Baseline estimates of Australia’s health system greenhouse gas emissions
Categories: Net zero health systems, GHG emissions assessments, Action plans for sustainable low carbon health systems, Western Pacific, Climate Resilient Health Systems, Low Carbon Sustainable Health Systems
Country: Australia
Context
Climate change presents a significant threat to global health, exacerbating vulnerabilities in health systems and widening health inequities. Maintaining Australia’s world-class healthcare system, while acting to reduce its impact on climate change, is a priority for the Australian Government, acknowledging that climate change is already causing significant physical and mental health challenges for Australians, and with its impact expected to increase in the future.
Australia is a federation, made up of a Commonwealth government together with six states and two territories. The Australian health system consists of multiple layers of governance, management, and care delivery, all which affect emissions measurement and reporting. The Commonwealth government has clear roles and responsibilities in supporting healthcare delivery, including funding states and territories to deliver a range of services from acute inpatient care through to in-home and residential care. In addition, private and denominational healthcare service providers are important suppliers of healthcare services.
The Department of Health, Disability and Ageing (“the Department”) has the responsibility to address climate health challenges in Australia. In 2023, Australia’s first National Health and Climate Strategy (the Strategy) was released. The Strategy outlines priorities for the following five years to address the health and wellbeing impacts of climate change and to develop a sustainable and resilient health system that supports healthy, sustainable and resilient communities. One of the four core objectives of the Strategy is:
- Health system decarbonisation: building a sustainable, high quality, net zero health system.
To achieve a net zero health system, Australia identified the need to establish a clear understanding of the major sources of emissions within its health system.
In 2025 the Department published Estimates of Australian Health System Greenhouse Gas Emissions, 2021-22. A hybrid assessment model (combining bottom up and top-down methodologies) was used to produce the estimates contained in this report. This model combined activity-based estimation and Environmentally Extended Input-Output (EEIO) assessment methods to provide a comprehensive national view of baseline health system emissions.
Implementation process
An important first step in estimating Australia’s greenhouse gas emissions measurement was defining its boundary, which involved identifying the scope of the health system to be included in emissions estimates. The health system boundary was defined using the Australia New Zealand Standard Industry Classification (ANZSIC) and the 116 Input-Output Industry Groups (IOIGs) as defined by the Australian Bureau of Statistics. Specifically, the health system was defined to encompass three IOIGs (reflecting domestic production only):
- 8401 – Health Care Services (hospitals, general practice and specialist medical services)
- 8601 – Residential Care and Social Assistance Services (aged-care residential services and social assistance), and
- 1801 – Human Pharmaceutical and Medicinal Product Manufacturing (manufactured pharmaceutical and medicinal products for human use).
A range of data sources were used to generate production-based (scope 1) and scope 2 emissions estimates – including the National Inventory by Economic Sector (NIbES) and data from the National Greenhouse Energy and Reporting Scheme. To generate scope 3 emissions estimates, the production-based estimates from NIbES were combined with National Accounts (expenditure) data using Environmentally Extended Input-Output Analysis to map emissions to consuming sectors, with deductions made from the resulting consumption inventory to avoid double counting of scope 1 and scope 2 emissions.
Figure 1 below demonstrates the flow of data and calculations involved in estimating health system emissions using the hybrid method for this report.
Figure 1: Schematic of hybrid methodology used to estimate greenhouse gas emissions
(Credit: Australian Department of Health, Disability and Ageing)
The report estimates total greenhouse gas emissions by the Australian health system in 2021-2022 were 23.52 Mt CO2-e, or 5.44% of Australia’s total greenhouse gas emissions. These emissions are divided as follows by IOIG code:
- Health Care Services: 13.79 Mt CO2-e (59% of the total)
- Residential Care and Social Assistance Services: 7.80 Mt CO2-e (33%)
- Human Pharmaceutical and Medicinal Product Manufacturing: 1.92 Mt CO2-e (8%)
Further disaggregation of emissions by scope in Table 1 below reveals the following:
Table 1: Emissions by scope in the Australian health system (2021-2022)
Scope | Description | Mt CO2-e | % of total |
|---|---|---|---|
1 | Direct emissions, including natural gas and liquid fuels from sources such as stationary fuel use, anaesthetic gases, or fuel used in vehicles owned or leased by the health system | 1.53 | 7% |
2 | Indirect emissions from purchased energy | 4.69 | 20% |
3 | Indirect emissions from sources other than purchased energy. | 15.88 | 68% |
Outside | Patient travel to and from health facilities | 1.40 | 6% |
Figure 2 below shows the total health systems emissions for 2021/22 disaggregated by scope 1, 2 and 3 emissions.
Figure 2: Total Health Systems Emissions Australia 2021-22 (Credit: Australian Department of Health, Disability and Ageing)
Lessons learned
Overall, this project required significant coordination of effort, including technical experts drawn from public and private entities, academia and industry groups and was underpinned by strong Commonwealth government leadership. Strong project management, clear and open communication, and a shared commitment to environmental reporting were also clear lessons learned and that will be applied ongoing as Australia continues to refine approaches to greenhouse gas emissions estimation. A further important lesson learned is that health-related greenhouse gas emissions estimation is an evolving process, where methodological approaches are rapidly maturing in line with increased and more timely access to data.
Challenges
The Estimates of Australian Health System Greenhouse Gas Emissions, 2021-22 report is an important starting point for future health system emissions estimation and reporting. The report adheres to international standards and methodologies, including the Intergovernmental Panel on Climate Change Guidelines for National Greenhouse Gas Inventories and the Greenhouse Gas Protocol (GHG Protocol), to estimate emissions generated by the health system. Emissions estimates are categorised using the and ISO14064:2018, to align with existing international health system emissions reports. It is, however, limited in certain respects due in part to gaps in the underlying data and significant and varied challenges posed by the complexity of the health system’s value chain. The report discusses these limitations and challenges in detail.
Recommendations
Based on the Australian experience, the following recommendations are made to support enhanced reporting of GHG emissions from health systems:
- Pair technical model development with training programmes for government analysts, health administrators, and facility teams. Strengthening local analytical skills ensures long-term ownership of the model and supports evidence-based policy decisions.
- Report any limitations by disclosing gaps and assumptions.
- Present data in a clear and accessible way, and identify enhancements planned for future reporting
- Consult widely with stakeholders, and partner with climate-health experts in industry, government and academia.
Key resources
The following key resources were used to develop the Estimates of Australian Health System Greenhouse Gas Emissions, 2021-22 report.
- Australia’s National Health and Climate Strategy 2023
- Australia’s National System of Accounts
- Department of Climate Change, Energy, the Environment and Water (DCCEEW) National Inventory by Economic Sector (NIbES)
- Australia New Zealand Standard Industrial Classification (ANZIC) Scheme
- National Greenhouse and Energy Reporting Scheme (NGER)
More information
For more information, please contact: Professor Madeleine Skellern (Director, National Health, Sustainability and Climate Unit, Department of Health, Disability and Ageing, Australian Government) at NHSC.Unit@Health.gov.au.
This case study is part of the work of the ATACH Task Team for health systems GHG emissions measurement, complementing the WHO guidance for measuring greenhouse gas emissions in health systems.