Challenges for decarbonising healthcare, and strategies to overcome

Last week, I attended the World Health Organization’s (WHO) 'Training of Trainers’ event in Madrid. It was a fantastic few days, bringing together member states participating in the ATACH, and a range of external experts. I was invited to participate in a Panel discussion on delivering low carbon and climate resilient healthcare. Given my experience, I was asked about the common challenges encountered by healthcare facilities in reducing greenhouse emissions, and what strategies can help to overcome them? I was also asked how I see this approach being applied at the national system level? My points seemed to resonate with many in the audience, and I had some fantastic follow-up discussions with individuals facing many of the issues I raised. So, in response to that, I felt it would be useful to summarise my key points in this blog.

But firstly…

What is ATACH?

COP26 was a big moment for climate and health. The WHO, UK Government’s Foreign, Commonwealth and Development Office, Health Care Without Harm (HCWH) and the UN Climate Change High-Level Climate Champions launched the COP26 Health Programme, through which 50+ countries committed to developing low carbon (some net zero) and/or climate resilient healthcare. Since then, as minds moved to action, the Alliance for Transformative Action on Climate and Health (ATACH) was established to support the delivery phase of the Programme. Its membership brings together all committed member states (now over 80), technical partners and external experts to provide a community of practice, tools and resources, and ultimately accelerate healthcare’s climate transition.

What are the common challenges?

In terms of challenges, there are the obvious usual suspects: a lack of funding, skills and capacity. There are also such a wide range of tools available that we can often be overwhelmed: Which one(s) should we use? How do we know we are picking the right one for our health facility/system? However, these challenges are so commonplace that I chose not to dwell on them too much. Instead, I highlighted some of the more significant issues I have seen.

Conflicting priorities: Our health facilities are faced with a seemingly endless list of challenges, and these vary significantly depending on geography and structure. Yes, some health systems want to be super sustainable. Whilst others just want a hospital that works, with proper sewage systems, infection control, and waste disposal. In these circumstances, sustainability can easily (and understandably) fall down the priority list.

Lack of local leadership: Facility-level leadership buy-in is hugely important. Without this, we have no real direction or vision.

Lack of national leadership: Without leadership from the system level (e.g. Ministry of Health), it is very difficult to understand the impact our efforts at the facility are having. And a lack of supporting policies can result in a very disconnected approach to decarbonisation, where policy can actually form a barrier to meeting our objectives.

Overwhelmed by scale: Decarbonising healthcare is a daunting task. Our health systems are huge and complex, with massive technical challenges to overcome. So we can often develop a kind of fear: Where do we start? How do we progress? Where should we focus our attention? And what if it’s not good enough? Adding to this, we can often be guilty of driving for perfection.

Strategies to overcome

It’s important to realise that there is no silver bullet. Our health systems are all unique and we can experience any combination of these challenges and to different levels, at any time. There are various strategies that we can implement to address these and some are more obvious than others. For example, we need to develop strategies, systems, processes, governance and structures. These elements are critical, but do take time and patience to build. Further strategies include: 

Building a network and community: This allows us to connect, talk to and learn from each other, swap best practices, share resources, and (best of all) share the pain!

Not reinventing the wheel: Innovation is important, but not always necessary. Sometimes it’s enough to adopt ideas that are already tried and tested, adapt them and try them out in your own context

Adopting a measurement tool: I mentioned already that there are various tools out there for both facility and system level, including those from HCWH, ECODES and Aga Khan. But how do we know which is right? In many ways, it doesn’t really matter which tool you use, at least in the beginning. Just start using one! And remember to document your methodology, so your measurements are comparable and useful the next time round. It’s only through this experience that we get a sense of whether it is the right solution and whether it needs to be adapted. 

Building the business case: We need to think about return on investment and payback periods. We need to sell the health co-benefits. We need to be thinking about mitigation and resilience and the common ground between them. All these things help make the business case for the projects we want to deliver. Healthcare is in a unique position when it comes to addressing climate change - what is good for the planet is (in many cases) also good for health. So we need to capitalise on that position and demonstrate the added value of reducing emissions.

Tailoring our message: How we speak to a politician is very different to how we speak to a CEO, or a Finance Director, or a doctor, or a nurse, or a patient. So it is vital to tailor our message to our audience. We need to speak their language to gain the necessary buy-in.

Starting small: I often see health systems that want to hit emissions reductions as hard and as fast as they can - but this can be super challenging and, at times, unrealistic. In many instances, the low hanging fruit is the most effective. So start small and simple and, as our experience builds, we start to develop new ideas.

Measure and report on progress and success: At some point, you will be asked to justify the resources dedicated to sustainability. It is important to keep a solid record of your progress and successes. This will build trust and acceptance, and unlock future resources.

And, the final point I would add is to remember that it is not about perfection - we will never get this absolutely perfect! It is about developing our understanding, implementing, growing and improving.

Applying at national level

Reducing greenhouse gas emissions in the health sector is often delegated to individual facilities. But to drive the change that is needed, we require strong leadership at all levels, whether that’s at the local or national (system/ministry) levels. 

Developing a national decarbonisation roadmap is a vital step in the process. However, this is often seen as a technical document; we measure emissions, we model different pathways to net zero, we look at technical actions we can take to reduce emissions. But it’s not just a technical document, it is also a policy document. Because without the supporting policies, whether that’s financing, incentives, legislation, regulation or guidance… Without those things adapting and changing, we cannot build a favourable environment in which reducing emissions can be achieved. And by having that roadmap and those changes in policy, we give legitimacy to spend both human and financial resources on sustainability within healthcare facilities. So our hospital leadership, who are dealing with staff shortages and beds in the corridors, can say it’s okay to spend money and time on sustainability. 

Conclusion

To wrap things up, we need to remember the importance of language. Yes, we are trying to reduce greenhouse gas emissions and improve resilience - but that is technical speak. This is about improving operations, reducing costs, increasing efficiency, and improving care, and the quality of that care. But, more importantly, decarbonising healthcare is about better health, improving lives and reducing deaths. So language is critical. And it is much easier and cheaper to do it now than in the future.