The Healthcare Industry's Climate Time Bomb
All stakeholders in healthcare now aim to make the sector greener, and several ongoing initiatives show that real changes are possible.
Recently, the 2024 Global Report from The Lancet Countdown issued an urgent warning that human health is threatened by climate inaction. Experts have cautioned that we have reached a 'point of no return' as global warming systematically undermines public health worldwide.
However, what happens when the health system itself is polluted? Data from the Ministry of Health show that the healthcare sector accounts for approximately 4.4% of net global greenhouse gas emissions, roughly 1.6 gigatons of CO 2 . What is being done about this?
Sector Emissions
According to a new report by Health Care Without Harm, in collaboration with Arup, 'The Health Sector's Climate Footprint: How the Health Sector Contributes to the Global Climate Crisis: Opportunities for Action,' the largest contributors are the United States (546 million metric tons of CO 2 equivalent), China (342 million metric tons of CO 2 equivalent), and the European Union (248 million metric tons of CO 2 equivalent). More than half of this footprint stems from energy consumption, such as electricity, gas, steam, and air conditioning systems, combined with operational emissions.
Other significant sources included agriculture (9%, including food service in health centres and cotton cultivation for surgical gowns), pharmaceuticals, and chemicals (5%, excluding production energy transport [7%] and waste treatment [3%]). A further 1% of the health sector's global climate footprint, or nearly 4 million metric tons of emissions, is derived from anaesthetic gases (0.6%) and metered-dose inhalers (0.3%).
The ECODES report 'Reduction of GHG Emissions in the Healthcare Sector Focus on Scope 3 of the Carbon Footprint' categorises emissions into three types of scopes. According to Health Care Without Harm, Scope 1 covers direct emissions from daily operations, such as burning fossil fuels for heating, cooling, and anaesthetic gases; owned vehicle exhaust; and fugitive emissions from air conditioning and cold storage systems, accounting for approximately 17% of the total. Scope 2 covers indirect emissions from the acquisition and consumption of electrical energy by healthcare facilities, including electricity, steam, refrigeration, and heating, accounting for approximately 12% of the total emissions. Scope 3, the largest category, includes the production, distribution, and disposal of goods and services consumed by the sector, such as medical supplies, medicines, equipment, and associated transport.
Waste Management
Several initiatives have been launched from international, national, regional, public, and private perspectives. The Global Green and Healthy Hospitals Network (GGHH) includes more than 1900 members in over 80 countries, representing approximately 70,000 hospitals. GGHH supports its members in conducting sustainability projects by providing access to a wide range of exclusive and innovative tools and resources.
In May 2025, GGHH published a report on the 'Chemical recycling of plastic waste from the healthcare sector,' evaluating recycling technologies, toxic by-products, carbon footprint, and economic viability to identify the best options for healthcare plastic waste.
In Spain, the AIMPLAS Technological Centre in Valencia, Spain, is engaged in circular economy and decarbonisation projects, producing biocompatible, biodegradable, injectable, and resorbable materials such as polylactic acid (PLA) and their copolymer poly(lactide-co-glycolide), poly(ε-caprolactone) — PCL — and PLA-PCL, using various technologies such as synthesis and reactive extrusion. These biopolymers offer sustainable alternatives to conventional plastics and significantly reduce non-biodegradable pollution.
In 2025, Granada-based Athisa opened Spain's first sustainable healthcare waste treatment plant in Ciudad Real, Spain. One of its milestones is the management of solid cytostatic waste, which, unlike traditional incineration methods, uses advanced oxidation with an ozone-like oxidant that does not generate hazardous waste. This alternative avoids the emission of greenhouse gases and the generation of hazardous ash, which is typically deposited in specialised landfills, representing a more sustainable option than incineration.
Carbon Reduction
The Ministry of Health launched the National Information System on the Healthcare Carbon Footprint. This tool collects and provides data on the calculation of atmospheric greenhouse gas emissions from processes that occur in different healthcare centres during a given year.
In March 2025, the Ministry resumed carbon footprint workshops on the carbon footprint in healthcare centres as part of the Strategic Health and Environment Plan. From Health #ForTheClimate (ECODES) on this key initiative for decarbonisation of the healthcare sector.
In a public-private partnership, the MAPIC+s project (ECODES and GSK) aims to reduce the carbon footprint of the National Health System and drive environmental sustainability. MAPIC+s offers a roadmap for healthcare organisations by integrating sustainability into strategic plans, forming sustainability committees, replacing single-use materials, and reducing fluorinated gases, with case studies from Spain.
Eli Lilly and Company and DHL Freight launched a project to reduce CO₂ emissions on international routes. By using biodiesel vehicles and carefully planning routes, they aim to lower emissions from shipments between Eli Lilly and Company's Alcobendas plant in Madrid and destinations in Belgium and the Netherlands.
Anaesthetic Emissions
The pharmaceutical industry is also working to reduce the environmental impact of anaesthetic gases and metered-dose inhalers. Efforts are underway to accelerate the shift to near-zero carbon propellant inhalers, with the next generation expected to be launched by 2025.
However, as Carlos Almonacid, MD, vice president of the Spanish Society of Pulmonology and Thoracic Surgery, emphasised at a recent press conference, good clinical control offers both environmental and economic benefits. This leads to a reduced use of rescue inhalers, which typically have a higher carbon footprint, thereby supporting healthcare system sustainability. It also conserves healthcare resources and minimises patient travel to medical centres, thereby lowering pollution associated with transportation. These factors, in turn, strengthen the doctor-patient relationship, improve treatment adherence, and build trust in the healthcare system.
In January 2025, the Ministry announced the 'Green Anaesthesia' working group; the objective is to continue advancing the sustainability of the healthcare system and to develop a document of best practices and solutions to achieve 'better anaesthesia for patients and the planet,' an estimated 2% of the National Health System's carbon footprint and approximately 10% of the direct emissions from health centres.
Mónica García, MD, Minister of Health of Spain, and a public-sector anaesthesiologist for 20 years, reaffirmed her 'conviction that it is possible to reduce anaesthesia's environmental impact without compromising care quality, patient health, or professional practice. That is why we convened this working group.'
Digital Health
Another major step in reducing the environmental footprint is moving towards digital health. However, experts caution that the environmental impact of technologies such as artificial intelligence must also be considered.
Speaking to El Medico Interactivo , Miguel Ángel Casermeiro, secretary of the Spanish Association for Environmental Impact Assessment, noted that the digital sector is expected to become one of the main consumers of energy, as shown by the rising energy demand in this field.
Many data centre projects are currently underway in Spain, positioning the country as a key player in the global management of digital resources. 'This new digital health landscape must also be assessed in terms of its energy use,' he said.
At the same time, Casermeiro emphasised that 'Digital health will also yield significant savings in travel and information handling — potentially reducing diagnostic tests — leading to substantial savings for the National Health System.'
Similarly, Jaime del Barrio, MD, president of the Digital Health Association, told El Medico Interactivo that while 'digital health has environmental impacts throughout its life cycle, including production, transportation, operations, and end-of-life management. However, the development and implementation can have a positive effect, significantly reduce the carbon footprint, and making the healthcare sector more efficient.'
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