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Healthcare systems in low- and middle-income countries (LMICs) are producing substantial carbon emissions and plans for delivering universal health coverage must tackle this to avoid further escalation, according to analysis published in The BMJ.
The carbon footprint of healthcare worldwide — the total amount of greenhouse gases released into the environment by health systems — is equivalent to 2-2.4 Gigatonnes of carbon dioxide (CO2), or around five per cent of total global emissions, studies have shown.
Healthcare in LMICs is a carbon-intensive activity which is “likely to grow with the delivery of commitments to universal health coverage”, according to researchers from Switzerland, India, Belgium and Brazil writing in The BMJ.
“Embedding carbon reduction as a core theme to the delivery of universal health coverage would help ensure a greater health and healthcare dividend for any investments in growing healthcare.”
Jerome Baddley, chartered environmentalist
The World Health Organization (WHO) estimated in 2017 that to achieve the UN Sustainable Development Goal targets for universal health coverage, 67 LMICs would need an additional annual investment of US$371 billion by 2030.
“If the carbon impact of this investment follows the average emissions intensity for the 24 LMICs [that the analysis assessed], achieving universal health coverage could result in an additional 382 million tonnes of CO2 equivalent a year,” The BMJ analysis said. “This would increase the global carbon footprint of healthcare by about 16 per cent from 2.4 billion tonnes.”
Jerome Baddley, an author of the analysis and a senior advisor on environmentally sustainable healthcare for Aga Khan Development Network, in Geneva, Switzerland, told SciDev.Net that most investments to cut carbon emissions also reduced costs, increased resilience and improved public health.
“Embedding carbon reduction as a core theme to the delivery of universal health coverage would help ensure a greater health and healthcare dividend for any investments in growing healthcare,” he said.
The researchers attributed the high carbon footprint of healthcare systems in LMICs in part to unreliable electricity grids, which leave health facilities dependent on expensive and polluting generators.
Ambulances and other transportation vehicles often run on fossil fuels and contribute to the emissions, they said. Use of some clinical products, such as pressurised metered-dose inhalers and anaesthetics, can also result in carbon emissions, they added.
Speaking about the challenges in developing low-carbon health facilities, Baddley said: “This is not only about facilities, but also products, travel, suppliers, and models of care. For example, primary care is lower carbon than hospital care.”
He said access to expertise to calculate carbon footprints, target action, and build the case for investment had been challenging.
“Access to appropriate financing to purchase the most efficient technologies is also often a significant challenge,” he added.
The researchers advocate use of telehealth and digital healthcare in LMICs to increase access to healthcare and decrease carbon emissions.
“Healthcare providers in LMICs should be expected by ministries of health to calculate the carbon footprints of their organisations and to embed action in the delivery of universal health coverage to reduce emissions,” they said.
They also recommend building zero-carbon healthcare facilities, using low-carbon power sources, prescribing low-carbon products, packaging and logistics, and minimising transportation of patients.
“Government health regulatory bodies must convert the [healthcare] facilities to ‘non-carbon emitting’ ones in a phased manner,” said Diptendra Sarkar, a public health specialist and professor of surgery at the Institute of Post Graduate Medical Education and Research in Kolkata, India.
“It must soon become a ‘climate waste’ disposal mechanism quite like the ‘biomedical waste’ disposal approach. Hospitals must set up autonomous committees to ensure regular audits,” he told SciDev.Net.
At the UN climate change conference, COP26, held in Glasgow this month, governments from 45 countries pledged to convert to “more sustainable and low-carbon” healthcare systems. Fourteen countries set a target to reach net zero carbon emissions by 2050, according to the WHO.
Marsha Wills-Karp, chair of the department of environmental health and engineering at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, USA, told SciDev.Net: “The recent COP26 commitment of countries around the world to developing climate-resilient healthcare systems is a critical step in the right direction of combatting the current and future impacts of climate change on the public’s health.
“Leadership by healthcare institutions is essential both to reduce the carbon footprint of their services as well as to preserve critical healthcare infrastructures in the wake of climate change-mediated disruptions.”
This piece was produced by SciDev.Net’s Global desk.