proportion of patients with poor control of asthma (ACT score < 15 points) from 14.9 to 1.2% ( p < 0.001) [ 29 ]. Patient satisfaction with the Easyhaler increased progressively during the study, as assessed by multiple metrics, including ease of preparation for use, maintenance, incorporation of Easyhaler use into the activities of daily living and the overall physical acceptability of the device (size, weight, portability, etc.)…”

Overdiagnosis is increasing the carbon footprint of healthcare

“…Recently Tennison and colleagues examined carbon dioxide equivalent (CO 2 e) emissions in the NHS over three decades, 1990 to 2019, finding that the service had reduced CO 2 e emissions by 26%—a world leading achievement 15. Episodes of inpatient care doubled over the same period and health spending tripled in real terms, even though the population only increased by 17%.…”

“…Emissions from medical instruments have remained stable and emissions from commissioned care (clinical services procured by the NHS from private healthcare providers) increased fivefold. Between 2001 and 2012 total NHS England emissions increased slightly as investment in healthcare expanded from 4.7% to 7.6% of gross domestic product, before falling again in line with ongoing decarbonisation of UK electricity 15…”