Authors: Omaira Valencia (Colombia), Maria Ribeiro da Cunha (Portugal), Amal Dahri (Morocco), Aban Gautam (Nepal), Abdur Rauf (Pakistan), Aline Mittag (Germany)

Reviewers: Hiba Al Naabi (YEL 2019, Accreditation head, the Royal Hospital, Oman), Olivier Costa (YEL 2022, Chief Medical Officer, Algemeen Ziekenhuis Sint-Maria Halle, Belgium), Carmen Menendez (Senior Project Officer, Geneva Sustainability Centre)

Introduction

The urgency of addressing climate change has never been more evident. The global community faces increasingly severe challenges, and without action, global temperatures could exceed the 1.5°C limit set by the Paris Agreement, potentially rising over 3°C by the century’s end (IPCC, 2021). The healthcare sector, responsible for about 5% of global emissions, is at the forefront of this crisis and must respond decisively to mitigate its impact (Karliner et al., 2019). Rapid warming, driven by unsustainable energy use, has profound public health implications, increasing heat-related illnesses, respiratory problems, and infectious diseases (Watts et al., 2018).

Adopting sustainable practices in healthcare is imperative. However, it requires concrete, actionable strategies across facilities. This article focuses on how the healthcare sector can reduce its environmental footprint while promoting public health by implementing sustainable practices. We propose four key areas intrinsically linked to global warming: energy efficiency, waste management, water conservation, and addressing climate change challenges for population health. These areas were selected as principal points where facilities can reduce their carbon footprint and align with global sustainability goals. Each area not only contributes to emission reductions but also strengthens the sector’s resilience against climate change impacts (World Health Organization, 2021).

Waste management

According to the World Health Organization (WHO), hospitals that implement sustainable waste management programmes can reduce their operating costs related to waste disposal by up to 20% (World Health Organization, 2018). Additionally, not only reduce their carbon footprint but also improve the safety and satisfaction of staff and patients, with a reported 15% increase in staff satisfaction in facilities with active recycling programmes (Watts et al., 2018).

Case study: Waste management reduction in healthcare facilities

Sustainable waste management in healthcare facilities is a global challenge that requires innovative and effective strategies. A notable example is Kaiser Permanente and Cleveland Clinic in the United States, which has achieved a 40% diversion of waste from landfills through recycling and composting programmes, as well as the implementation of a robust hazardous waste management programme (HPRC, 2022). However, these efforts are not exclusive to the United States. To better understand the practical steps involved in implementing a robust hazardous waste management programme, the following diagram outlines the key stages and actions taken by Kaiser Permanente (figure 1).

Figure 1: Sustainability programme cycle

When comparing waste management initiatives across different countries, similar approaches can be observed, with key differences in implementation. In Germany, the Freiburg University Hospital has managed to reduce hazardous waste by 35% by adopting advanced waste treatment technologies and strict segregation policies (Kaiser & Schmid, 2020). In Colombia, the Fundación Santa Fe de Bogotá has adopted Green Care initiatives that include reducing the use of single-use plastics (According to the national law) and implementing a recycling programme that has reduced waste sent to landfills by 25% over the past three years (Fundación Santa Fe de Bogotá, 2022). This success has been achieved through continuous staff education and collaboration with local recycling organizations. Unlike the United States and Colombia, where education and staff commitment are the main drivers, Germany has placed greater emphasis on technological investment to achieve its sustainability goals.

On the other hand, in Japan, hospitals have implemented a zero-waste approach, where more than 80% of materials are recycled or reused. This approach has been made possible through strong collaboration between the government, healthcare facilities, and local communities, resulting in a deeply ingrained culture of sustainability (Yamamoto & Kaneko, 2019).

Recommendations

1. Conduct regular waste audits and establish baseline data for progress measurement.
2. Train staff on new protocols and the importance of waste reduction.
3. Develop partnerships for effective recycling and composting programmes.

Water conservation

Water conservation is increasingly critical in healthcare facilities, where resource efficiency directly impacts both operational costs and environmental sustainability. Hospitals around the world are implementing innovative strategies to reduce water consumption while maintaining high standards of care.

Case study: Water conservation

Cleveland Clinic in the USA has achieved a 30% reduction in water usage through advanced recycling systems and low-flow fixtures. Similarly, Rochdale Infirmary in the UK uses rainwater harvesting to supply non-potable water needs, complementing this with a rigorous leak detection programme that further minimizes wastage.

On the other hand, In India, Sir Ganga Ram Hospital has adopted a zero-discharge system, treating and reusing 100% of its wastewater for non-potable purposes. This approach not only conserves water but also reduces the hospital’s environmental footprint. Mount Elizabeth Hospital in Singapore has installed efficient cooling systems and sensor-activated faucets, significantly lowering water usage across the facility.

Hospital Universitario Austral in Argentina focuses on water-efficient landscaping and drip irrigation, which has led to substantial reductions in irrigation water demand. Mayo Clinic in the USA utilizes green roofs that collect rainwater for irrigation and employs advanced cooling tower management to minimize water waste. In Taiwan, Tzu Chi General Hospital has implemented water-efficient appliances and systems to reuse sterilization water, ensuring minimal waste. Table 1 shows some strategies used for implementing diverse water conservation strategies.

Table 1. Action steps for implementing water conservation techniques in healthcare facilities:

Recommendations

1. Regularly audit plumbing systems and implement leak detection programmes.
2. Promote the use of low-flow fixtures and water-efficient landscaping.
3. Educate staff and the public on water conservation practices.

Energy efficiency and renewable energy

Energy and efficiency in healthcare institutions: German case study

The report from the Ministry of Environment, Climate, and Energy of Baden-Württemberg (2016) provides case studies of successful implementation of energy efficiency measures in healthcare facilities in the region. Examples include the modernization of heating, ventilation, and air conditioning (HVAC) systems, the use of cogeneration systems, and the incorporation of renewable energies such as solar and biomass. These cases demonstrated not only significant cost savings but also improved comfort for patients and staff. Additionally, the Münch Foundation (2023) offers a handbook on actions and technologies for energy efficiency in hospitals. Key recommendations include regular energy audits, optimization of existing systems before investing in new technologies, and integration of energy management systems (EMS) that enable more effective monitoring and control of energy consumption. These approaches are essential to ensuring that investments in energy efficiency are cost-effective and sustainable in the long term.

Likewise, the Viamedica Foundation (2009) focuses on the adoption of renewable energy in German clinics, highlighting the use of solar energy and biomass. The energy demand in healthcare facilities and especially in hospitals is immense due to their constant availability, the high demand for technology.

In the adoption of these strategies, the following categories should be considered:

Energy efficiency

• Energy-saving behaviour: Encourage energy-saving behaviour among employees and patients. This requires a corporate culture that favours energy-saving actions and personnel to provide training on this topic. Examples include switching off lights and medical devices when not in use and installing water-saving fittings (MOH;2016).
• Lighting: Use LEDs, which require 90% less energy than conventional light bulbs and have a longer lifetime. Implement motion detectors for lighting control.
• Technical facilities: Replace and install high-efficiency pumps for heat and water transfer systems. Use heat recovery from waste heat to achieve energy savings.

Renewable energy

• Power source: Healthcare facilities should obtain electricity from renewable energy sources. Install solar systems on large hospital roof surfaces and consider adding battery storage systems. Choose green electricity suppliers to achieve the energy transition.
• Heat source: Utilize solar thermal, geothermal energy, biomass, or heat pumps. Integration into the regional heating network should also be considered.

Recommendations

1. Develop a corporate culture that encourages energy-saving behaviours.
2. Invest in energy-efficient technologies and infrastructure.
3. Transition to renewable energy sources for both electricity and heat.

Addressing climate change challenges and improving population health

Climate change significantly worsens existing health issues, such as heat-related illnesses, respiratory problems, and infectious diseases, with an estimated 250,000 additional deaths per year expected between 2030 and 2050 (Watts et al., 2018). The health sector plays a vital role in addressing these challenges by reducing greenhouse gas emissions, enhancing infrastructure resilience, and implementing early warning systems for disease outbreaks (World Health Organization, 2018). Climate-related factors like heat waves, floods, and lack of clean water disproportionately affect vulnerable populations, driving the spread of diseases such as dengue, malaria, cholera, and tuberculosis (Ebi et al., 2018). Adressing these challenges requires urgent climate action and the adoption of integrated approaches like Ecosalud and One Health. Ecosalud broadly addresses the ecological determinants of health by integrating environmental, social, and economic factors, while One Health specifically focuses on the interconnectedness of human, animal, and environmental health, particularly concerning infectious diseases (Zinsstag et al., 2015).  Both approaches advocate for interdisciplinary collaboration and recognise the need for systems thinking to address complex health issues. In practice, Ecosalud and One Health can be integrated to provide a comprehensive approach to health that includes managing environmental determinants of health (Ecosalud) and preventing  zoonotic diseases (One Health) (figuere 2 and 3).

Figure 2: The one health approach

Adapted of Hancock 1990; Ecosystemic approach of Health, Jean Lebel, IDRC, 2003

An example of the application of this approach is an intervention implemented in Girardot, Colombia, involved a step-by-step approach: (1) Assess ecological, biological, and social factors contributing to Aedes aegypti proliferation. (2) Develop a community-based intervention with insecticide-treated water container covers, window screens, and health education. (3) Implement the intervention in targeted areas, distributing materials and conducting home inspections. (4) Monitor and evaluate the impact using statistical models to compare dengue incidence before and after the intervention. (5)

Figure 3: The ecosystemic approach of health

Ensure sustainability by expanding coverage and maintaining community engagement to institutionalize the control measures. This intervention resulted in a reduction of dengue incidence by approximately 95 cases per year on average in the areas where the intervention was implemented (Quintero, 2020).

Recommendations

1. Identify and assess vulnerabilities in communities and regions, health determinants and behavior challenges, health system capacities and identify multisectoral actors.
2. Develop and implement targeted strategies in collaboration with various sectors.
3. Monitor and evaluate the effectiveness of interventions regularly and scale-up models or effective strategies.

Conclusion

Addressing sustainability in healthcare is not just an option but a necessity. As young and future healthcare leaders, it is our responsibility to lead by example and implement sustainable practices within our organizations. By focusing on energy efficiency, waste management, water conservation, and addressing climate change challenges, we can significantly reduce the environmental footprint of healthcare facilities and promote public health.

The Young Executive Leaders (YEL) programme provides an excellent platform to share best practices, learn from each other, and drive the change needed for a sustainable future. Let us take decisive, effective action towards a more sustainable and resilient healthcare sector, leading the global effort to mitigate the effects of climate change.

References

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