COPping out, for the greater good?

Given the choice between strengthening and expanding health systems versus diverting resources to GHG reduction efforts, India chose the former 

The run up to the ongoing Conference of the Parties (COP28) negotiations on climate change in Dubai saw quite a few reports linking climate change to health. For instance, the 8th annual Lancet Countdown on Health and Climate Change report, released on November 15, threw light on the convergence of factors fueling the climate crisis.

The report underlines how these factors jeopardise the well-being of individuals, public health, and healthcare systems on a global scale and hence calls for reduction in the use of fossil fuels. The authors point out that as the healthcare sector accounts for an estimated 4.6 per cent of global greenhouse gas (GHG) emissions, it needs to transition to sustainable energy sources and adopt greener practices.

Similarly, a Call for Action released by United Nations (UN) agencies before COP28, pointed out that the effects of climate events on maternal and child health have been neglected, underreported and underestimated.

Doctors and health care professionals had a ringside view as the climate crisis morphed into a health crisis. Extreme climate related catastrophes like floods and droughts lead to water borne infections and malnutrition in the short term. In the long term, disruptions in health systems mean a further slide in health indicators and a strain on resources. The COVID pandemic and other zoonotic diseases breakouts are clearly linked to shrinking habitats. Increasing incidence of severe COPD, asthma and other pollution related illnesses are other clues to the climate-health nexus.

Against this backdrop,COP28 is being billed as a milestone, as it puts health at the centre of climate action. The first ever Health Day and linked activities continue to join the dots between climate change and health catastrophes.

Despite these pressing arguments, India’s Health Ministry delegation reportedly did not participate in the Health Day activities. And India chose not to sign the COP28 Health and Climate Declaration, as the draft reportedly included a commitment to reduce GHG emissions from cooling applications within healthcare infrastructure. Officials were concerned that these commitments would not be feasible for most healthcare facilities in India. Thus, given the choice between strengthening and expanding health systems versus diverting resources to GHG reduction efforts, India chose the former.

Quite a lot of research has already been done on reducing the carbon footprint of hospitals. For instance, a research paper published in April 2023 in the Journal of the Royal Society of Medicine, analysed the carbon footprint of products used in five common surgical operations, and identified contributing products and processes.

The results showed that the mean average carbon footprint of products used for carpal tunnel decompression was 12.0 kg CO2e (carbon dioxide equivalents); 11.7 kg CO2e for inguinal hernia repair; 85.5 kg CO2e for knee arthroplasty; 20.3 kg CO2e for laparoscopic cholecystectomy; and 7.5 kg CO2e for tonsillectomy.

Across the five operations, 23 per cent of product types were responsible for ≥80 per cent of the operation carbon footprint. Products with greatest carbon contribution for each operation type were the single-use hand drape (carpal tunnel decompression), single-use surgical gown (inguinal hernia repair), bone cement mix (knee arthroplasty), single-use clip applier (laparoscopic cholecystectomy) and single-use table drape (tonsillectomy).

Mean average contribution from production of single-use items was the highest at 54 per cent, followed by decontamination of reusables (20 per cent), waste disposal of single-use items (8 per cent), while both production of packaging for single-use items and linen laundering accounted for 6 per cent each.

The authors concluded that change in practice and policy should be targeted towards those products making greatest contribution, and should include reducing single-use items and switching to reusables, alongside optimising processes for decontamination and waste disposal, modelled to reduce carbon footprint of these operations by 23 per cent – 42 per cent.

At the macro level, healthcare facilities could literally be washed away by climate change related catastrophes. The XDI Global Hospital Infrastructure Physical Climate Risk Report unveiled at COP28 cautions that failure to phase out fossil fuels by 2100 could put 1 in 12 global hospitals at high risk of shutdown due to extreme weather events.

An analysis of 2 lakh hospitals worldwide, (including 53,473 in India), assessing climate change hazards from 1990 to the end of the century, showed that in India, currently, 2700 hospitals are at high risk.

Without a fossil fuel phase-out, the XDI report cautions that this will increase to 5120 hospitals (9.6 per cent) projected to relocate or close by 2100, due to riverine flooding, surface water flooding and coastal inundation.

The good news is that hospitals have guidelines to start them on the sustainability path. In February 2023, India’s National Programme on Climate Change and Human Health (NPCCHH), National Centre for Disease Control, released Guidelines for Green and Climate Resilient Healthcare Facilities. The green measures to be implemented at health care facilities may seem very basic (energy audits, installation of LED lighting, installation of solar panels, and water conservation measures, mainly rain water harvesting) but the signalling is crucial. As per the NPCCHH guideline document, 65 per cent of energy consumption in a healthcare facility is due to lighting, water heating, cooling, and ventilation.

The bad news is the upfront costs of going green are considerable. The NPCCHH norms apply to public healthcare facilities, which can access some funding under the National Health Mission’s Programme Implementation Planning (PIP) process.

Given the PE and VC backed consolidation in India’s private healthcare sector, many corporate hospitals do have the funding to go beyond these norms and adopt higher sustainability targets. Will India’s healthcare sector take the cue from COP28 and renew its commitment to going green?



Climate changeCOP28green house gasesNational Health Mission
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