In the ever-heightening debate on climate change, the healthcare industry seldom features. Yet the sector is a major contributor to climate change, emitting 4.4% of global greenhouse gases.

If the health sector were a country, it would be the fifth-largest emitter on the planet, a report on the industry's climate footprint said. The sector includes life sciences tools, equipment, biotechnology, pharmaceuticals, providers and facilities.

The healthcare industry — which brings in $7.2 trillion annually, or 10% of the world's GDP — has been "largely ignored" in climate change discussions until recently, according to the report, published in September by nonprofit organization Health Care Without Harm and engineering consulting firm Arup Ltd.

The U.S. is the No. 1 contributor to global healthcare emissions, with China and the EU following. Also the three highest contributing regions to overall emissions, they make up 56% of the total healthcare climate footprint.

"Places of healing should be leading the way, not contributing to the burden of disease," World Health Organization Director-General Tedros Ghebreyesus said.

Climate change is a human health crisis, the report explained. Fossil fuel combustion causes air pollution, which prematurely kills more than 7 million people a year. Air pollution also increases the occurrence of noncommunicable chronic diseases, especially prevalent in low- and middle-income countries, exacerbating health equity issues and in turn, driving up healthcare costs.

"Climate change is the greatest threat to global health in the 21st century," the WHO said.

Emissions

The healthcare supply chain is responsible for 71% of the sector's emissions, while healthcare facilities and healthcare-owned vehicles account for 17%. Indirect emissions, such as cooling and heating, electricity and steam make up the remaining 12%, HCHW and Arup's report showed. Within those categories, fossil fuel combustion is the major contributor to emissions.

Anesthetic gases and metered-dose inhalers, used for asthma and other respiratory conditions, contribute 0.6% and 0.3%, respectively, to healthcare emissions. The hydrofluorocarbons used in metered-dose inhalers have warming potentials between 1,480 to 2,900 times that of carbon dioxide, the report said.

Systems that capture waste could mitigate the anesthetic gas emissions, and metered-dose inhalers could be replaced by alternative delivery mechanisms such as dry powder-based inhalers, the report suggested.

HCWH and Arup noted a limitation on data availability, particularly for global anesthetic gas and metered-dose inhalers, which the report concluded speaks to the lack of attention paid by the health sector to investigating its own climate change impact.

Quiet action

According to the Dow Jones Sustainability World Index's 2019 Industry Leader Report, compiled Sept. 13, Biogen Inc. leads the biotechnology industry in sustainability, while GlaxoSmithKline PLC leads pharmaceuticals. In life sciences tools, Agilent Technologies Inc. holds the industry leader spot, and Abbott Laboratories leads healthcare equipment and supplies companies; Cigna Corp. is the industry leader among healthcare providers and services.

However, like a similar report card from S&P Global Ratings issued in May, the Index's assessment of each subsector in healthcare primarily focused on social risks to the industry, namely drug pricing, business ethics, human capital management and cost-effectiveness. The Sustainability Index is tracked by S&P Dow Jones Indices and RobecoSAM.

Biogen's corporate sustainability report said it is aiming for a 2030 absolute greenhouse gas reduction target of 35% in line with the Paris Agreement. Biogen has invested in climate-smart technologies, such as Leadership in Energy and Environmental Design, or LEED, Platinum and LEED Gold buildings and looked to its highest climate-impacting supply chain partners to make direct climate reductions in purchased products and services.

Merck KGaA has also implemented more energy-efficient display technologies, such as organic light-emitting diodes or OLEDs, and stopped using microplastic particles, S&P Global Ratings reported.

Johnson & Johnson and Koninklijke Philips NV have pledged to use 100% renewable energy in their operations by 2050 or earlier, according to HCWH and Arup.

Kaiser Permanente Inc., the University of California Health System and Cleveland Clinic have set goals for carbon neutrality and carbon net positivity, the report said.

In China, regulations have focused on energy conservation in public institutions. In Europe, England's National Health Service has reduced the healthcare and social care climate footprint by 18.5% since 2007, in accordance with the country's Climate Change Act. Scandinavia and the Netherlands have also committed to zero emissions hospital buildings and climate-smart technology and supply chains.

The report added that the U.S. is "arguably [where] the most work needs to be done."

The report said much remains to be done in healthcare, specifically — and now. Healthcare facilities and the healthcare supply chain should be decarbonized, and the industry should aim for zero emissions by 2050. A global framework is needed for climate action, including setting targets for the industry.

Global institutions should provide aid for such climate-smart efforts, and national and sub-national governments should implement action plans.

The report added that moving the health sector toward climate-smart technologies, like onsite renewable energy sources and buildings with natural ventilation, would be more cost-effective in the long run.