Green health: how to decarbonise global healthcare systems

Healthcare systems are major emitters of greenhouse gases that contribute to climate change. The resulting climate crisis harms human and planetary health and increasingly impacts lives on Earth. Because of their status as high emitters and their social role in society, healthcare systems have a clear obligation to decarbonise. This study investigates how healthcare systems worldwide can lower their greenhouse gas emissions and thereby contribute to global climate action. We performed a systematic literature review, searching PubMed, GreenFILE, Business Source Complete and CINAHL for relevant empirical studies, non-research papers and grey literature published between 1 January 2018 and 28 March 2023. The Greenhouse Gas Protocol applied to healthcare systems guided thematic and descriptive analyses to explore interventions targeted at scope 1, 2 and 3 emissions. The PRISMA guidelines were followed for reporting and synthesising the results. A total of 742 publications were initially identified, 230 of which were included in the systematic literature review, comprising 96 empirical studies, 132 non-research papers and two governmental reports. Numerous conventional and unique decarbonisation actions related to healthcare have been reported in the literature. Eight themes were identified: transportation, anaesthesia, energy, travel, supply chain, clinical practices, planetary health literacy and system changes. This study shows the abundant potential for healthcare decarbonisation while highlighting key uncertainties around decarbonisation in healthcare and providing ambitious recommendations to lower emissions globally. Decarbonisation actions are needed at the personal, organisational and system levels. The health workforce is vital in driving transformative change but needs to be adequately trained and educated about the importance of low-carbon solutions in healthcare. Countries worldwide must exchange knowledge about successful decarbonisation interventions and best practices to push global progress. Looking forward, action plans and audits at the local level combined with large-scale measures and policies are needed to influence the system as a whole.