Technical Case Study
by Gesundheit Österreich GmbH | Competence Center Climate and Health
Key takeaways:
- Healthcare systems contribute substantially to greenhouse gas emissions. Developing a strategy to reduce their carbon footprint is essential to mitigate climate change and achieve climate goals
- Many countries have international commitments to reduce carbon emissions as part of global efforts to combat climate change. Developing a climate neutral healthcare system is crucial for meeting these obligations
- Climate friendly healthcare systems which promote health can lead to cost savings through reduced energy consumption and lower operational expenses and by strengthening resilience. Investments in climate protection can result in long-term financial benefits
- As an influential sector, the healthcare sector can set an important example and promote climate protection as a frontrunner. Its commitment to climate neutrality can inspire other sectors, organizations and individuals to adopt more climate friendly practices
- Climate friendly healthcare facilities can enhance an institution's reputation and its attractiveness as an employer
1. Why take action?
The effects of climate change have become increasingly visible and noticeable, posing a growing threat to the health of individuals and the healthcare system alike. The healthcare sector contributes 6.7 percent to Austria's carbon footprint and also emits a considerable amount of greenhouse gases (Weisz et al. 2020); therefore it is a crucial sector to help achieve the Austrian government's goal of "climate neutrality by 2040" and its international obligations on reducing greenhouse gases.
- "Climate change is the biggest health threat of the 21st century" - The 2021 Report of the Lancet Countdown on Health and Climate Change: Code Red for a Health Future (Romanello et al. 2021)
- The carbon footprint of the healthcare sector is around 7% of the national footprint (Weisz et al. 2020)
- The consequential costs of the climate crisis are highest in the health sector (Steininger et al. 2020)
Without rapid and ambitious climate protection, increased risks and, in some cases, unavoidable damage to people and ecosystems are to be expected. A far-reaching and timely implementation of climate protection measures this decade would reduce the predicted damage to people and ecosystems and include many additional benefits, especially for air quality and health (IPCC 2022). Ambitious climate protection brings numerous advantages and benefits in various areas. These positive additional effects are becoming increasingly important and are key drivers for implementing climate protection measures.
The benefits of climate protection and climate change adaptation measures lie in:
- positive effects on health
- reduction in costs
- strengthening the resilience and security of supply chains
Not engaging in climate protection not only has an impact on the environment and health but also results in a massive additional burden on the public budget. For example, the consequential costs of direct damage related to weather and climate change in Austria amounted to around one billion euros in 2020. This sum is expected to rise to between six and twelve billion euros per year by 2050, with the largest share of the consequential costs being borne by the health sector (Steininger et al. 2020). Experts agree that the consequential costs of the climate crisis will exceed the costs of committed climate protection in the long term. If the health benefits of climate protection are also taken into account in the cost-benefit analysis, the benefits far outweigh the investment costs associated with climate protection (Shindell et al. 2021).
Saving energy, switching to more energy-efficient products or processes and renewable sources, and shifting more energy production to a regional or local level could reduce the consumption of oil and gas, thereby reducing dependence on imported oil and gas and increasing energy security. At the cross-sectoral interface between climate and health policy, options for action can be identified that have a positive impact on the climate and bring additional individual and social benefits as well, above all for the health of the population (Salas et al. 2020). Such co-benefits support prevention and health promotion, thus leading to a reduction in the use of the healthcare system and, in turn, making a valuable contribution to climate neutrality. Key targets here include active mobility, healthy and climate friendly nutrition, and the creation of green spaces. The associated co-benefits are an important starting point on the road to climate neutrality.
KEY MESSAGES:
Implementing a strategy for a climate neutral healthcare system can help to:
- reduce greenhouse gas emissions
- reduce costs
- improve health
- increase resilience
2. How to get started
For a long time the healthcare sector was neither specifically addressed in relation to climate protection nor was there a strategy for a climate neutral healthcare system. The various negative consequences of the climate crisis, the astronomical costs associated with it, nationally and internationally defined and binding target structures as well as the recommendations made by international and national experts in the Austrian Special Report on Health, Demography, and Climate Change all mean that it is vital to establish a strategy for a climate neutral healthcare system.
In 2022, the Austrian Federal Ministry of Social Affairs, Health, Care and Consumer Protection commissioned the Competence Center Climate and Health at the Austrian National Public Health Institute (Gesundheit Österreich GmbH, GÖG) to develop such a strategy.
© Monika Fellner
The Competence Center brings together interdisciplinary expertise from science, policy, and practice at the interface of climate protection, climate change adaptation, health promotion, and healthcare. Its aim is to develop sustainable strategies for the healthcare system as well as to create scientific content and databases for the development of health policy frameworks.
The Strategy for a Climate Neutral Healthcare System developed by the Competence Center aims to focus on health services that are indispensable – despite increased health promotion and more efficient treatment – exploring ways to reduce their emissions and optimize their efficiency and environmental performance in order to foster the transformation to climate neutrality on a broad basis.
2.1. Key learning: Adopting an interdisciplinary approach
Research on climate change and health is an interdisciplinary field, and understanding its social, economic, political, and environmental implications requires integration across areas of research. The experts who worked on the strategy came from a variety of backgrounds ranging from social sciences and natural sciences to political science. Interdisciplinarity ensures comprehensive understanding of the challenges and potential solutions. Collaborating across disciplines encourages the development of innovative solutions. Experts and stakeholders from different fields bring unique perspectives and ideas to the table that lead to creative approaches to reducing healthcare emissions. Interdisciplinarity allowed us to establish connections between the different fields of action, resulting in a wide range of suggested measures and the framework conditions necessary to support the implementation of those measures. Beyond that, the interdisciplinary approach opens up communication between complementary fields, fills knowledge gaps, and facilitates progress within all fields concerned. A climate neutral healthcare system is not just a short-term goal but a long-term commitment. Interdisciplinarity helps develop strategies that consider the sustainability of healthcare practices, reducing long-term environmental impacts.
KEY LEARNING: When developing a strategy for a climate neutral healthcare system, interdisciplinarity is essential for addressing the complexity of this challenge. It fosters collaboration, innovation, and a holistic approach, leading to more effective and sustainable solutions that benefit both the environment and public health.
2.2. Key learning: Engaging actors, experts, and stakeholders
The Austrian healthcare system is organized in a very complex and fragmented way due to the diversity of actors involved. The main players are the federal government, the provinces, and municipalities as well as the Federation of Social Insurances as a self-governing body. Other relevant stakeholders include interest groups such as the Austrian Medical Chamber and the Chamber of Pharmacists.
Early engagement with actors, stakeholders, and experts in the fields of health and climate change was crucial in both developing and presenting the Strategy for a Climate Neutral Healthcare System.
Involving stakeholders in the strategy development process provides valuable insights and knowledge. They can share information about the specific challenges, resources, and opportunities in their own domains, helping to create well-informed and context-appropriate measures. In addition, when stakeholders are actively engaged in the strategy development process, they are more likely to feel a sense of ownership and commitment to the resulting strategy. This fosters buy-in and support, making it easier to implement and sustain the strategy.
While the strategy was being developed, a participatory process with workshops was launched. A special focus was placed on hospitals as well as pharmaceuticals and medical products as these are the areas that have the largest share of the CO2 footprint.
The aim of the workshops was to develop a package of climate protection measures for the healthcare sector in a cooperative process and to involve the relevant actors, stakeholders, and experts. The workshops aimed to define and develop:
- fields of action
- concrete framework conditions
- measures that support climate neutrality and strengthen resilience in the areas of pharmaceuticals and medical devices as well as for hospitals
In addition, a space was created to enable intersectoral exchange on these key topics.
© Monika Fellner
Stakeholders can play a vital role in implementing the strategy by contributing their resources, expertise, and influence. Key actors and decision makers within the health sector were invited to participate in the Enquete on a Strategy for a Climate Neutral Healthcare System on 24 October 2023 at which the draft strategy was presented. Their active involvement can streamline its implementation and enhance its effectiveness.
KEY LEARNING: Bringing stakeholders together from the outset supported the development of the strategy and was vital for increasing the commitment of all stakeholders concerned to start with its implementation.
2.3. Key learning: Peer review
Peer review is an iterative process that can lead to multiple rounds of revisions. This iterative approach will allow the strategy to evolve and improve over time, taking into account the feedback received. To confirm the validity of the strategy and to help improve the manuscript, the draft was first sent to peer reviewers who were experts in the fields of health and/or climate change or experts in one of the climate-relevant fields of action in the health sector. Their perspectives were incorporated into the strategy and their interdisciplinary background had an invaluable contribution to make to improving it.
After the strategy was presented on 24 October 2023 as part of the Enquete with the health minister and the climate minister, the draft document was sent to relevant stakeholders and actors within the health sector. They now have the opportunity to raise comments and remarks in the review process and make recommendations for further improvements. They can identify gaps in the strategy, recommend improvements, and suggest alternative approaches based on their knowledge and experience.
After this review process the final strategy will be presented in early 2024.
KEY LEARNING: Peer review is another important step in the development of a strategy for a climate neutral healthcare system. It improves its quality, ensures recognition of the strategy, and provides expert feedback, making the strategy more robust and effective in addressing the complex challenges of climate change and healthcare.
© Monika Fellner
3. Tracking progress
Monitoring and reporting on the reduction in greenhouse gas emissions (GHGs) from healthcare facilities is a central indicator and could be used in the future to ascertain how the implementation of the strategy is progressing. This can include tracking emissions from energy consumption, transportation, waste, and other sources.
Evaluating the overall carbon footprint of healthcare facilities and services on a regular basis, including emissions related to energy consumption, procurement, transportation, and waste, can provide a comprehensive overview of their environmental impact.
4. In practice
As outlined above, the strategy was presented on 24 October 2023 as part of an Enquete organized by the Minister of Social Affairs, Health, Care and Consumer Protection. Various representatives took part in the event, including the main players within the health care sector at federal government and provincial level as well as from umbrella organizations. The Minister for Climate Action, Environment, Energy, Mobility, Innovation and Technology also participated. Providing bundled information on how a climate neutral healthcare system can succeed strengthened their commitment and motivated all actors and players to take action and implement the strategy.
Some countries and healthcare systems have already started working on strategies and initiatives to achieve climate neutral healthcare. The presentation of the Austian strategy was, therefore, another important milestone for the healthcare sector on the road to climate neutrality. The Austrian strategy can serve as a model for other countries to develop and implement strategies of their own for a climate neutral healthcare system.
5. Key resources
Lichtenecker, Ruperta; Schanes, Karin; Durstmüller, Felix; Lichtblau, Claudia; Truppe, Michaela; Lampl, Christina (2023): Strategie Klimaneutrales Gesundheitswesen. Analyse und Grundlagen: Rahmenbedingungen, Handlungsfelder und Handlungsoptionen. Gesundheit Österreich, Wien
https://agenda-gesundheitsfoerderung.at/kokug
More information
For more information, please contact: Ruperta Lichtenecker
klimaneutrales.gesundheitswesen@goeg.at, ruperta.lichtenecker@goeg.at
6. References
- IPCC (2022): Summary for Policymakers. In: Climate Change 2022: Mitigation of Climate Change Contribution of Working Group III to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change [PR Shukla, J Skea, R Slade, A Al Khourdajie, R van Diemen, D McCollum, M Pathak, S Some, P Vyas, R Fradera, M Belkacemi, A Hasija, G Lisboa, S Luz, J Malley, (eds)]. Cambridge University Press, Cambridge, UK and New York, USA
- Romanello, M.; McGushin, A.; Di Napoli, C.; Drummond, P.; Hughes, N.; Jamart, L.; Kennard, H.; Lampard, P.; Solano Rodriguez, B.; Arnell, N.; Ayeb-Karlsson, S.; Belesova, K.; Cai, W.; Campbell-Lendrum, D.; Capstick, S.; Chambers, J.; Chu, L.; Ciampi, L.; Dalin, C.; Dasandi, N.; Dasgupta, S.; Davies, M.; Dominguez-Salas, P.; Dubrow, R.; Ebi, K. L.; Eckelman, M.; Ekins, P.; Escobar, L. E.; Georgeson, L.; Grace, D.; Graham, H.; Gunther, S. H.; Hartinger, S.; He, K.; Heaviside, C.; Hess, J.; Hsu, S. C.; Jankin, S.; Jimenez, M. P.; Kelman, I.; Kiesewetter, G.; Kinney, P. L.; Kjellstrom, T.; Kniveton, D.; Lee, J. K. W.; Lemke, B.; Liu, Y.; Liu, Z.; Lott, M.; Lowe, R.; Martinez-Urtaza, J.; Maslin, M.; McAllister, L.; McMichael, C.; Mi, Z.; Milner, J.; Minor, K.; Mohajeri, N.; Moradi-Lakeh, M.; Morrissey, K.; Munzert, S.; Murray, K. A.; Neville, T.; Nilsson, M.; Obradovich, N.; Sewe, M. O.; Oreszczyn, T.; Otto, M.; Owfi, F.; Pearman, O.; Pencheon, D.; Rabbaniha, M.; Robinson, E.; Rocklöv, J.; Salas, R. N.; Semenza, J. C.; Sherman, J.; Shi, L.; Springmann, M.; Tabatabaei, M.; Taylor, J.; Trinanes, J.; Shumake-Guillemot, J.; Vu, B.; Wagner, F.; Wilkinson, P.; Winning, M.; Yglesias, M.; Zhang, S.; Gong, P.; Montgomery, H.; Costello, A.; Hamilton, I. (2021): The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future. In: Lancet 398/10311:1619-1662
- Salas, Renee N; Maibach, Edward; Pencheon, David; Watts, Nick; Frumkin, Howard (2020): A pathway to net zero emissions for healthcare. In: BMJ 371/:m3785
- Shindell, Drew; Ru, Muye; Zhang, Yuqiang; Seltzer, Karl; Faluvegi, Greg; Nazarenko, Larissa; Schmidt, Gavin A.; Parsons, Luke; Challapalli, Ariyani; Yang, Longyi; Glick, Alex (2021): Temporal and spatial distribution of health, labor, and crop benefits of climate change mitigation in the United States. In: Proceedings of the National Academy of Sciences 118/46:e2104061118
- Steininger, Karl W; Bednar-Friedl, Birgit; Knittel, Nina; Kirchengast, Gottfried; Nabernegg, Stefan; Williges, Keith; Mestel, Roland; Hutter, Hans-Peter; Kenner, Lukas (2020): Klimapolitik in Österreich: Innovationschance Coronakrise und die Kosten des Nicht-Handelns. Wegener Center Research Briefs. Klima- und Energiefonds, Wien
- Weisz, U.; Pichler, P.; Jaccard, I.S.; Haas, W.; Matej, S.; Bachner, F.; Nowak, P.; Weisz, H. (2020): Carbon emission trends and sustainability options in Austrian health care. In: Resources, Conservation and Recycling 160/:104862