Climate Smart Health Care Low-Carbon and Resilience Strategies

for the Health Sector

Susan Wilburn, Sustainability Director, GGHHswilburn@hcwh.org

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

CLIMATE CHANGE IS A GLOBAL HEALTH EMERGENCY

–The Lancet

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

Ratio

a)ChangeinHeat-waveFrequency(1995-2090) b)ChangeinExposure(2010population)

c)ChangeinExposure(2090population) d)Time-seriesofExposureEvents

3

2

10

Bllions/yr

ExposureEventsperkm2peryear

ExposureEventsperkm2peryear

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

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

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

Whatistheroleandtheresponsibilityofhealthcareinaddressingthemostprofound

crisisofourtime?

16

HEALTH CARE IS NOT PREPARED FOR CLIMATE CHANGE

LANCET: POLICY RESPONSES FOR HEALTH

“Tackling climate change could be the greatestglobal health opportunity of the 21st

century”

ChinaUSA

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?

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

Climate Smart Health Systems

*Reduce health care’s carbon footprint

*Build climate resilience

*Improve Access to Health Care

*Promote Sustainable Development

Climate-Smart Healthcare: The intersection of low-carbon

healthcare and resilience

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.”

“Access to health care can be enhanced and made more reliable

throughoff-grid renewable energy systems.”

System Resilience

Source: WHO

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, telehealthand 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.

Low-Carbon Health Care

The Good NewsThe 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.

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 andpromoting public and environmental health.

LatinAmerica477Hospitals,63HealthCareFacilities,38HealthSystemsand15Organizations,representingtheinterestof1723HospitalsandHealthCenters. Africa

46Hospitals,14HealthCareFacilities,5HealthSystemsand2Organizations,representingtheinterestof1484HospitalsandHealthCenters.

Asia104Hospitals,3HealthCareFacilities,9HealthSystemsand27Organizations,representingtheinterestof13,469HospitalsandHealthCenters.

Pacific7Hospitals,21HealthSystemsand8Organizations,representingtheinterestof627HospitalsandHealthCenters.

Europe22Hospitals,1HealthCareFacility,19HealthSystemsand11Organizations,representingtheinterestof7253HospitalsandHealthCenters.

USAandCanadaGGHH’simplementationarmintheUS,PracticeGreenhealth has1,400HospitalmembersintheU.S.InCanada,GGHHmembersinclude1Hospital,5HealthSystemsand2Organizationsrepresentingtheinterestof1081HospitalsandHealthCenters.

Totals: As of September 2017, GGHH has 905 members from 49 countries representing the interest of 28,077 Hospitals and Health Centers.

Global1HealthSystemand4Organizationsrepresentingtheinterestof1040Hospitals.

HCWH Regional OfficesStrategic Partners

the 2020 ChallengeThe 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.

Low – carbon building designButaro 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

Low – carbon building designKohinoor 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

Low – Carbon DesignSanatorio 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

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

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 Lentegurhospitals’ laundry efficiency measures alone include more than19 million liters of water, 550metric tons of CO2e and $62,000.

Building retrofitYonsei University Health System, Seoul, South Korea

Target to reduce GHG emissions 30% by 2020Annual 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

Low-CarbonWasteManagementBir 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

Low-carbon: anesthetic gas managementHospital 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

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)

Resilience to Grid Power Cuts, Renewable EnergyGunjaman 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

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

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.

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

Low-Carbon ProcurementHCWH 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

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 EnvironmentalConventions Procurer’s Guide

• Training: Ukraine, India, GGHH regional and country staff

OF CONCERN TOHEALTH AND ENVIRONMENT

OF CONCERN TO

HEALTH AND ENVIRONMENT

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

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

Ambitious 2025 Goals

51

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

Change in Healthcare Catalyzes Broader Change

54

Transforming the Global Economy

Transforming Policy and

Key Markets – Food,

Materials, Energy, etc.

Transforming the Health

Sector

THANK YOU

Gracias

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Salamat

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Obrigado Cam'on

Grazie

Terima Kasih

Merci

Asante Sana