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. 2021 Feb;5(2):e84-e92.
doi: 10.1016/S2542-5196(20)30271-0.

Health care's response to climate change: a carbon footprint assessment of the NHS in England

Imogen Tennison  1 , Sonia Roschnik  1 , Ben Ashby  2 , Richard Boyd  2 , Ian Hamilton  3 , Tadj Oreszczyn  3 , Anne Owen  4 , Marina Romanello  5 , Paul Ruyssevelt  3 , Jodi D Sherman  6 , Andrew Z P Smith  3 , Kristian Steele  2 , Nicholas Watts  5 , Matthew J Eckelman  7
Affiliations

Health care's response to climate change: a carbon footprint assessment of the NHS in England

Imogen Tennison et al. Lancet Planet Health. 2021 Feb.

Abstract

Background: Climate change threatens to undermine the past 50 years of gains in public health. In response, the National Health Service (NHS) in England has been working since 2008 to quantify and reduce its carbon footprint. This Article presents the latest update to its greenhouse gas accounting, identifying interventions for mitigation efforts and describing an approach applicable to other health systems across the world.

Methods: A hybrid model was used to quantify emissions within Scopes 1, 2, and 3 of the Greenhouse Gas Protocol, as well as patient and visitor travel emissions, from 1990 to 2019. This approach complements the broad coverage of top-down economic modelling with the high accuracy of bottom-up data wherever available. Available data were backcasted or forecasted to cover all years. To enable the identification of measures to reduce carbon emissions, results were disaggregated by organisation type.

Findings: In 2019, the health service's emissions totalled 25 megatonnes of carbon dioxide equivalent, a reduction of 26% since 1990, and a decrease of 64% in the emissions per inpatient finished admission episode. Of the 2019 footprint, 62% came from the supply chain, 24% from the direct delivery of care, 10% from staff commute and patient and visitor travel, and 4% from private health and care services commissioned by the NHS.

Interpretation: This work represents the longest and most comprehensive accounting of national health-care emissions globally, and underscores the importance of incorporating bottom-up data to improve the accuracy of top-down modelling and enabling detailed monitoring of progress as health systems act to reduce emissions.

Funding: Wellcome Trust.

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Figures

Figure 1
Figure 1
Sources of emissions organised by Greenhouse Gas Protocol Scopes and by NHS emissions categories Columns represent NHS emission categories and rows the Greenhouse Gas Protocol Scopes. NHS=National Health Service. *Not normally considered within the Greenhouse Gas Protocol.
Figure 2
Figure 2
Time series results for the greenhouse gas emissions of the NHS in England, broken down by source of emission, 1990–2019 Data available in appendix 1 (p 39). MDI=metered dose inhaler. Mt CO2e=megatonnes of carbon dioxide equivalent. NHS=National Health Service.
Figure 3
Figure 3
Greenhouse gas emissions for the NHS in England, presented as total emissions (A), emissions per inhabitant (B), emissions per real unit of spending (C), and emissions per inpatient FAE (D) Data available in appendix 1 (pp 40–41). Real spending is calculated in terms of GBP for the 2018–19 financial year. FAE=finished admission episode. GBP=British pound. Mt CO2e=megatonnes of carbon dioxide equivalent. NHS=National Health Service.
Figure 4
Figure 4
Contribution of different sectors to the greenhouse gas emissions of the NHS England, 2019 Data available in appendix 1 (p 39). MDI=metered dose inhaler. NHS=National Health Service.
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References

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