Health systems and environmental sustainability: updating frameworks for a new era

Healthcare systems around the world have a responsibility to “do no harm” but are responsible for substantial negative health effects through the production of greenhouse gases, particulate matter, pharmaceutical waste, and other environmental pollutants.1 Recent studies estimate that the healthcare sector accounts for 4.6% of global greenhouse gases, and over 8% of these emissions in some countries.23 Although high income countries produce most health system pollution, low and middle income countries also contribute through poor hazardous waste disposal practices and other carbon intensive healthcare activities.45

Growing numbers of health systems have recognised the importance of their environmental impact and are acting to reduce it. To date, 82 countries, nearly half of which are classified as low or lower middle income by the World Bank, have signed an international pledge to develop climate resilient and low carbon health systems.6 In early 2023, over 100 health systems in the US signed a health sector climate pledge endorsed by the White House to achieve net zero emissions by 2050.7 Health systems in the UK and many other European countries have also developed extensive decarbonisation plans.89

Despite these multiplying pledges and the urgency to act, real progress has been uneven. Simple and important actions, such as substituting highly polluting anaesthetic gases for equally effective, less polluting options, have not been universally adopted.10 In clinical practice, heavy reliance on disposable devices persists even when moving to a reusable option is safe, less costly, and less polluting.11 Education on the inter-relatedness of climate and health and the importance of health system sustainability remains rare in medical …