The Role of Health Systems in climate change


Published: Dec 26, 2025
Keywords:
Climate change Healthcare Sustainable development strategies
Nikolaos Neokleous
https://orcid.org/0000-0002-2657-2512
Michael Talias
https://orcid.org/0000-0002-1802-5586
Abstract

Climate change is one of the greatest threats to human health, while affecting the ecosystem, food production, health, and well-being of populations around the world. The healthcare sector is responsible worldwide for around 5% of greenhouse gas emissions playing an important role in the sustainability of the planet. This literature review summarizes information and data on the role of health systems in the burden and in the fight against climate change. The strategies for reducing negative impact are commented and different ways of action are presented to support the ecological "processing" of health systems by encouraging the achievement of sustainable development targets. At the same time, a wide range of “green” practices are mentioned which can have a positive impact. However, individual and limited actions are not sufficient unless they are accompanied by systemic strategies that change the way of demand and supply of health care. Sustainable strategies, except the benefits of the environment, bring about an improvement in the efficiency of health care processes and long-term economic gains. The health sector has a unique opportunity to exploit its position and resources by providing a comprehensive strategy to improve the health of the population and the environment that it affects and from which it is affected.

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Antasouras, G., Vasios, G. K., Kontogiorgis, C., Ioannou, Z., Poulios, E., Deligiannidou, G. E., Troumbis, A. Y., & Giaginis, C. (2023). How to improve food waste management in hospitals through focussing on the four most common measures for reducing plate waste. The International Journal of Health Planning and Management, 38(2), 296–316. https://doi.org/10.1002/hpm.3586
Atwoli, L., Baqui, A. H., Benfield, T., Bosurgi, R., Godlee, F., Hancocks, S., Horton, R. C., Laybourn-Langton, L., Monteiro, C. A., Norman, I., Patrick, K., Praities, N., Olde Rikkert, M. G., Rubin, E. J., Sahni, P., Smith, R. S., Talley, N. J., Turale, S., & Vázquez, D. (2021). Call for emergency action to limit global temperature increases, restore biodiversity, and protect health. The Medical Journal of Australia, 215(5), 210–212. https://doi.org/10.5694/mja2.51221
Brandmayr, C., Kerber, H., Winker, M., & Schramm, E. (2015). Impact assessment of emission management strategies of the pharmaceuticals Metformin and Metoprolol to the aquatic environment using Bayesian networks. The Science of the Total Environment, 532, 605–616. https://doi.org/10.1016/j.scitotenv.2015.05.074
Carino, S., Porter, J., Malekpour, S., & Collins, J. (2020). Environmental Sustainability of Hospital Foodservices across the Food Supply Chain: A Systematic Review. Journal of the Academy of Nutrition and Dietetics, 120(5), 825–873. https://doi.org/10.1016/j.jand.2020.01.001
Copernicus, (2024). The 2023 Annual Climate Summary: Global Climate Highlights 2023. https://climate.copernicus.eu/global-climate-highlights-2023
Cummins, M. R., Shishupal, S., Wong, B., Wan, N., Han, J., Johnny, J. D., Mhatre-Owens, A., Gouripeddi, R., Ivanova, J., Ong, T., Soni, H., Barrera, J., Wilczewski, H., Welch, B. M., & Bunnell, B. E. (2024). Travel Distance Between Participants in US Telemedicine Sessions With Estimates of Emissions Savings: Observational Study. Journal of Medical Internet Research, 26, e53437. https://doi.org/10.2196/53437
Hunter, D. J., Frumkin, H., & Jha, A. (2017). Preventive Medicine for the Planet and Its Peoples. The New England Journal of Medicine, 376(17), 1605–1607. https://doi.org/10.1056/NEJMp1702378
Dullet, N. W., Geraghty, E. M., Kaufman, T., Kissee, J. L., King, J., Dharmar, M., Smith, A. C., & Marcin, J. P. (2017). Impact of a University-Based Outpatient Telemedicine Program on Time Savings, Travel Costs, and Environmental Pollutants. Value in health: The Journal of the International Society for Pharmacoeconomics and Outcomes Research, 20(4), 542–546. https://doi.org/10.1016/j.jval.2017.01.014
EC. (2019). The European Green Deal Striving to be the first climate-neutral continent, Brussels: European Commission. https://commission.europa.eu/strategy-and-policy/priorities-2019-2024/european-green-deal_en
Eckelman, M. J., & Sherman, J. (2016). Environmental Impacts of the U.S. Health Care System and Effects on Public Health. PloS One, 11(6), e0157014. https://doi.org/10.1371/journal.pone.0157014
Eckelman, M. J., Sherman, J. D., & MacNeill, A. J. (2018). Life cycle environmental emissions and health damages from the Canadian healthcare system: An economic-environmental-epidemiological analysis. PLoS Medicine, 15(7), e1002623. https://doi.org/10.1371/journal.pmed.1002623
EEA. (2020). Urban adaptation in Europe: how cities and towns respond to climate change. https://www.researchgate.net/publication/358264183_Urban_adaptation_in_Europe_how_cities_and_towns_respond_to_climate_change
Forrest, F. (2023). The impact of climate change on the pharma supply chain. https://www.pharmaceutical-technology.com/sponsored/the-impact-of-climate-change-on-the-pharma-supply-chain/
Gadegaard, A., & Penny, T. (2015). Case Study: Type 2 Diabetes Management Care Pathway. https://shcoalition.org/wp-content/uploads/2021/02/Type-2-Diabetes-Care-Pathway.pdf
Greenwood Dufour, B., Weeks, L., De Angelis, G., Marchand, D. K., Kaunelis, D., Severn, M., Walter, M., & Mittmann, N. (2022). How We Might Further Integrate Considerations of Environmental Impact When Assessing the Value of Health Technologies. International Journal of Environmental Research and Public Health, 19(19), 12017. https://doi.org/10.3390/ijerph191912017
Gundersen Health System. (2014). AJAM: Wisconsin hospital uses alternative energy. https://www.gundersenenvision.org/envision/resources/videos/wisconsin-hospital-uses-alternative-energy
Hardy, J. Jones, P., Simpon, T., Gullapudi, V. R. L., & Wright, M. (2022). Review of the Haemodialysis processes in a single satellite dialysis unit, Leeds: Leeds Teaching Hospitals NHS Trust. https://map.sustainablehealthcare.org.uk/leeds-teaching-hospitals-nhs-trust/review-haemodialysis-processes-single-satellite-dialysis-unit
HCWH. (2025). Health Care Without Harm Europe, Europe: HCWH. https://europe.noharm.org
Hensher, M. (2020). Incorporating environmental impacts into the economic evaluation of health care systems: Perspectives from ecological economics (Version 1). University of Tasmania. https://hdl.handle.net/102.100.100/555916
Holmner, A., Ebi, K. L., Lazuardi, L., & Nilsson, M. (2014). Carbon footprint of telemedicine solutions--unexplored opportunity for reducing carbon emissions in the health sector. PloS One, 9(9), e105040. https://doi.org/10.1371/journal.pone.0105040
Jayakrishnan, T. T., Gordon, I. O., O’Keeffe, S., Singh, M. K., & Sehgal, A. R. (2023). The Carbon Footprint of Health System Employee Commutes. The Journal of Climate Change and Health, 11, 100216. https://doi.org/10.1016/j.joclim.2023.100216
Kalambwa, Z., Chabalenge, B., Zulu, J., Mudenda, S., Chimombe, T., Mufwambi, W., Hamachila, A., Ngula, M. I., & Hi- kaambo, C. N. (2024) Patients’ Knowledge, Attitude and Practices on Disposal Me- thods of Expired and Unused Medicines: Implication for Creation of Drug Take- Back Program. Pharmacology & Pharmacy, 15, 113-128. https://doi.org/10.4236/pp.2024.154008
Kaplan, S., Sadler, B., Little, K., Franz, C., & Orris, P. (2012). Can sustainable hospitals help bend the health care cost curve? Issue brief (Commonwealth Fund), 29, 1–14.
Law, A. V., Sakharkar, P., Zargarzadeh, A., Tai, B. W., Hess, K., Hata, M., Mireles, R., Ha, C., & Park, T. J. (2015). Taking stock of medication wastage: Unused medications in US households. Research in Social & Administrative Pharmacy, 11(4), 571–578. https://doi.org/10.1016/j.sapharm.2014.10.003
Lenzen, M., Malik, A., Li, M., Fry, J., Weisz, H., Pichler, P. P., Chaves, L. S. M., Capon, A., & Pencheon, D. (2020). The environmental footprint of health care: a global assessment. The Lancet. Planetary Health, 4(7), e271–e279. https://doi.org/10.1016/S2542-5196(20)30121-2
MacNeill, A. J., Lillywhite, R., & Brown, C. J. (2017). The impact of surgery on global climate: a carbon footprinting study of operating theatres in three health systems. The Lancet. Planetary Health, 1(9), e381–e388. https://doi.org/10.1016/S2542-5196(17)30162-6
Malik, A., Lenzen, M., McAlister, S., & McGain, F. (2018). The carbon footprint of Australian health care. The Lancet. Planetary Health, 2(1), e27–e35. https://doi.org/10.1016/S2542-5196(17)30180-8
Marrauld, L. Sattler, M., Rambaud, T., Sarfati, M., Egnell, M., Geist, JN., Lesimple, H., Proto, E., & Verneuil, B. (2020). Décarboner la santé pour soigner durablement, Paris: The shift Project. https://theshiftproject.org/app/uploads/2025/01/180423-TSP-PTEF-Synthese-Sante_v2.pdf
Marsh, K., Ganz, M. L., Hsu, J., Strandberg-Larsen, M., Gonzalez, R. P., & Lund, N. (2016). Expanding Health Technology Assessments to Include Effects on the Environment. Value in health: Τhe journal of the International Society for Pharmacoeconomics and Outcomes Research, 19(2), 249–254. https://doi.org/10.1016/j.jval.2015.11.008
McGain, F., Moore, G., & Black, J. (2016). Hospital steam sterilizer usage: could we switch off to save electricity and water? Journal of Health Services Research & Policy, 21(3), 166–171. https://doi.org/10.1177/1355819615625698
Meier, T., von Borstel, T., Welte, B., Hogan, B., Finn, S. M., Bonaventura, M., Friedrich, S., Weber, K., & Dräger de Teran, T. (2021). Food Waste in Healthcare, Business and Hospitality Catering: Composition, Environmental Impacts and Reduction Potential on Company and National Levels. Sustainability, 13(6), 3288. https://doi.org/10.3390/su13063288
Nansai, K., Fry, J., Malik, A., Takayanagi, W., & Kondo, N. (2020) Carbon footprint of Japanese health care services from 2011 to 2015. Resources Conservation and Recycling, 152, https://doi.org/10.1016/j.resconrec.2019.104525.
NHS. (2020). Delivering a net zero NHS. https://www.england.nhs.uk/greenernhs/a-net-zero-nhs.
Nicolet, J., Mueller, Y., Paruta, P., Boucher, J., & Senn, N. (2022). What is the carbon footprint of primary care practices? A retrospective life-cycle analysis in Switzerland. Environmental Health: a Global Access Science Source, 21(1), 3. https://doi.org/10.1186/s12940-021-00814-y
Or, Z., & Seppänen, A. V. (2024). The role of the health sector in tackling climate change: A narrative review. Health Policy, 143, 105053. https://doi.org/10.1016/j.healthpol.2024.105053
Pichler, P., Jaccard, I., Weis, U. & Weisz, H., (2019). International comparison of health care carbon footprints. Environmental Research Letters,, 14(6). DOI 10.1088/1748-9326/ab19e1.
Pickering, H., & Mactavish, A., (2023). The sustainability challenge in healthcare. https://www.curriebrown.com/en/news-insights/insights/2023/the-sustainability-challenge-in-healthcare/
Pollard, A. S., Taylor, T. J., Fleming, L. E., Stahl-Timmins, W., Depledge, M. H., & Osborne, N. J. (2013). Mainstreaming carbon management in healthcare systems: a bottom-up modeling approach. Environmental Science & Technology, 47(2), 678–686. https://doi.org/10.1021/es303776g
Purohit, A., Smith, J., & Hibble, A. (2021). Does telemedicine reduce the carbon footprint of healthcare? A systematic review. Future Healthcare Journal, 8(1), e85–e91. https://doi.org/10.7861/fhj.2020-0080
Ravelo, J. L. (2023). These 10 lifesaving medical products are contributing to climate change. https://www.devex.com/news/these-10-lifesaving-medical-products-are-contributing-to-climate-change-106673
Reed, T. (2020). Kaiser Permanente's health system reaches carbon-neutral status. https://www.fiercehealthcare.com/hospitals/kaiser-permanente-s-heath-system-reaches-carbon-neutral-status
Rizan, C., Steinbach, I., Nicholson, R., Lillywhite, R., Reed, M., & Bhutta, M. F. (2020). The Carbon Footprint of Surgical Operations: A Systematic Review. Annals of Surgery, 272(6), 986–995. https://doi.org/10.1097/SLA.0000000000003951
Rizan, C., Bhutta, M. F., Reed, M., & Lillywhite, R. (2021) The carbon footprint of waste streams in a UK hospital. Journal of Cleaner Production, 286. 125446. https://doi:10.1016/j.jclepro.2020.125446
Robinson, N. (2023). Sustainable Healthcare: Navigating Towards a Greener Future. https://www.moorhouseconsulting.com/insights/insights/sustainable-healthcare-guide/
Romanello, M., van Daalen, K., Anto, J. M., Dasandi, N., Drummond, P., Hamilton, I. G., Jankin, S., Kendrovski, V., Lowe, R., Rocklöv, J., Schmoll, O., Semenza, J. C., Tonne, C., & Nilsson, M. (2021). Tracking progress on health and climate change in Europe. The Lancet. Public health, 6(11), e858–e865. https://doi.org/10.1016/S2468-2667(21)00207-3
Romanello, M., Di Napoli, C., Drummond, P., Green, C., Kennard, H., Lampard, P., Scamman, D., Arnell, N., Ayeb-Karlsson, S., Ford, L. B., Belesova, K., Bowen, K., Cai, W., Callaghan, M., Campbell-Lendrum, D., Chambers, J., van Daalen, K. R., Dalin, C., Dasandi, N., Dasgupta, S., … Costello, A. (2022). The 2022 report of the Lancet Countdown on health and climate change: health at the mercy of fossil fuels. Lancet, 400(10363), 1619–1654. https://doi.org/10.1016/S0140-6736(22)01540-9
Roschnik, S., Martinez Sanchez G., Yglesias-Gonzalez, M., Pencheon, D., & Tennison, I. (‎2017)‎. Transitioning to environmentally sustainable health systems: the example of the NHS in England. Public health panorama, 03 (‎02)‎, 229 - 236. World Health Organization. Regional Office for Europe. https://iris.who.int/handle/10665/325309. License: CC BY-NC-SA 3.0 IGO
Seppänen, A. V., & Or, Z. (2025). A Scoping Review of Interventions to Reduce the Environmental Footprint of Healthcare. Value in Health: The Journal of the International Society for Pharmacoeconomics and Outcomes Research, 28(7), 1110–1125. https://doi.org/10.1016/j.jval.2025.01.021
Silverstein, K. (2022). Gundersen Health Systems Is on a Mission to Remain Energy Independent.. Environment+Energy Leader. https://www.environmentenergyleader.com/stories/gundersen-health-systems-is-on-a-mission-to-remain-energy-independent,2667
Spiby, J., Griffiths, J., Hill, A., & Stott, R. (2008). Ten practical actions for doctors to combat climate change. BMJ: British Medical Journal, 336(7659), 1507. https://doi.org/10.1136/bmj.39617.642720.59
Tauber, J., Chinwuba, I., Kleyn, D., Rothschild, M., Kahn, J., & Thiel, C. L. (2019). Quantification of the Cost and Potential Environmental Effects of Unused Pharmaceutical Products in Cataract Surgery. JAMA Ophthalmology, 137(10), 1156–1163. https://doi.org/10.1001/jamaophthalmol.2019.2901
Taylor, T., & Mackie, P. (2017). Carbon footprinting in health systems: one small step towards planetary health. The Lancet. Planetary Health, 1(9), e357–e358. https://doi.org/10.1016/S2542-5196(17)30158-4
Tennison, I., Roschnik, S., Ashby, B., Boyd, R., Hamilton, I., Oreszczyn, T., Owen, A., Romanello, M., Ruyssevelt, P., Sherman, J. D., Smith, A. Z. P., Steele, K., Watts, N., & Eckelman, M. J. (2021). Health care's response to climate change: a carbon footprint assessment of the NHS in England. The Lancet. Planetary Health, 5(2), e84–e92. https://doi.org/10.1016/S2542-5196(20)30271-0
Thiel, C. L., Eckelman, M., Guido, R., Huddleston, M., Landis, A. E., Sherman, J., Shrake, S. O., Copley-Woods, N., & Bilec, M. M. (2015). Environmental impacts of surgical procedures: life cycle assessment of hysterectomy in the United States. Environmental Science & Technology, 49(3), 1779–1786. https://doi.org/10.1021/es504719g
Thiel, C. L., Mehta, N., Sejo, C. S., Qureshi, L., Moyer, M., Valentino, V., & Saleh, J. (2023). Telemedicine and the environment: life cycle environmental emissions from in-person and virtual clinic visits. NPJ Digital Medicine, 6(1), 87. https://doi.org/10.1038/s41746-023-00818-7
UN. (2023). Global Sustainable Development Report (GSDR) 2023, New York: United Nations: Department of Economic and Social Affairs Sustainable Development. https://sdgs.un.org/gsdr/gsdr2023
UNDP. (2021). Sustainable health in procurement project (SHiPP) Annual Report 2021, s.l.: Health Care without Harm. https://www.undp.org/sites/g/files/zskgke326/files/migration/tz/undp.-tz.IGfactsheet-SHiPP2022.pdf
Walsh, S. J., O'Leary, A., Bergin, C., Lee, S., Varley, Á., & Lynch, M. (2024). Primary healthcare's carbon footprint and sustainable strategies to mitigate its contribution: a scoping review. BMC health Services Research, 24(1), 1630. https://doi.org/10.1186/s12913-024-12068-8
Wong, Y. L., Noor, M., James, K. L., & Aslam, T. M. (2021). Ophthalmology Going Greener: A Narrative Review. Ophthalmology and Therapy, 10(4), 845–857. https://doi.org/10.1007/s40123-021-00404-8
Wyssusek, K. H., Keys, M. T., & van Zundert, A. A. J. (2019). Operating room greening initiatives - the old, the new, and the way forward: A narrative review. Waste Management & Research: The Journal of the International Solid Wastes and Public Cleansing Association, 37(1), 3–19. https://doi.org/10.1177/0734242X18793937
Zikhathile, T., Atagana, H., Bwapwa, J., & Sawtell, D. (2022). A Review of the Impact That Healthcare Risk Waste Treatment Technologies Have on the Environment. International Journal of Environmental Research and Public Health, 19(19), 11967. https://doi.org/10.3390/ijerph191911967.