Environmental sustainability in the healthcare sector: Imperative or opportunity?
<p>If the world healthcare sector were a country, it would be the fifth-largest greenhouse gas emitter on the planet</p>
In January 2021, the firm Takeda announced that it had achieved carbon neutrality in fiscal year 2019, or zero footprint (in its entire value chain)3. This was an important move by this Japanese pharmaceutical company, the tenth largest in the world in terms of turnover4 , especially because the intensity of emissions from the pharmaceutical industry was 13% higher than that of the automotive5 industry in 2019 (and 55% in 2015), even though the market is 28% smaller, according to calculations from that same study.
The figures may be surprising; after all, the carbon footprint of the health industry in general and pharma in particular have received very little attention because of their enormous impact on saving lives.
Emergency for an industry with zero footprint
This post highlights the sector’s initial situation, the imperatives for its transformation, the changes that are underway and the initiatives/success stories worth tracking. We will not discuss how biotech can help transition to a more circular economy, even though it plays a key role in this (in renewable raw materials, the development of new products and materials, the redesign of product life cycles, the use of composting, the reintroduction of carbon into material flows ...)6 We will talk about what the healthcare sector should do to meet the commitments of the Paris7 Agreement and the European8 Green Deal and attain zero emissions by 2050.
The life sciences and healthcare sector have a complex relationship with climate change. On the one hand, the direct effects of global warming on health, and its indirect effects via natural disasters (including pandemics like Covid 19) are the utmost health threat and challenge predicted for the 21st century. On the other, the combined emissions of hospitals, services related to the sector and the medical product supply chain are highly polluting. In 2014, the 34 OECD countries on which there are figures accounted for 4.4% of the planet's9 emissions and an average of 5.5% of their respective national footprints (Figure 1).
Figure 1: Healthcare carbon footprint (HCF) expressed as the percentage of the national carbon footprint, by geographic regions where the emissions are produced (a) and by per capita and financing sector (b). 2014 figures on the countries with available data. Source: https://iopscience.iop.org/article/10.1088/1748-9326/ab19e1/meta#erlab19e1s3.
The organization Healthcare Without Harm (HCWH)10 claims that if the global healthcare sector were a country, it would be the fifth-largest greenhouse gas emitter on the planet, with a footprint equivalent to annual emissions from 514 thermal11 power plants . This effect comes from energy consumption, transportation and product manufacturing, use and elimination.
According to the reports from this nonprofit organization made up of public and private stakeholders from the sector, 17% of emissions come from healthcare activities, 12% from the energy used throughout all the processes and 71% from production, transportation and elimination. This study traces emissions going back to their sectors of origin, as shown in Figure 2 and the report's12 methodology. For HCWH, this non sustainability begins with drug development. Laboratories use 5 to 10 times more energy than what an office building needs. And in some cases (clean rooms), they use up to 100 times more13. High-energy consumption and the use of many single use products are the main enemies of sustainability in laboratories. This is highlighted in the September issue of the publication el·lipse by the Barcelona Biomedical Research Park (PRBB), which discusses whether sustainability is the pending challenge in biomedical14 research and reports the specific actions of the IMIM and PRBB as examples.
Figure 2: Global footprint of the healthcare sector tracing back to the original source of emissions. Source: Health Care's Global Climte Footprint report
Other reports, like the one from the Sustainable Health Commission of the British National Health System (NHS), focus on manufacturing processes, where large amounts of energy and water are used in the supply chain, which contributes to a great deal of emissions generated in global product transportation15. The NHS’s approach is to attribute the emissions from the health value chain to the activity segments to which this sector supplies goods and services.
In another meaningful contribution to the debate, the World Health Organization points to the incineration of waste from the sector as an important source of dioxins, furans and suspended particles.
But this is nothing new: these effects have been reported for decades16.
What can the sector do?
According to a report from Deloitte17 , the life sciences and healthcare industry should prioritize suppliers with zero carbon policies, waste and water recycling and the use of sustainable materials in packaging and parts. We have focused on the global roadmap to decarbonize the sector and comply with the Paris Agreement proposed by Healthcare Without Harm (Figure 3). It outlines three ways to move towards zero emissions:
1. Decarbonizing healthcare.
2. Decarbonizing the product and service supply chain.
3. Contributing to accelerating the decarbonization of society and the economy18.
This roadmap is a fairly convincing strategy among the different ones proposed for the sector on its way towards climate neutrality.
Figure 3: Assuming that the countries fulfill the commitments agreed upon in the Paris Agreement, there will be three pathways connected with 7 high-impact actions and specific recommendations which would make the sector more resilient and would help it reach decarbonization by 2050. Source:Healthcare Without Harm Roadmap
The seven proposals
1. To supply the healthcare system with 100% clean and renewable energy
2. To invest in zero-emissions buildings and infrastructures
3. To transition to zero emissions with sustainable travel and transportation
4. To provide healthy and sustainably grown food
5. To encourage and manufacture low carbon pharmaceutical products
6. To implement circular healthcare and sustainable healthcare waste management
7. To make the healthcare system more effective by lowering emissions and improving efficacy
But what are countries, healthcare systems, entities and companies doing? What global initiatives are leading the way? How can the European Commission assist in this transformation?
Working towards transformation
Countries are implementing regulations like carbon taxes. The financial and banking sectors have integrated ESG (environmental, social and governance) standards into their financing19 criteria. Great Britain is focusing on a zero footprint strategy for 2040. The German government is financing hospital reform with sustainability criteria in all their services20.
So, what about companies? A note issued by the British parliament in 202021, signed by a member of the Trust22 sustainability program, groups companies into three categories: those that need a drastic change, those that have neutrality objectives within reach, and those that have already attained them or will do so shortly (it mentions Roche, J&J, Amgen, AstraZeneca and Bristol).
Three of the many initiatives that come with this transformation are:
- L’European Healthcare Climate Council (EHCC), a coalition of hospitals and healthcare systems committed to boosting the sector's response to climate change, established in 2016 by Health Care Without Harm Europe.
- Sustainable Healthcare Coalition, a group led by the healthcare sector which seeks to inspire sustainable healthcare practices through coalitions.
- The sustainability networks of the Max Planck: institutes were founded in 2019. They are comprised of sustainability groups from the different centers committed to creating a sustainability scientific environment.
- Sustainable Science, devoted to raising awareness of the plastic waste generated every day by research laboratories around the world and to prompting a debate on how it can be reduced.
Europe is leading the way with the policies, regulations and strategies in the Green New Deal, which is advocating a quick shift towards a circular economy based on recycling, reusing23, remanufacturing and sharing use, applying “triple policies” that benefit health, the environment and equity. This strategic framework can offer unprecedented opportunities for hospitals, companies and healthcare systems in Europe to achieve their sustainability goals. One practical example is the EU’s public procurement system, which stimulates associations with administrations and stakeholders that can prove sustainable24 practices. Implementing the European Green Deal will have implications for other countries and regions because both the challenge and the solution are global25.
To anchor the initiatives in our ecosystem, we should recall the 2018 document from the Ecoinnovation Laboratory26 with proposals on the circular economy for the healthcare sector. Farmaindustria mentions Sigre27 as one of the sector's bids for sustainability. In 2021, CataloniaBio&HealthTech, in turn, has launched a working group to promote sustainability in life sciences and healthcare companies, and in 2020 Ferrer signed the first green loan in the country, associated with the company's sustainability indicators.
In 2021, EFPIA published a white paper on climate change in which it commits to promoting policies and strategies that have an impact on the entire value chain, to seek to lower CO2 based on scientific data, to contribute to lowering energy consumption, to seek opportunities to use more renewable energies in the entire value chain and to publish its CO2 emissions figures every year following recognized methodologies.
In conclusion, the healthcare sector has to respond to the climate emergency while taking responsibility for its own footprint. It must do so not only by caring for the health problems derived from this emergency, but also by putting the principles of prevention into practice to lower its own contribution to the problem. Health organizations, professionals and the sector as a whole as an integral part of it—have a huge impact on society's attitude and changing habits. Let's take advantage of #LabWasteDay (September 21) to encourage this essential reflection on this matter.
Sources:
UNESCO (United Nations Education, Science and Culture Organization) defines sustainability as the process of using resources in a way that does not compromise the environment or exhaust materials for future generations. See the definition of sustainability at http://www.sustainabilitylabs.org/approach/
[3] Carbon neutrality or zero footprint refers to achieving net zero carbon dioxide emissions by balancing emissions with their elimination or the elimination of emissions from society.
[4] https://www.fiercepharma.com/special-report/top-20-pharma-companies-by-2020-revenue
[5] https://www.sciencedirect.com/science/article/abs/pii/S0959652618336084
[6] https://www.sciencedirect.com/science/article/pii/S1871678420301692
[7] The 2015 Paris Agreement establishes measures to lower greenhouse gas emissions after 2020. It was adopted by 195 countries within the United Nations Framework Agreement on Climate Change.
[8] The EU's 2019 Green Dea is the roadmap with policy initiatives to promote the efficient use of resources and accelerate the move towards a clean, circular economy in Europe. It covers all the sectors of the economy and describes the investments and financing tools needed to make Europe the first carbon neutral continent by 2050.
[9] https://iopscience.iop.org/article/10.1088/1748-9326/ab19e1/pdf
[10] A nonprofit network of European hospitals, medical service providers, local authorities, academic institutions and environmental organizations.
[12] HealthCaresClimateFootprint_092319.pdf (noharm-global.org)
[13] Laboratories for the 21st Century: An Introduction to Low-Energy Design (revision) (nrel.gov)
[14] https://ellipse.prbb.org/ca/la-sostenibilitat-el-repte-pendent-de-la-recerca-biomedica/
[18] https://healthcareclimateaction.org/roadmap
[19] The only way for entities and companies to avoid poor lending conditions or exclusion from capital markets is by showing proof that they have developed robust sustainability and ESG strategies.
[20] KLIK - Klimamanager für Kliniken: Projektbeschreibung (klik-krankenhaus.de)
[21] https://committees.parliament.uk/writtenevidence/9756/pdf/
[22] https://trusttwinning.eu/
[23] Reconstructing a product to meet the specifications of the product originally manufactured through a combination of reused, repaired and new parts.
[24] https://ec.europa.eu/environment/gpp/
[25] https://linkinghub.elsevier.com/retrieve/pii/S0140673620301094
[26] Of the Fundació Fòrum Ambiental, made up of public administrations and private companies: https://www.slideshare.net/empresaenxarxa/guia-leconomia-circular-aplicada-a-lmbit-de-la-salut
[27] An entity that manages packaging and leftovers of home medicines
