In recent months, three hospital and healthcare networks have declared a climate emergency – all of them in England. With each organization’s declaration, the targets for “deep” de-carbonization have become progressively more ambitious. In June, Newcastle-upon-Tyne pledged to become net carbon neutral by 2040; (NHS Foundation Trust. 2019) in August, Greater Manchester committed to decarbonize by 2038; (Greater Manchester Health and Social Care Partnership. 2019) (NHS chief executive and Greater Manchester Mayor back plan to green the NHS. 2019)  and in October, Bristol aimed for 2030. (NHS Trust. 2019) Importantly, these organizations are pursuing de-carbonization at the city scale, in collaboration with municipal governments and local universities.

The gravity of the climate crisis suggests that such ambition is not misplaced. The 2018 summary for policymakers from the International Panel on Climate Change (IPCC) is sobering. We have already warmed by 1 degree; if the world is to have a reasonable chance of limiting warming to 1.5 degrees Celsius, “rapid and far-reaching transitions” will be needed, with declines in emissions of 45% from 2010 levels by 2030, reaching net zero by 2050. (IPCC. Global warming of 1.5C. 2018) Meanwhile climate change represents a current and accelerating threat to health – “impacting human health from infancy and adolescence to adulthood and old age.” (Watts et. al. 2019) 2020 must be the year of peak emissions.

Yet even if convinced of the need to act, not all will see a specific role for health systems. Healthcare’s carbon footprint is significant, at 4.6% of global emissions, (Watts et. al. 2019) but not enormous. Health systems sit atop an energy and transportation infrastructure that they do not directly control. Perhaps healthcare should be the last social institution to make sacrifices. What, then, is the rationale for health system action?

Let’s start with two reasons. First: No one can sit this one out. The carbon footprint of Canada’s health system is estimated at 5.1% of national emissions (Pichler et. al. 2019)- among the highest per-capita healthcare emissions in the world. (Watts et. al. 2019) The health harms of healthcare cannot be ignored, nor can the health benefits of reduced emissions, now and into the future. Second, the impact of health systems extends beyond their immediate carbon footprint. They are large employers, big buyers and major users of land, energy and transportation, affecting local communities and global supply chains. (Reed et. al. 2019) They are also trusted social institutions. Indeed, Medicare is consistently identified as the leading symbol of Canadian identity. (Tuohy, 2018) At a time of deepening economic inequality and social disillusionment, health system leadership on climate change can energize collective social action.

I think it’s safe to predict that health systems around the world will commit themselves to the transition. Not all will lead, but few will remain laggards for long. Already, smart leaders are detecting growing concern within their organizations and moving to embed sustainability into their strategic plans. So what can health systems do? We can start by borrowing from work done elsewhere. The English NHS leads the way, having invested in a dedicated unit to advance sustainability in health and social care since 2008. Their work shows that most of the carbon footprint of healthcare is not in its facilities – though there are important gains to be made there. Pharmaceuticals, medical devices and equipment are carbon “hot spots”; patient, caregiver and staff travel make a major contribution too. (NHS England. 2014) Thus, reducing the carbon intensity of health systems requires changes to care itself, including changing how we use some health technologies (e.g., asthma inhalers, anaesthetic gases); reorganizing care pathways to reduce waste, inappropriate care and unnecessary travel; and encouraging health promotion (e.g., social and green prescribing) and prevention ( Sustainable Development Unit for NHS England and Public Health England. 2018). Which brings us to the third reason why health systems should act: because the move to reduce carbon intensity is aligned with the agenda for high quality, integrated, patient-centred, place-based “population health systems.” (Alderwick et. al. 2015)

This is not to suggest that this transition will be easy. Though some of the solutions are established, much remains unknown. Indeed, none of the hospitals and health networks that have committed to decarbonization have yet released a detailed plan. Bold ambition will be needed, with a commitment to innovation, robust research and to learning by doing. It is time for Canada’s health systems to declare a climate emergency.

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