Many nations aren’t meeting their green health care commitments, study says

Countries around the world are falling short of their international commitments to improve the sustainability of their health care systems, according to a new study co-led by Yale's Jodi Sherman.

The shortfalls range from a failure to assess and monitor greenhouse gas emissions effectively to a lack of planning to make health care systems, procedures, and oversight more robust and sustainable. These deficiencies severely hamper the likelihood of achieving significant sustainability gains in what is one of the more carbon-intensive sectors, authors of the study say.

"The health care sector is responsible for nearly 5% of global greenhouse gas emissions, and results in 4 million Disability Adjusted Life Years [a measure of years lost due to ill health, disability, or early death] lost annually," said Jodi Sherman, an associate professor of anesthesiology at Yale School of Medicine and of epidemiology in environmental health sciences at Yale School of Public Health, and co-senior author the new study.

"At the same time, people need more health care to treat climate and pollution-related diseases, and health systems must increase their resilience to severe weather-related events," Sherman said.

The study appears in Lancet Planetary Health.

For the study, an international team of researchers analyzed the progress, or lack of progress, made by the more than 80 countries that agreed to key initiatives of the COP26 Health Programme - which emerged from the 26^th United Nations Climate Change Conference (COP26) in 2021, in Glasgow. The COP26 Health Programme promoted a tiered system of national commitments for achieving climate resilient, low carbon health systems.

But according to the study, only 30% of the countries making commitments reported having conducted essential vulnerability and adaptation assessments of their health care systems.

Although 85 countries and areas agreed to commit to adopting low-emission or net-zero health care systems, those nations account for only 26% of global health care emissions. Further, just 11% of those countries even assessed their health care emissions. The study also notes that less than half of the countries have integrated health care into their national climate strategies.

The study identifies critical gaps in monitoring sustainable health care progress through existing or proposed World Health Organization indicators. The authors said such indicators do not adequately reflect progress in sustainability and, in fact, raise concerns about "greenwashing" - the notion of reporting data that gives a false sense of sustainability progress without achieving meaningful results.

"The lack of independent monitoring and the absence of robust, outcome-oriented indicators for sustainable health care is deeply concerning," said Iris Martine Blom, the study's first author and a physician and Ph.D. candidate at the London School of Hygiene & Tropical Medicine.

"Without meaningful tracking, we risk giving the illusion of progress while the real work of transforming our health systems remains unfinished," she said.

The study's authors say countries must develop and integrate more robust outcome indicators for health care systems. Such monitoring, they said, is essential to ensure that international commitments result in real-world progress.

Andrea MacNeill of the University of British Columbia is a co-senior author of the study, and co-leader of the Lancet Commission on Sustainable Healthcare. Xuejuan Ning of the Yale School of Public Health is also a co-author of the study. Sherman is also co-leader of the Lancet Commission on Sustainable Healthcare and director of the Yale Program on Healthcare Environmental Sustainability.

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