This is one of the key messages in a new industry white paper by design and engineering consultancy WSP, which analysed how nine different healthcare systems – in Australia, Canada, Chile, Hong Kong, New Zealand, South Africa, Sweden, the UK, and the United States – are decarbonising. Seven out of the nine healthcare systems have enshrined in law a commitment to achieve net-zero emissions by 2050 at the latest. The exceptions, South Africa and Hong Kong, have stated respectively a vision to achieve this goal, and a target of carbon neutrality by the same date.

Healthcare buildings are among the most carbon-intensive structures in their operation and construction, and indirectly via the wider healthcare supply chain. Overall, the healthcare sector is responsible for almost 5 per cent of global carbon emissions, and the report notes the urgent need to reduce this contribution and align it with the Paris Agreement target of limiting the average temperature increase to 1.5°C above pre-industrial levels.

Titled ‘Healthcare beyond carbon: Exploring nine healthcare systems’ journeys to net zero’, the report charts the progress of the nine health systems to date and aspirations for the future, within the context of often contrasting, political, economic and environmental conditions.

The paper covers:

• the decarbonisation strategies of each system, the challenges they face, and the solutions deployed;
• how the digital transformation of healthcare is supporting the sector’s transition to net zero;
• the importance of appraising the emissions of healthcare facilities over their whole life-cycle;
• different strategies being taken to become energy self-sufficient;
• the challenges and opportunities of different funding routes;
• co-benefits of decarbonisation through influencing scope 3 emissions and creating healthier, more resilient facilities; and
• the opportunity for a global healthcare decarbonisation framework to inform decision-making on policies, processes and technologies.

Long-term decisions

One common thread running through the paper is the decision-making process that governs the speed at which the healthcare estate can decarbonise. What is key is appraising the carbon emissions of a healthcare facility over its entire lifecycle, or several decades, at least, the report notes. As 2050 approaches, the carbon intensity of the electricity grid in each country will fall, and the pace of change will accelerate. The paper explains that this will also result in the progressive decarbonisation of healthcare facilities – but only if they’re already powered by electricity, or similarly reliable alternatives.

The acceleration of digital healthcare since the pandemic could also have widespread positive impacts on the carbon emissions associated with both operating healthcare facilities and their supply chains (scope 3 emissions) – in particular, by pushing the delivery of services out into the community instead of concentrating them all in large, energy-intensive buildings. If the centralised approach is still the most suitable, hospitals should be located near mass transit hubs, encouraging shared modes of travel, and providing charging stations for electric vehicles or digital interfaces to support low-carbon choices and reduce transport-associated emissions.

Healthcare providers can also exert strong influence over scope 3 emissions by maintaining an inventory of their supply chains and embedding decarbonisation into procurement decisions. Other sustainability benefits can result from an increased focus on upstream emissions of products, too. The report highlights the example of South Africa, where, since many building components are imported, local supply chains are being forged for materials such as blockwork – not only reducing transport emissions but also generating jobs and economic growth.

Net producers of power

Extreme weather events and their increasing frequency demand that resiliency is built into every healthcare facility. For various reasons, including reducing reliance on overstretched energy grids, cutting energy bills and demand at peak times, or lowering carbon emissions, many healthcare providers are looking to expand on-site renewables. One strategy being deployed in the US and Sweden is the use of microgrids that combine grid energy and on-site renewable generation with battery or thermal storage.

In future, hospitals may also become net producers of power, says the report, adding a new revenue stream for hospitals through the sale of renewable power to neighbouring landowners and leaseholders.

In the UK, embodied carbon is already a significant consideration in commercial redevelopment decisions, while in Sweden, new limits on construction emissions are being introduced, along with further requirements to measure whole-life emissions.

Over time, foresees the report, justifying the demolition and rebuilding of healthcare facilities will become much harder, owing to the embodied carbon involved and the urgency to decarbonise energy systems in all buildings as quickly as possible. Consequently, healthcare facilities must be built that are not only suited to today’s needs but are also sufficiently flexible and adaptable, so they don’t become obsolete in the future.

The report observes that some of the obstacles surrounding decarbonisation of the healthcare estate are derived from funding models. In some markets, where public-private-partnership is well-established, strict contractual payment mechanisms can be a barrier to innovation. A different approach is adopted in the US, however, where, points out the report, the country’s Health Sector Climate Pledge – a voluntary rather than mandated policy – is accelerating and encouraging decarbonisation through tax and financial incentives.

Co-benefits and tensions

There are also myriad co-benefits to be gained from decarbonisation approaches, with the report underlining that a low-emissions building is also a healthier building – not least because exposure to combustion is reduced, with its negative respiratory impacts. In another example, polluting medical gases can be replaced for less polluting alternatives, while maintaining patient care as a priority.

Tensions can also be perceived around decarbonisation and infection control, with the paper emphasising the role that digital tools can play in this regard. Computational fluid dynamics (CFD) modelling can provide data to optimise the design of healthcare facilities at concept stage, determining the most suitable air path to control air quality. This, says the paper, can deliver both more effective infection control and lower carbon emissions by reducing demand for air-conditioning.

The report concludes by asking whether there is a need for a uniform set of performance criteria and overarching global performance-based framework that apply to all healthcare facilities.

“Addressing both the embodied and operational carbon emissions of healthcare buildings, country- and grid-customised metrics would provide a basis upon which to benchmark healthcare buildings around the world in terms of energy use and greenhouse gas emissions,” states the paper. “As a meaningful number of health authorities seek to use the metrics to chart their own progress, questions and lessons learned from each healthcare system’s decarbonisation journey would be evident in the data and promote further discussion and sharing of key policy, processes and technologies.”

A universal issue needs a cross-border response

Summing up in the foreword to the report, Anisha Mayor, UK head of healthcare at WSP, said: “Healthcare beyond carbon has provoked much debate among our healthcare specialists, illuminating many of the convergent and divergent trends of how we design, power, construct and retrofit our healthcare facilities.

“What is unequivocal is that, just as decarbonisation is a universal global issue for healthcare providers the world over, so too is the need for us to unite in providing a cross-border international response.”