The COVID-19 pandemic has brought to light the importance of healthcare infrastructure. In the last year, many countries around the world found themselves putting up infrastructure in record time to add capacity to fight COVID-19. In China, a hospital was built within five days to help manage the outbreak. In Ghana, a private-sector led initiative came together to construct an infectious disease centre to support the COVID-19 effort and in Mexico similar efforts occurred to construct a hospital in the City Puebla to add capacity. Simultaneously, there has been a rise in temporary field hospitals. In London, we saw the conversion of the ExCel Centre in a field hospital to house 4,000 beds. Similar infrastructure has been set up all around the world.   

The increased need for hospital infrastructure, paired with the pressure to ensure we meet our broader sustainability targets, leads us to a very important question: do we need to pay more attention to the intersection between sustainability and the healthcare sector?

One of our EDGE Expert Partners, Natalia Korchakova-Heeb, is an expert in sustainable health. She is Managing Director of sustainability consultancy boutique SDG.17 Consulting GmbH, founder of PPPHealth4All and a member of the Informal Interagency Task Team of the UN on Sustainable Procurement in the Health Sector.

We sat down with Natalia to take a quick look at sustainability in the healthcare industry, why it’s important and how it can be implemented effectively.

Thanks for joining us today, Natalia. Can you help us understand what the key sustainability issues are in the healthcare sector?

Sustainability is a combination of environmental, social and economic factors.

When we think about the environment, climate change is one of the most pressing issues. What most people don’t realise is that the healthcare sector contributes almost 5 percent of the global carbon emissions. That is a very significant portion, and it has to be addressed immediately.

What’s more, climate change impacts health. According to the World Bank, climate change could drag more than 100 million people back into extreme poverty by 2030. Climate change is known to have a greater impact on most vulnerable populations. Children, for instance, are disproportionately affected by changes in their environment, as well as the elderly and the sick who are at much greater risk during heat waves. Low-income and communities of colour are also more likely to be disproportionately impacted by climate change due to existing health disparities.

One of the key culprits of greenhouse gas emissions in the healthcare sector is, of course, hospital infrastructure. To mitigate the impacts of climate change, we need to design, build, operate, decommission and invest in health systems and facilities that generate zero or minimal amounts of greenhouse gases.

The World Health Organisation (WHO) recently put out a discussion draft report developed together with Health without Harm called “Healthy hospitals healthy planet, healthy people – Addressing climate change in health care settings.” In this report, the WHO identifies seven areas we should focus on when developing climate-friendly hospital infrastructure:

• Energy efficiency – Reduce hospital energy consumption and costs through efficiency and conservation measures.
• Green building design – Build hospitals that are responsive to local climate conditions and optimized for reduced energy and resource demands.
• Alternative energy generation – Produce and/or consume clean, renewable energy onsite to ensure reliable and resilient operation.
• Transportation – Use alternative fuels for hospital vehicle fleets; encourage walking and cycling to the facility; promote staff, patient and community use of public transport; site health-care buildings to minimize the need for staff and patient transportation.
• Food – Provide sustainably grown local food for staff and patients.
• Waste – Reduce, re-use, recycle, compost; employ alternatives to waste incineration.
• Water – Conserve water; avoid bottled water when safe alternatives exist.

How viable is it to actually implement those seven principles in hospital infrastructure?

More viable than you think! More than half of those elements are covered by IFC’s EDGE App, which helps hospital developers and owners review efficiency measures and identify the most cost-effective way of implementing sustainability in their hospitals.

In your experience, why would hospitals choose to pursue the sustainability route? Are there benefits to having a green certified hospital?

Numerous studies suggest that green hospitals are not only good for the environment, but also good for the patients. Building green hospitals reduces the carbon footprint, hence helping to mitigate climate change and the long-term health impacts associated with it. They also offer a lot of economic benefits, including cost savings on utility bills, lower costs of construction, a higher property value for investors, and job creation. There is also an added value for the communities where cost savings achieved because they can be reinvested in the health facility for enhanced patient care.

Is it possible to have a green hospital without sacrificing other things, or do hospitals need to give up something to be able to build green?

There is no sacrifice necessary. The operational costs of hospitals are very high, and so the savings from building green are significant.

Did you know that a large hospital in Germany consumes the energy of a small town and produces almost one ton of waste per patient per year? Energy improvements alone could reduce the CO₂ balance of Bavarian hospitals by around one million tons. According to the Bavarian Ministry of Health, this would save around 105 million euros a year in internal costs, or about 1,400 euros per hospital bed.

In the US healthcare sector, every dollar saved on energy is equivalent to generating $20 in new revenues for hospitals or $10 for medical offices. One study conducted by Health Care Without Harm found that just through energy and water reductions and more efficient purchasing in operating rooms, U.S. hospitals could save $5.4 billion over 5 years, and $15 billion over 10 years.

Hospitals can be built green and generate cost- savings immediately, and that is true for hospitals globally. In Germany, our classic example is the Helmut-G.-Walther-Klinikum Lichtenfels, which was the first green hospital in Bavaria. After a 9-year planning and construction phase, it was opened in summer 2018. The hospital was built using sustainable building materials, and has measures for noise minimization as well as photovoltaic systems in the building facade and roof.

How can we accelerate the deployment of sustainability initiatives in the healthcare sector?

Our success relies on our collective ability to limit climate risks and achieve sustainable healthcare. We must collaborate across sectors to accelerate the greening of the healthcare sector.

We also need to keep the Sustainable Development Goals (SDGs) at the heart of action. Climate action is just one of the goals we need to achieve by 2030. Other goals include universal health coverage, the elimination of poverty and hunger, quality education for all, gender equality, sustainable cities, and biodiversity on land and in the oceans.

Finally, to truly advance sustainability in healthcare, we need to see ambitious commitments from governments around the world. Eleni, Sintali is based in the UK, right? The NHS (National Health Services of UK) pledged to become carbon zero by 2040 and is working around the following issues critical for climate mitigation:

• Estate and facilities
• Medicines
• Supply chain
• Travel and transport
• Food, catering and nutrition
• Research, innovation and offsetting

This multiyear plan will allow the NHS to become the world’s first carbon net zero national health system. Other national health services and ministries should do the same and commit to sustainable and carbon-free healthcare.

Let’s hope more follow suit. You are working with some government entities through your organisation, PPPHealth4All. Can you tell us a bit about the organisation and how it helps governments and the private sector solve the challenges we have discussed today?

Absolutely. Our mission is to improve global health by empowering governments and societies to enhance their health services and healthcare infrastructure through a multi-stakeholder digital knowledge platform PPPHealth4All. PPPHealth4All provides access to international experience, expertise and resources and facilitates development of sustainable people-centered public-private partnerships for global health.

We are working on the development of a seamless approach for the sustainable lifecycle of healthcare projects, in particular public-private partnerships. This includes sustainable design, sustainable procurement, sustainable financing, sustainable construction, sustainable operation and maintenance, sustainable decommissioning of the projects and impact assessment. We offer project screening and environmental and social due diligence with the aim of achieving carbon-free projects.

PPPHealth4All also advocates for sustainable and people-centered projects, and work on initiatives to educate the market on issues of gender-smart infrastructure, as well as addressing poverty, inclusion and diversity. We developed a knowledge base of resources on sustainable healthcare available to registered users and are currently designing trainings on how to design sustainable PPPs in the health sector.

Sounds exciting! Who should get involved in PPPHealth4ALL and where should they go to get more information?

We offer advisory services related to sustainable health and sustainable healthcare public-private partnerships to various groups, from national and local governments to private companies to financial institutions. This includes consultations on demand, screening of the healthcare projects for energy, water, material efficiency, carbon footprint calculations, access to marketplaces of sustainable solutions and many other services and products.

Please visit our website https:/ppphealth4all.de for further details and subscribe to our monthly newsletter. You can also follow our work on Linkedin , Facebook and Twitter.

Thank you so much for this valuable information, Natalia. We are hopeful that sustainability will play an increasingly important role in healthcare infrastructure moving forward as we all move towards a net zero future.