When most people think of healthcare, what usually comes to mind is going to a doctor's office, waiting in line, getting the right treatment and medication, and finally being relieved from pain.
What many people overlook is the waste that is generated with every visit to a clinic or hospital, and the enormous amount of energy consumed to keep the gears of the healthcare sector turning 24/7.
Energy-hungry medical equipment, general heating and cooling, and keeping the lights on day and night all require huge amounts of energy, but the main contributors to this energy are Scope 3 emissions – emissions that come directly from industry supply chains and improperly disposed waste.
This includes the production of medical supplies and medicines, waste such as personal protective equipment and disposable equipment such as syringes, and the transportation needed to transport medicines and medical supplies to clinics, as well as the transport used by nurses, doctors and patients.
Globally, the healthcare sector accounts for up to 5 percent of total carbon emissions, more than the aviation and shipping industries. If left unchecked, the World Economic Forum predicts that healthcare's carbon emissions could triple by 2050.
The majority of healthcare emissions come from Asia.
Emissions from healthcare account for about 8.5% of total emissions in the United States and about 5% of emissions in Europe, while the healthcare sector in Asia accounts for about 30% of the region's total carbon emissions.
There are several reasons for this: the region's ageing population — expected to account for two-thirds of the world's people aged 65 and over by 2030 — combined with steady economic growth in recent years is driving up healthcare costs.
The region’s lack of proper waste management infrastructure, coupled with the enormous volumes of medical waste generated by the COVID-19 pandemic and ongoing medical practices, has resulted in unprecedented volumes of medical waste being generated.
Asia is also particularly vulnerable to climate-related health risks: as heat-related illnesses, injuries and risks increase in frequency and intensity, more people will be sent to clinics and hospitals, and vulnerable populations will often bear the brunt.
John Graham, group chief executive of healthcare solutions provider Zuellig Pharma, said the never-ending cycle of climate-induced suffering, treatment and the resulting medical waste and emissions was unsustainable.
“The growing impacts of climate change are having an undeniable impact on the health of society – extreme weather events, air pollution and increased incidence of vector-borne diseases due to rising temperatures are all evidence of this,” Graham said.
The challenge of decarbonization
Ensuring that vaccines and medicines remain effective during transport is one reason why reducing emissions from the healthcare sector remains difficult, Graham said.
“For example, ensuring the integrity of temperature-sensitive vaccines and medicines is paramount to ensure they arrive intact and in the intended condition to the end user,” he said.
There is also energy-intensive equipment relied upon to diagnose and treat patients, such as magnetic resonance imaging (MRI) and computed tomography (CT) machines, as well as the heating, ventilation and air conditioning systems required to maintain a sterile environment.
Another challenge is a lack of manpower to monitor emissions and waste, says Manjit Sohal, regional climate manager for Southeast Asia at Health Care Without Harm (HCWH), a non-profit organisation that promotes sustainable health practices.
Sohal said this makes it difficult to track and measure Scope 3 emissions, which are key to long-term reduction efforts. “Healthcare facilities may lack standardized methods to collect accurate data, such as patient transport habits or waste management procedures implemented by a third party,” she said.
The healthcare supply chain also complicates the effort with a large number of players involved – numerous suppliers, manufacturers and distributors – making tracking and reducing emissions a difficult task, Sohal said, adding that 70 percent of healthcare emissions come from the supply chain alone.
Graham adds that stakeholders within the healthcare supply chain are “distributed” in nature – meaning they're geographically dispersed or not limited to one location – making emissions more difficult to track and reduce.
“This involves everything from clinical trials to supply chains to distribution,” he said, noting that reducing Scope 3 emissions requires coordination among suppliers, distributors, healthcare providers and regulators in Asia and around the world.
The Need for National Policy
There are currently no binding laws mandating the reduction of healthcare emissions or waste, either globally or in Asia, despite calls to reduce healthcare emissions, including the World Health Organization encouraging countries to work on developing climate-resilient healthcare systems at the 26th Conference of the Parties to the United Nations Framework Convention on Climate Change (COP26) in Glasgow in 2021. However, there are several frameworks and roadmaps aimed at reducing carbon emissions.
One is the UN-backed Race to Zero campaign led by HCWH, in which healthcare organisations representing more than 14,000 facilities have pledged to halve their emissions by 2030 and reach net zero by 2050. The other is the Global Roadmap for Decarbonising Healthcare initiative led by HCWH and design and engineering firm Arup, which offers a structured approach for the healthcare sector to reduce emissions.
While these efforts show some progress, Sohal argues that until mandates are implemented at a national level, the healthcare industry may not see real change.
“Progress must go beyond individual facilities and become a systemic effort. Governments and ministries of health need to mandate emissions reporting, monitoring and the transition to sustainable, low-carbon alternatives across their entire health care systems,” she said.
“For example, tertiary public health facilities in the Philippines cannot decide to transition on their own because such a decision typically involves resources that require national approval. This 'centralized' decision-making process is common in many Southeast Asian countries where health systems are heavily influenced by national policies and regulations.”
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The growing impacts of climate change are having an undeniable impact on the health of societies. Extreme weather events, air pollution and increased incidence of vector-borne diseases due to rising temperatures are all evidence of this.
John Graham
Consider waste and emissions
In the absence of regulations, the onus is on healthcare solutions companies to find ways to reduce their own emissions and waste.
For example, Zuellig Pharma has reduced its Scope 3 emissions by implementing greenhouse gas emissions tracking and monitoring in its processes, and it assesses the sustainability of its business partners through compliance-based questionnaires.
This allows the company to only work with suppliers and partners who are making progress in reducing their carbon footprint, Graham noted, adding that the company is also introducing more electric vehicles to its fleet and technology to cool trucks and reduce air conditioning energy use by up to 30 percent.
Doing so has reduced transportation and fuel costs and packaging waste, improved inventory management and reduced emissions, he added.
“We are also optimizing loads to maximize capacity for each delivery and using a mixed model of contract, owned and brokered trucks to minimize the number of vehicles used while ensuring a continuous supply of critical healthcare products,” Graham explained.
Zuellig Pharma has also found ways to recycle medical packaging waste. In 2022, the company partnered with the Business Council for Sustainable Development Malaysia (BCSD) and Baxter Healthcare to launch an initiative called “Jom Recycle – Plastic Recycling in Home Care,” which involves recycling uncontaminated kidney dialysis bags from patients' homes and recycling them into secondary raw materials.
Graham noted that the initiative has diverted more than 500 kilograms of high-quality plastic waste from landfills to recycling facilities in Malaysia. Each year, more than 260 tonnes of recyclable non-clinical plastic waste ends up in Malaysian landfills.
Zuellig Pharma has reduced landfill waste by 24 percent over the past two years and is on track to achieve zero waste by 2030, according to its 2023 sustainability report.
A delicate balance
With a focus on patient health, the region needs to decarbonize quickly and easily while exploring long-term solutions. This can start with building facilities sustainably from the ground up, Sohal said, noting that features like good ventilation, natural lighting and energy-efficient machinery go a long way.
Existing healthcare facilities can also consider telemedicine, or remote, real-time patient-doctor video consultations, to reduce Scope 3 emissions. Patients can pay for the consultation and prescriptions online, and the prescriptions can be delivered directly to the patient's home or picked up at a pharmacy or healthcare facility.
One 2021 study found that each virtual medical consultation can save between 0.70 and 372 kg of carbon dioxide equivalent.
“Every time someone goes to hospital, there are emissions from supplies such as transport, single-use plastics and products used in outpatient visits. Some of these visits can be conducted remotely or online, avoiding the emissions associated with patient visits to hospital,” Sohal said.
“As demand for medical services increases, transitioning outpatient services that do not require hospital visits to telemedicine becomes a viable option.”
But until stricter regulations mandating reduced healthcare emissions are implemented, the region’s healthcare industry must continue to strike a careful balance between protecting patient health and keeping waste and emissions low.
“The (healthcare) industry must continue to work together to innovate and invest in solutions that reflect modern priorities and continue to build and invest in strategies, key policies and technologies so sustainability can be embedded into every aspect of an organisation's purpose, governance, decision-making processes and operations,” Graham said.
“We must continually improve access to quality health care without negatively impacting the societies in which we operate and the planet we live on.”
