If the global healthcare sector were a country, it would be the fifth-largest greenhouse gas (GHG) emitter on the planet, according to a new report. Its authors, who argue for zero carbon emissions, say it is the first-ever estimate of healthcare’s global climate footprint.

While fossil fuel burning is responsible for more than half of the footprint, the report says there are several other causes, including the gases used to ensure that patients undergoing surgery feel no pain.

It is produced by Health Care Without Harm (HCWH), an international NGO seeking to change healthcare worldwide so that it reduces its environmental footprint and works for environmental health and justice globally. It was produced in collaboration with Arup.

The report says the European Union healthcare sector is the third largest emitter, accounting for 12% of the global healthcare climate footprint. More than half of healthcare’s worldwide emissions come from the top three emitters – the EU, the US and China. The report includes a breakdown for each EU member state.

An earlier report, published in May this year in the journal Environmental Research Letters, said the health care sectors of the 36 countries sampled were together responsible in 2014 for 1.6 GtCO2e (gigatonnes of carbon dioxide equivalent), or 4.4% of the total emissions from these nations, and 4.4% is the total used in the HCWH report.

(Carbon dioxide equivalency is a simplified way to put emissions of various GHGs on a common footing by expressing them in terms of the amount of carbon dioxide that would have the same global warming effect, usually over a century.)

Places of healing should be leading the way, not contributing to the burden of disease.

HCWH says well over half of healthcare’s global climate footprint comes from fossil fuel combustion. But it identifies several other causes for concern as well. One is the range of gases used in anaesthesia to ensure  patients remain unconscious during surgery.

These are powerful greenhouse gases. Commonly used anaesthetics include nitrous oxide, sometimes known as laughing gas, and three fluorinated gases: sevoflurane, isoflurane, and desflurane. At present, the greater part of these gases enter the atmosphere after use.

Research by the UK National Health Service (NHS) Sustainable Development Unit shows the country’s anaesthetic gas footprint is 1.7%, most of it attributable to nitrous oxide use.

The UN climate change convention (UNFCCC) found that in 2014 a group of developed nations with 15% of the global population, 57% of the global GDP and 73% of global health expenditure was also responsible for 7 MtCO2e of medical nitrous oxide use. (“MtCO2e” means “million metric tons of carbon dioxide equivalent”.)

The UNFCCC concluded that the full impact of the gas’s global use in anaesthesia “can be expected to be substantially greater”.

Use is growing

For fluorinated gases used in anaesthesia, global emissions to the  atmosphere in 2014 were estimated to add 0.2% to the global health care footprint. Because of the growing use of these gases, increasingly chosen  in preference to nitrous oxide, the footprint from anaesthetic gases is also likely to increase.

In measured tones, HCWH says: “Wider adoption of waste anaesthetic capture systems has the potential to be a high impact health care-specific climate mitigation measure” – or in other words, trap them and dispose of them carefully before they can just escape through an open window to join the other GHGs already in the atmosphere.

But HCWH adds a warning: “For many individual health facilities and systems of hospitals the proportion of the contribution of both nitrous oxide and fluorinated anaesthetic gases to their climate footprint can be significantly higher.

“For instance, Albert Einstein Hospital in São Paulo, Brazil found that GHG emissions from nitrous oxide contributed to nearly 35% of their total reported GHG emissions in 2013.”

Its report said choosing to use desflurane instead of nitrous oxide meant a ten-fold increase in anaesthetic gas emissions.

Other remedies available

The HCWH report also sounds the alert about metered-dose inhalers (MDIs), devices which are typically used for the treatment of asthma and other respiratory conditions, and which use hydrofluorocarbons as propellants. These are also highly potent greenhouse gases, with warming potentials between 1,480 and 2,900 times that of carbon dioxide.

Again, though, the report says the full global emissions from MDIs will probably be much greater than today’s figure. Alternative ways of using MDIs, such as dry powder -based inhalers, it says, are available and provide the same medicines without the high global warming potential propellants.

The report argues for the transformation of the healthcare sector so that it meets the Paris Agreement goal of limiting temperature rise attributable to climate change to 1.5°C.

HCWH says hospitals and health systems should follow the example of the thousands of hospitals already moving toward climate-smart healthcare via the Health Care Climate Challenge and other initiatives.

Welcoming the report, the director-general of the World Health Organization, Dr Tedros Adhanom Ghebreyesus, said hospitals and other health sector facilities were a source of carbon emissions, contributing to climate change: “Places of healing should be leading the way, not contributing to the burden of disease.”

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