CLIMATE-SMART HEALTH CARE, LOW-CARBON AND RESILIENCE STRATEGIES FOR THE HEALTH SECTOR

1. Climate Smart Health Care
Low-Carbon and Resilience Strategies
for the Health Sector
Susan Wilburn, Sustainability Director, GGHH
swilburn@hcwh.org

2. Outline
• Climate change is a health issue
• Climate Smart Health Care
• Global Green and Healthy Hospitals 2020
Health Care Climate Challenge
• Climate Smart Health Care case studies

3. CLIMATE CHANGE IS A
GLOBAL HEALTH EMERGENCY
–The Lancet

4. 1. HEALTH IMPACTS
a. Potentially catastrophic for human
survival
b. Undermine the last half-century of
gains in development and global
health
c. A medical emergency

7. Ratio
a) Change in Heat-wave Frequency (1995-2090) b) Change in Exposure (2010 population)
c) Change in Exposure (2090 population) d) Time-series of Exposure Events
3 2 1 0
Bllions/yr
Exposure Events per km2 per year
Exposure Events per km2 per year

13. Global Health Exposure
• 3 billion additional exposure events for
elderly people experiencing heat-wave
• 1.4 billion additional person drought
exposure events per year by the end of
the century
• 2 billion additional extreme rainfall
exposure events annually

14. Globally, uneven impacts
• Women, children and the poor worst
affected:
– Additional 20-25 million under-nourished
children by 2050 (17-22% global increase)
– Low and middle-income countries often
unable to adapt - higher exposures, burden of
disease
– Natural disasters kill more women than men

15. The Paris Treaty
• Framework for transition to a
low carbon economy.
• “The most important Public
Health Treaty of the 21st
century” --WHO
• “A landmark and a milestone
… But many more milestones
need to be added…in order
to implement and to realize
the full potential of the Paris
agreement.” –Patricia
Espinosa, UNFCCC

16. What is the role and the
responsibility of health care in
addressing the most profound
crisis of our time?
16

17. HEALTH CARE IS NOT PREPARED FOR
CLIMATE CHANGE

18. LANCET: POLICY RESPONSES
FOR HEALTH
“Tackling
climate
change could
be the
greatest
global health
opportunity
of the 21st
century”

19. China
USA
India
Russia Japan
Germany
Canada
South
Korea
Iran
UK
Data Source: US Energy Information Agency,
2012
+
US Healthcare 10%
EU Healthcare 5%
+
Indonesia
+
China Healthcare?

20. By transitioning to low-carbon health systems,
health care can:
• mitigate its own climate impact;
• become more climate resilient;
• lead by example
HEALTH CARE CAN MOVE FROM BEING
PART OF THE PROBLEM TO PART OF THE
SOLUTION

21. Climate Smart Health
Systems
*Reduce health care’s
carbon footprint
*Build climate resilience
*Improve Access to
Health Care
*Promote Sustainable
Development

22. Climate-Smart Healthcare:
The intersection of low-carbon
healthcare and resilience

23. Health systems “can lead by example, advancing models
of low-carbon health care that improve access to health
care services, reduce occupational and environmental
health risks and save energy costs across high, middle
and low-income settings.”

24. “Access to health care can be
enhanced and made more reliable
through
off-grid renewable energy systems.”

25. System Resilience
Source: WHO

26. Climate Smart Health Care
Key Elements
• Building design and construction
based on low carbon approaches.
• Investment in renewable energy
and energy efficiency.
• Waste minimization and sustainable
health care waste management.
• Sustainable transport, telehealth
and water consumption policies.
• Low carbon procurement policies
for pharmaceuticals, medical
devices, food and other products.
• Resilience strategies to withstand
extreme weather events.
• Overall system design for
coordinated care, emphasis on local
providers, and driven by public
health needs.

27. Low-Carbon Health Care

28. The Good News
The health care sector is already playing a leading role in solving these
problems.
Through its mission-driven interest in preventing disease and purchasing
power, the health care sector can help shift the entire economy toward
sustainable, safer products and practices.

29. GGHH (www.greenhospitals.net) is a project of Health Care Without Harm (HCWH)
ABOUT GLOBAL GREEN AND HEALTHY HOSPITALS
Global Green and Healthy Hospitals (GGHH) is an international network of
• Hospitals
• Health care facilities
• Health systems
• Health organizations
Members are dedicated to reducing their environmental footprint and
promoting public and environmental health.

30. Latin America
477 Hospitals , 63 Health Care
Facilities, 38 Health Systems
and 15 Organizations,
representing the interest of
1723 Hospitals and Health
Centers.
Africa
46 Hospitals, 14 Health Care Facilities, 5
Health Systems and 2 Organizations,
representing the interest of 1484 Hospitals
and Health Centers.
Asia
104 Hospitals, 3
Health Care Facilities,
9 Health Systems and
27 Organizations,
representing the
interest of 13,469
Hospitals and Health
Centers.
Pacific
7 Hospitals, 21 Health Systems
and 8 Organizations,
representing the interest of
627 Hospitals and Health
Centers.
Europe
22 Hospitals, 1 Health Care Facility, 19 Health Systems
and 11 Organizations, representing the interest of
7253 Hospitals and Health Centers.
USA and Canada
GGHH’s implementation arm in the US,
Practice Greenhealth has 1,400 Hospital
members in the U.S. In Canada, GGHH
members include 1 Hospital, 5 Health Systems
and 2 Organizations representing the interest
of 1081 Hospitals and Health Centers.
Totals: As of September 2017, GGHH has 905 members from 49 countries
representing the interest of 28,077 Hospitals and Health Centers.
Global
1 Health System and 4 Organizations
representing the interest of 1040 Hospitals.
HCWH Regional Offices
Strategic Partners

32. the 2020 Challenge
The Challenge is based on three pillars:
• Mitigation – Reducing health care’s
own carbon footprint.
• Resilience – Preparing for the
impacts of extreme weather and the
shifting burden of disease.
• Leadership – Educating staff and the
public while promoting policies to
protect public health from climate
change.

33. Low – carbon building design
Butaro District Hospital, Rwanda
100% Fossil Free by 2020
• Hospital construction use local
materials and 100% local labor
• Reduced energy consumption by
using narrow floor plates, natural
daylight and natural ventilation, along
with high-volume, low-speed fans
and germicidal UV lights to provide
energy efficient ventilation while
controlling the transmission of
airborne diseases.
• Masonry building with partially
below grade spaces use thermal
mass to moderate temperatures
• Rainwater harvested for flushing
toilets and landscape irrigation

34. Low – carbon building design
Kohinoor Hospital, Mumbai, India, 2009
• LEED Certified
• Low – energy lighting
• Solar photovoltaic hot water
• Rainwater harvesting
• Treats own sewage to reduce
water use
• High-efficiency wall and window
systems

35. Low – Carbon Design
Sanatorio Finochietto, Buenos Aires, Argentina
Integrated Systems
• Thick thermal insulation in
walls
• Sunshades and a
ventilated facade system
• Geothermal interchange
• Heat exchange between
exhausts and fresh air
inlets
• Natural lighting
• Roof gardens and
green roofs

36. Energy Efficiency and Health Co-Benefits
Torre de Especialidades, Mexico City
• Reduces pollution by removing
smog from the surrounding air.
• The hospital is surrounded by
a giant, honeycomb – like
screen that is coated with
titanium dioxide converting
smog, blocking sunlight,
reducing energy required for
cooling

37. Building Retrofit
Western Cape, South Africa
• Eliminated the coal- and oil- fired
boilers at nearly all of its 53
hospitals
• Task orientated lighting using T5
fluorescent tubes, mini CFL’s and
LED lamps – combined with light
coloured walls
• Annual savings from Lentegur
hospitals’ laundry efficiency
measures alone include more
than19 million liters of water, 550
metric tons of CO2e and
$62,000.

38. Building retrofit
Yonsei University Health System, Seoul, South Korea
Target to reduce GHG emissions 30% by 2020
Annual energy savings: 1,901,686,000 won
• Replaced old heating/air conditioning equipment
• Changed all lights at fire exits to LED
• Switched to high efficiency transformer
• Increased thermal efficiency of boiler and refrigerators
• Installed solar powered streetlights
• Controlled the supply of air conditioning and heating
during summer/winter seasons
• Distributed energy reduction guide and regulations
• Air conditioning system renovations

39. Low-Carbon Waste Management
Bir Hospital, Kathmandu, Nepal
HCWH/GGHH collaboration with
Health Care Foundation Nepal
(HECAF)
• Reduced medical waste in half
• Recycles 50% of all waste,
producing income
• Treats infectious waste with
autoclaves
• Produces biogas from
vermicomposting
Installed 248 solar panels with
support of WB
Before
After

40. Low-carbon: anesthetic gas management
Hospital Albert Einstein, Brazil
Reduced GHG
emissions by 41%
(between 2007 and
2014)
• Study found over 50%
of anesthetic gas
emissions from N2O
– Reduced N2O use by
23%
• LEED certified buildings
• GHG Protocol reporting

41. Low-carbon and Resilient:
Georgetown Hospital, St Vincent and the Grenadines
• Strengthened roof to
withstand Hurricanes and
volcanic ash
• Solar Panels to generate
electricity
• Reduced energy
consumption by over 60%
• Water storage system
• Natural lighting
• Part of PAHO Smart
Hospitals Initiative
Georgetown Hospital (Photo: stlucianewsonline.com)

42. Resilience to Grid Power Cuts, Renewable Energy
Gunjaman Singh Hospital, Pithuwa Village, Nepal
Solar panels/batteries
provide all power for hospital
• Includes power for x-ray and waste
autoclave
• Avoids power cuts from
unreliable power grid
• Power management enables use up
to 18 hours per day

43. Renewable Energy
Gundersen Health, USA
Energy independence in 2014
• 60% Clean Renewable
• 40% Energy reduction
– Saves US $2-million per year
• Renewable energy
– Solar power
– Geothermal energy
– Wind Turbines
– Dairy digesters
– Combined heat and power
– Biomass boiler
Photo: Gundersen Health

44. Renewable Energy
• Uganda: 15% of hospitals use
solar to complement grid
electricity access
• Sierra Leone, 36% of health
facilities and 43% of hospitals
use solar in combination with
other sources.
• Solar refrigerators are pre-
qualified by WHO for vaccine
and blood storage
• Several bilateral and
multilateral aid initiatives
support solar clinics.

45. Low – Carbon Procurement
NHS England, Procurement represents 39% of Public Sector Carbon Footprint

46. Low-Carbon Procurement
HCWH and UNDP
• Joint project on sustainable procurement in the
health sector
– Support to
– Goal:
• Reduce toxicity of chemicals and materials in health product
• Reduce greenhouse gases in the supply chain
• Conserve resources (e.g water in manufacturing)
• HCWH Role: Conduct a systematic evidence review to
determine chemicals of high concern to phase out in
procurement

47. HCWH and UNDP
Phase I outcomes
• Supplier engagement strategy
• Online platform:
www.savinglivessustainably
• Environmental questionnaire for
manufacturers
• List of chemicals of concern:
based on evidence review of
authoritative list (BRS, REACH,
Prop 65) to phase out in
procurement
• International Environmental
Conventions Procurer’s Guide
• Training: Ukraine, India, GGHH
regional and country staff
OF CONCERN TO
HEALTH AND ENVIRONMENT
OF CONCERN TO
HEALTH AND ENVIRONMENT

48. 1. De-carbonization and Resilience
Climate-smart, carbon neutral healthcare
becomes standard throughout the world
• Health care is decarbonized and
aligns with Paris Treaty ambition
• Reduces its annual carbon
emissions
² by at least 1 billion metric tons
(40%) by 2030 and
² 2 billion metric tons (80%) by
2050.
• Low-carbon strategies foster
community resilience and health
equity
A VISION FOR THE FUTURE

49. A VISION FOR THE FUTURE
2. Leadership for
Transformation
Health care leads—as
communicator, advocate and
investor.
• transition to clean, renewable
energy
• a low-carbon, climate resilient
economy
• health access and equity

51. Ambitious 2025 Goals
51

53. Benefits of Green, Low Carbon Health
Care
• Reduces health care’s carbon
footprint
– In system design
– In the care it provides
– Along the supply chain
– In the disposal of waste
• Saves money and strengthens
health systems
• Increases access to primary care
in energy poor settings
• Prepares health systems to
become more resilient and adapt
to climate change
• Positions health systems as
leaders in responding to climate
change

54. Change in Healthcare Catalyzes
Broader Change
54
Transforming
the Global
Economy
Transforming
Policy and
Key Markets
– Food,
Materials,
Energy, etc.
Transformin
g the Health
Sector

55. THANK YOU
Gracias
Xie xie
Salamat
Kamsahamnida
Obrigado Cam'on
Grazie
Terima Kasih
Merci
Asante Sana