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Environmental Sustainability and Healthcare: Examples From Worldwide Markets

Healthcare is a significant contributor to climate change through its substantial carbon footprint. If the health sector were a country, it would be the fifth largest emitter on the planet.¹ Healthcare not only contributes to climate change but is also impacted by it. Climate change leads to an increase in demand for healthcare and a decline in public health, with deaths attributable to rising temperatures² and air pollution.³ While the healthcare industry is relatively late to recognize its impact on the climate crisis compared to other industries, awareness and acknowledgement of the situation is growing. Addressing environmental sustainability in healthcare is therefore becoming a global priority, and policies and initiatives to build more sustainable health systems are multiplying.

In this article, we define the role of environmental sustainability in healthcare and share examples of current initiatives from various markets worldwide.

Environmental Sustainability in Healthcare

Environmental sustainability in healthcare focuses on improving, maintaining, or restoring individual and population health while minimizing adverse effects on the environment and taking advantage of opportunities to enhance and repair it for the benefit of both current society and future generations.

In this context, there is substantial consensus among policymakers, payers, procurement, physicians, providers, patients, academics, and society on the importance of incorporating environmental sustainability considerations into healthcare decision-making and technologies assessments. However, the international landscape in environmental sustainability in healthcare is growing fast and is complex given the number of stakeholders involved in healthcare decision-making:

Policymakers, academics, and international societies have set out goals and high-level strategic plans to address environmental sustainability.
Health Technology Assessment (HTA) bodies are publishing positions and roadmaps seeking to evaluate how to consider and assess environmental sustainability.
Payers are considering how to evaluate environmental sustainability when making price and reimbursement decisions and introducing some examples of pilots and restrictions.
Procurement teams and the medical community are leading the way in addressing environmental sustainability, with tenders increasingly incorporating environmental criteria and physicians updating clinical guidelines to support more sustainable care models.

Environmental Sustainability in Action

We have analyzed the initiatives in environmental sustainability in healthcare around the world and selected some examples of how countries are addressing this challenge.

United Kingdom | Sweden | Canada | France

United Kingdom

In the United Kingdom (UK), governmental commitment to reducing greenhouse gas emissions is evident through initiatives like the Net Zero Strategy⁴ and the Health and Care Act of 2022,⁵ which embeds net-zero targets into National Health Service (NHS) legislation. Policymakers have introduced procurement policies and social value models⁶ to ensure that environmental considerations are integrated into healthcare supply chains and decision-making processes:

The NHS Trusts are mandated⁷ to produce Green Plans,⁸ including implementation of carbon reduction strategies
All NHS suppliers must complete a Carbon Reduction Plan⁹ as part of the tendering process
The National Institute of Health and Care Excellence (NICE), the UK’s HTA body, has committed to assess¹⁰ how to integrate environmental sustainability into its decisions

Moreover, UK healthcare providers are actively engaging in initiatives such as Value-Based Procurement and implementing interventions to reduce carbon emissions, with successes ranging from reducing the carbon footprint of surgical procedures to optimizing medication prescribing practices. On the clinical front, UK physicians increasingly recognize their role in promoting environmental sustainability within healthcare delivery.

Professional bodies like the Royal College of Physicians¹¹ advocate for the integration of net-zero targets into healthcare policies, and the government has already taken concrete measures.
The Royal College of Anaesthetists¹² committed to stop using desflurane, an anesthetic with high global warming potential; the NHS decommissioned the product as a result.
Various publications and studies highlight the environmental impact of healthcare practices and advocate for changes such as transitioning to lower carbon inhalers and optimizing prescribing guidelines.
- The British Pharmacological Society published a paper¹³ exploring the role of inhaler prescribing in addressing climate change in the healthcare sector. The authors discuss the green prescriber movement, highlight the significant environmental impact of inhalers, review the issue of patient preference, and recommend the update of clinical guidelines to include more sustainable alternatives where clinically appropriate.

Patients are also becoming more aware of the environmental implications of healthcare choices. Initiatives like the NICE dialogue¹⁴ indicate growing patient interest in integrating sustainability into healthcare decision-making.

Sweden

In Sweden, policymakers are actively pursuing the environmentally sustainable use of medicines through the National Pharmaceutical Strategy,¹⁵ emphasizing collaboration between stakeholders and a “One Health” perspective. This approach incorporates criteria for environmental assessments and urges consideration of environmental aspects in pharmaceutical product evaluation. Additionally, the Swedish Dental and Pharmaceutical Benefits Agency (TLV) is tasked with proposing a model for a pilot project to introduce an environmental premium in pharmaceutical procurement.¹⁶ This project, set to run from 2024 to 2027, allows companies to voluntarily join an eco-rebate system, with medicines in certain categories eligible for rebates based on environmental qualifications assessed by relevant agencies. Furthermore, efforts are underway to integrate sustainability into procurement practices and to overcome challenges faced by pharmacies due to generic substitution obligations.

The National Agency for Public Procurement (NAPP) offers recommendations¹⁷ for incorporating sustainability requirements into procurement processes.
Providers, including the Swedish Pharmacy Association,¹⁸ are informing consumers about the environmental impact of medicines and developing criteria for responsible manufacturing.
Physicians, through organizations like the Swedish Medical Association¹⁹ and the Swedish Lung Medical Association, are advocating for increased awareness of the environmental impact of medications and measures to mitigate climate change’s effects on health.

Canada

In Canada, policymakers at both the federal and provincial levels are increasingly prioritizing environmental sustainability within healthcare systems. Federal initiatives such as the carbon trading scheme extend to pharmaceutical manufacturing, particularly in vaccine production. Federally funded research institutes like CASCADES are providing toolkits²⁰ to promote climate-conscious prescribing practices, emphasizing the reduction of the environmental footprint of inhalers in both inpatient and outpatient settings. Provincially, legislation like Ontario’s Broader Public Sector Accountability Act²¹ mandates procurement guidelines that consider environmental impacts, prompting hospitals to adopt sustainable practices. These efforts reflect a growing recognition of the importance of integrating environmental considerations into healthcare policymaking across different levels of government. Canada’s HTA body, the Canadian Agency for Drugs and Technologies in Health (CADTH), has a Strategic Plan²² that includes assessing the environmental impact of healthcare systems and adapting methodologies to incorporate environmental perspectives. CADTH’s value framework for evaluating non-drug health technologies already includes an “environmental impact” criterion, ensuring that environmental considerations are factored into technology assessments. Provincial bodies like British Columbia’s HTA are also integrating environmental factors into their evaluations, recognizing the importance of sustainability in healthcare decision-making. Providers, including hospitals and healthcare networks, are actively engaging in initiatives to reduce the environmental footprint of healthcare operations.

Organizations like the GreenCare Network in British Columbia and the Canadian Coalition for Green Health Care facilitate knowledge sharing and promote best practices for environmental sustainability in healthcare facilities nationwide.
Professional associations like the Canadian Medical Association and the Canadian Association of Physicians for the Environment (CAPE) advocate for policies that prioritize environmental sustainability in healthcare systems. Their efforts include developing recommendations for policymakers and providing resources for healthcare professionals to address climate change and promote eco-friendly practices.
CAPE created a climate change toolkit²³ for health professionals highlighting potential action they can take within healthcare facilities to address climate change and created a training advocacy program to train physicians on becoming environmental advocates.

France

In France, environmental sustainability has become a focal point for policymakers, particularly within the healthcare sector. The government’s initiative to transform France into a “Green Nation”²⁴ includes plans for a carbon-neutral healthcare sector by 2050, outlined in the roadmap for an ecological healthcare system.²⁵ This document outlines the objectives:

Accelerate and promote the transition to sustainable purchasing, particularly for healthcare products, by 2030
Transform and support practices towards eco-responsible care by 2023
Train on and raise awareness of the climate crisis, healthcare’s impact on the environment, eco-design of care, and medico-social issues among all healthcare professionals and stakeholders

Additionally, efforts to integrate environmental sustainability into healthcare extend to pricing decisions. PLFSS2024, the December 2023 law on social security financing,²⁶ is the first in France to mention incorporating environmental factors.

France’s National Health Authority/Haute Autorité de Santé (HAS) addressed how to include environmental considerations in HTAs in their most recent roadmap,²⁷ although efforts are still evolving.

From a procurement perspective, the Union of Hospitals for Purchasing (UNiHA) has already established comprehensive tender requirements²⁸ for environmental sustainability criteria. And healthcare providers in France are actively engaged in environmental sustainability initiatives, with hospitals leading efforts to reduce carbon emissions, adopt responsible consumption practices, and implement sustainable strategies. Certification standards now include environmental risk management, and collaborative projects between industry and providers aim to reduce the environmental footprint of healthcare technologies. Education programs for healthcare professionals prioritize training on environmental issues, and recommendations are made to reduce the carbon footprint of medical practices, including changes in prescription habits and reprocessing of medical devices.

Conclusion

Environmental sustainability is emerging as a priority for healthcare decision makers. Concrete and rapid changes are already observed at the policy, procurement, and provider levels, with initial shifts seen in HTAs and payer practices.

Increasingly, procurement processes integrate environmental criteria into the selection of healthcare products and services. Physicians are playing a crucial role in driving environmental sustainability within healthcare. Medical associations are advocating for the adoption of eco-friendly practices, such as prescribing environmentally friendly medications, promoting the use of sustainable medical equipment, and evolving clinical guidelines.

While the integration of environmental considerations is still in the early stages, HTA and regulatory agencies are beginning to recognize the significance of environmental sustainability. Efforts are underway to broaden the scope of evaluation to include environmental sustainability, reflecting a growing awareness of the interconnectedness between healthcare and the environment. As these trends continue to evolve, healthcare systems are poised to make significant strides towards a more sustainable future.

How We Help

The increasing importance of environmental sustainability suggests that accessing important healthcare markets today requires a future-focused strategy. Companies that successfully adapt by implementing environmental sustainability will thrive. Eventually, companies will only access healthcare markets if they consider the environmental impact of health technologies alongside financial and health impacts.

At Alira Health, we help pharma and medtech clients to build environmental sustainability into their business strategy. We support companies in understanding the dynamic landscape of environmental sustainability in healthcare, the stakeholders involved, and the potential business impacts in order to manage potential risks and leverage emerging opportunities.

Contact us to build environmental sustainability into your business strategy.