1. I Tennison et al. (2021) Health care’s response to climate change: a carbon footprint assessment of the NHS in England Lancet Planet Health 2021; 5: e84–92 https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(20)30271-0/fulltext
Health care’s response to climate change: a carbon footprint assessment of the NHS in England
Summary
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.
2. M J Eckelman, J D Sherman, A J MacNeill (2018) Life cycle environmental emissions and health damages from the Canadian healthcare system: An economic-environmental-epidemiological analysis. PLoS Med. 2018 Jul 31;15(7):e1002623. doi: 10.1371/journal.pmed.1002623
https://pubmed.ncbi.nlm.nih.gov/30063712/
Life cycle environmental emissions and health damages from the Canadian healthcare system: An economic-environmental-epidemiological analysis.
Abstract
Background: Human health is dependent upon environmental health. Air pollution is a leading cause of morbidity and mortality globally, and climate change has been identified as the single greatest public health threat of the 21st century. As a large, resource-intensive sector of the Canadian economy, healthcare itself contributes to pollutant emissions, both directly from facility and vehicle emissions and indirectly through the purchase of emissions-intensive goods and services. Together these are termed life cycle emissions. Here, we estimate the extent of healthcare-associated life cycle emissions as well as the public health damages they cause.
Methods and findings: We use a linked economic-environmental-epidemiological modeling framework to quantify pollutant emissions and their implications for public health, based on Canadian national healthcare expenditures over the period 2009-2015. Expenditures gathered by the Canadian Institute for Health Information (CIHI) are matched to sectors in a national environmentally extended input-output (EEIO) model to estimate emissions of greenhouse gases (GHGs) and >300 other pollutants. Damages to human health are then calculated using the IMPACT2002+ life cycle impact assessment model, considering uncertainty in the damage factors used. On a life cycle basis, Canada's healthcare system was responsible for 33 million tonnes of carbon dioxide equivalents (CO2e), or 4.6% of the national total, as well as >200,000 tonnes of other pollutants. We link these emissions to a median estimate of 23,000 disability-adjusted life years (DALYs) lost annually from direct exposures to hazardous pollutants and from environmental changes caused by pollution, with an uncertainty range of 4,500-610,000 DALYs lost annually. A limitation of this national-level study is the use of aggregated data and multiple modeling steps to link healthcare expenditures to emissions to health damages. While informative on a national level, the applicability of these findings to guide decision-making at individual institutions is limited. Uncertainties related to national economic and environmental accounts, model representativeness, and classification of healthcare expenditures are discussed.
Conclusions: Our results for GHG emissions corroborate similar estimates for the United Kingdom, Australia, and the United States, with emissions from hospitals and pharmaceuticals being the most significant expenditure categories. Non-GHG emissions are responsible for the majority of health damages, predominantly related to particulate matter (PM). This work can guide efforts by Canadian healthcare professionals toward more sustainable practices.
3. Sherman JD, Thiel C, MacNeill A, et al. The green print: advancement of environmental sustainability in healthcare. Resour Conserv Recycling 2020; 161: 104882.
https://www.sciencedirect.com/science/article/pii/S092134492030197X
The green print: advancement of environmental sustainability in healthcare
Abstract
Healthcare is a major emitter of environmental pollutants that adversely affect health. Within the healthcare community, awareness of these effects is low, and recognition of the duty to address them is only beginning to gain traction. Healthcare sustainability science explores dimensions of resource consumption and environmental emissions associated with healthcare activities. This emerging field provides tools and metrics to quantify the unintended consequences of healthcare delivery and evaluate effective approaches that improve patient safety while protecting public health. This narrative review describes the scope of healthcare sustainability research, identifies knowledge gaps, introduces a framework for applications of existing research methods and tools to the healthcare context, and establishes research priorities to improve the environmental performance of healthcare services. The framework was developed through review of the current state of healthcare sustainability science and expert consensus by the Working Group for Environmental Sustainability in Clinical Care. Key recommendations include: development of a comprehensive life cycle inventory database for medical devices and drugs; application of standardized sustainability performance metrics at the clinician, hospital/health system, and national levels; revision of infection control standards driving non-evidence-based uptake of single-use disposable devices; call for increased federal research funding; and formation of a Global Commission on the Advancement of Environmental Sustainability in Healthcare. There is an urgent need for research that informs policy and practice to address the public health crisis arising from healthcare pollution. A transformational vision is required to align research priorities to achieve a sustainable healthcare system that advances quality, safety and value.
4. United Nations Climate Change, 2021: Race To Zero is a global campaign
https://unfccc.int/climate-action/race-to-zero-campaign
5.United Nations Climate Change, 2021: Who's in Race to Zero?
https://unfccc.int/climate-action/race-to-zero/who-s-in-race-to-zero
6. World Bank, 2017: Climate-Smart Healthcare, Low-Carbon and Resilience Strategies for the Health Sector
7. Health Care Without Harm, 2011 : Global Green and Healthy Hospitals
8. WHO, 2021: COP26 Special Report / The health argument for climate action
https://www.who.int/publications/i/item/cop26-special-report
COP26 Special Report / The health argument for climate action
Overview
The 10 recommendations in the COP26 Special Report on Climate Change and Health propose a set of priority actions from the global health community to governments and policy makers, calling on them to act with urgency on the current climate and health crises.
The recommendations were developed in consultation with over 150 organizations and 400 experts and health professionals. They are intended to inform governments and other stakeholders ahead of the 26th Conference of the Parties (COP26) of the United Nations Framework Convention on Climate Change (UNFCCC) and to highlight various opportunities for governments to prioritize health and equity in the international climate movement and sustainable development agenda. Each recommendation comes with a selection of resources and case studies to help inspire and guide policymakers and practitioners in implementing the suggested solutions.
9. WHO, 2021: COP26 Key Messages on Climate Change and Health https://www.who.int/publications/i/item/cop26-key-messages-on-climate-change-and-health
COP26 Key Messages on Climate Change and Health
Overview
The science is clear: we must urgently scale up action to respond to the threat of climate change to have a chance of limiting warming to 1.5 degrees, and to adapt effectively and increase our resilience. Moreover, the public health motives for action have a strong science basis and are well evidenced and compelling.
In this briefing pack, key messages on climate change and health are highlighted across five priority areas of climate action: adaptation & resilience, energy transitions, nature, clean transport, and finance. This briefing pack highlights the health benefits of action in those areas, and hopes to contribute towards collective progress in the lead up to the 26th UN Climate Change Conference of the Parties (COP26).
10. WHO, 2021: COP26 Health Programme
https://www.who.int/publications/i/item/cop26-health-programme
COP26 Health Programme
Country commitments to build climate resilient and sustainable
health systems
Summary of initiative commitments
Commitment area 1: Climate resilient health systems
• Commit to conduct climate change and health vulnerability and adaptation assessments (V&As) at population level and/or health care facility level by a stated target date;
• Commit to develop a health National Adaptation Plan (HNAP) informed by the health V&A, which forms part of the National Adaptation Plan (NAP) to be published by a stated target date;
• Commit to use the V&A and HNAP to facilitate access to climate change funding for
health (e.g. project proposals submitted to the Global Environmental Facility (GEF), Green Climate Fund (GCF) or Adaptation Fund (AF) or GCF Readiness programme)
Commitment area 2: Sustainable low carbon health systems
▪ High ambition/high emitters: Commitment to set a target date by which to achieve health system net zero emissions (ideally by 2050).
▪ All countries: Commitment to deliver a baseline assessment of greenhouse gas emissions of the health system (including supply chains)
▪ All countries: Commitment to develop an action plan or roadmap by a set date to develop a sustainable low carbon health system (including supply chains) which also considers human exposure to air pollution and the role the health sector can play in reducing exposure to air pollution through its activities and its actions.
Process for recording/tracking commitments
• Commitments should be made at Ministerial level and published through government
communications channels. The COP26 Health Team should be informed of commitments to enable tracking: COP26Health@fcdo.gov.uk
• Country level commitments are not made to the COP Presidency or to the UK; they are made by countries to their own citizens.
This document was produced by UK Government with contributions from WHO, Wellcome Trust, London School of Hygiene and Tropical Medicine and the Global Climate and Health Alliance. Please note, that some of the slides may be developed further over time.
Published in November 2020
11. WHO, 2021: : COP26 Health Programme, Country Commitments
https://www.who.int/initiatives/cop26-health-programme/country-commitments
Country Commitments
A growing number of countries has formally committed to develop climate resilient and low carbon, sustainable health systems. These include:
|
Country |
Climate resilient health systems |
Sustainable low carbon health systems |
Net zero commitment |
Net zero target |
|
Argentina |
yes |
yes |
no |
|
|
Bahamas |
yes |
no |
no |
|
|
Bahrain |
yes |
no |
no |
|
|
Bangladesh |
yes |
yes |
no |
|
|
Belgium |
yes |
yes |
yes |
2050 |
|
Belize |
yes |
yes |
no |
|
|
Bhutan |
yes |
yes |
no |
|
|
Canada |
yes |
yes |
no |
|
|
Cape Verde |
yes |
yes |
no |
|
|
Central African Republic |
yes |
yes |
no |
|
|
Chile |
no |
yes |
no |
|
|
Colombia |
yes |
yes |
no |
|
|
Costa Rica |
yes |
yes |
no |
|
|
Dominican Republic |
yes |
yes |
no |
|
|
Egypt |
yes |
no |
no |
|
|
Ethiopia |
yes |
yes |
no |
|
|
Fiji |
yes |
yes |
yes |
2045 |
|
Germany |
yes |
yes |
no |
|
|
Ghana |
yes |
yes |
no |
|
|
Indonesia |
yes |
yes |
yes |
2030 |
|
Ireland |
yes |
yes |
no |
|
|
Jamaica |
yes |
yes |
no |
|
|
Jordan |
yes |
yes |
yes |
2050 |
|
Kenya |
yes |
yes |
yes |
2030 |
|
Lao PDR |
yes |
yes |
no |
|
|
Madagascar |
yes |
yes |
no |
|
|
Malawi |
yes |
yes |
yes |
2030 |
|
Maldives |
yes |
yes |
no |
|
|
Morocco |
yes |
yes |
yes |
2050 |
|
Mozambique |
yes |
yes |
no |
|
|
Nepal |
yes |
yes |
no |
|
|
Netherlands |
yes |
yes |
no |
|
|
Nigeria |
yes |
yes |
yes |
2035 |
|
Norway |
yes |
yes |
no |
|
|
Oman |
yes |
yes |
no |
|
|
Pakistan |
yes |
yes |
no |
|
|
Panama |
yes |
yes |
no |
|
|
Peru |
yes |
yes |
yes |
2050 |
|
Rwanda |
yes |
no |
no |
|
|
Sao Tome and Principe |
yes |
yes |
yes |
2050 |
|
Sierra Leone |
yes |
yes |
yes |
2035 |
|
Spain |
yes |
yes |
yes |
2050 |
|
Sri Lanka |
yes |
yes |
no |
|
|
Tanzania |
yes |
yes |
no |
|
|
Togo |
yes |
yes |
no |
|
|
Tunisia |
yes |
no |
no |
|
|
Uganda |
yes |
yes |
no |
|
|
United Arab Emirates |
yes |
yes |
no |
|
|
United Kingdom |
yes |
yes |
yes |
2040 |
|
United States of America |
yes |
yes |
|
|
|
Yemen |
yes |
yes |
yes |
2050 |
|
Total: 51 |
50 |
46 |
14 |
12. Nemzeti Tiszta Fejlődési Stratégia (tervezet), 2020. https://ec.europa.eu/clima/sites/lts/lts_hu_hu.pdf
VEZETŐI ÖSSZEFOGLALÓ
Az energiaunió és az éghajlat-politika irányításáról, valamint a 663/2009/EK és a 15/2009/EK európai parlamenti és tanácsi rendelet, a 94/22/EK, a 98/70/EK, a 2009/31/EK a 2009/73/EK, a 2010/31/EU, a 2012/27/EU és a 2013/30/EU európai parlamenti és tanácsi irányelv, a 2009/119/EK és az (EU) 2015/652 tanácsi irányelv módosításáról, továbbá az 525/2013/EU európai parlamenti és tanácsi rendelet hatályon kívül helyezéséről szóló, 2018. december 11-i, 2018/1999/EU európai parlamenti és tanácsi rendelet (a továbbiakban: Governance rendelet) 15. cikk (1) bekezdése kimondja, hogy 2020. január 1-jéig, majd 2029.január 1-jéig, azt követően pedig tízévente minden tagállam elkészíti és jelenti a Bizottságnak a legalább 30 éves kitekintéssel rendelkező hosszú távú stratégiáját.
A Magyar Országgyűlés által egyhangúlag elfogadott és a 2016. évi L. törvényben kihirdetett
Párizsi Megállapodás 4. cikkének 19 pontja szerint a „Részes Feleknek arra kell törekedniük,
hogy az üvegházhatású gázok alacsony kibocsátásával járó hosszú távú fejlesztési stratégiákat
fogalmazzanak meg és jelentsenek be, szem előtt tartva a 2. cikket, figyelembe véve közös, de
megkülönböztetett felelősségeiket és eltérő képességeiket, tekintettel az eltérő nemzeti
körülményekre.” Az ebben a pontban megfogalmazott felhíváshoz kapcsolódóan a Megállapodást elfogadó 1/CP.21 döntés 36. pontja felhívja a Feleket, hogy 2020-ig kommunikálják ezen stratégiáikat.
Eleget téve a Párizsi Megállapodás felhívásának, valamint tekintettel arra, hogy Magyarország a világ azon kevés országa közé tartozik, amelyek úgy tudták az üvegházhatású gáz kibocsátásaikat csökkenteni, hogy a gazdasági teljesítményük (GDP) nőtt, a jelen stratégia ennek a „tiszta növekedésnek” a tovább folytatását kívánja biztosítani. Ezek mentén Magyarország fokozatosan, 2050-ig klímasemleges országgá válhat anélkül, hogy az átmenet a gazdasági növekedést és a társadalmi jólétet veszélyeztetné.
Várhatóan a klímasemlegesség 2050-ig tartó eléréséhez Magyarországon az üvegházhatású gázok (a továbbiakban: ÜHG) kibocsátását 1990-hez képest kb. 95%-kal kell csökkenti. A jelenlegi ismereteink szerint a fennmaradó kibocsátásokat a hazai elnyelők (földhasználati szektor, elsősorban az erdők) tudják semlegesíteni. Habár vannak kutatások mesterséges nyelők kialakítására, de ezek esetleges jövőbeni alkalmazhatósága nagyon bizonytalan. Ennek a célnak az eléréséhez valamennyi kibocsátó szektorban (energiafelhasználás, ipar, mezőgazdaság, hulladék) szükséges beavatkozni, és a nyelő kapacitások fenntartása érdekében is lépéseket kell tenni. Magyarország számára fontos, hogy az alacsony kibocsátású gazdaságra való átálláshoz szükséges innovációk, energiahatékonysági intézkedések is minél előbb megvalósuljanak, hiszen ezek jelentősen segítik a célok elérését.
A 95%-os összkibocsátás-csökkentési cél elérése érdekében, amelyhez ma még nem ismert
technológiák is szükségesek lesznek, egyes ágazatokban (pl. áram és távhő termelése,
olajfinomítás, kokszolás, energiahatékonyság, a mezőgazdaság, a halászat, és az erdészet
energiaigénye, a termékhasználatban az üvegházhatású fluortartalmú gázok és oldószerek
használatának teljes kivezetése) szükséges a kibocsátások abszolút nullára történő
csökkentése. Lesznek viszont olyan ágazatok (mezőgazdasági kibocsátások, ipar, fugitív
emissziók, régi hulladéklerakók maradék hatása), amelyek esetén, a mainál jóval
alacsonyabb mértékben, de várhatóan maradnak fenn ÜHG kibocsátások.
A Nemzeti Tiszta Fejlődési Stratégiában szereplő jövőkép nagyban támaszkodik a következő
30 év technológiai fejlődésére. A jövőkép olyan innovatív technológiák megjelenésére számít,
mint az energiatároló rendszerek (pl. power-to-gas vagy hidrogén), széndioxid leválasztása és
tárolása vagy felhasználása, a nagy kibocsátású ipari üzemekben tiszta forrásból származó
hidrogénredukálásra való használata vagy ipari tüzelése a magas hőfokú folyamatok
fűtéséhez.
Az átállás költségei a következő 30 évre nem előrelátható politikai, szabályozási,
technológiai, társadalmi stb. és nem utolsósorban éghajlati változásai miatt rendkívül nehezen
becsülhetők. Továbbá kiemelendő, hogy az átállás költségeinek nem a teljes része
addicionális költség, hiszen egyébként is elvégzendő feladatokat is takar (pl. a következő
30 évben mindenképpen le fog cserélődni szinte a teljes közúti gépjármű-állomány, az elavult
erőmű-park és az épületek fűtőberendezései a járművek és berendezések élettartamának
lejárta miatt). A költségek ellenére a dekarbonizáció számtalan társított előnnyel is jár, a
gazdaság és a társadalom számára nemcsak terhet, hanem munkahely-teremtési lehetőséget is
jelent, tisztább levegőt, vizet, környezetet és így kevesebb betegséget és halálozást
eredményez, illetve a fosszilis tüzelőanyagok importjának kiváltása megalapozza
Magyarország energiafüggetlenségét, és óriási kiadásoktól mentesíti Magyarországot.
A 2050-es klímasemlegesség elérésének becsült költsége nagyságrendileg mindösszesen
kb. 50 ezer milliárd Ft, amely nagyságrendileg 2050-ig évente a GDP 2,5%-ának
megfelelő mértékű források bevonását feltételezi.