Vivian Tseng, CSHS Intern
As more Canadians experience the devastating effects of pollution, wildfires, heat waves and the spread of infectious diseases brought about by climate change, the calls to action become more urgent. This month, the Government of Canada has taken a major step in answering these calls by releasing the Canadian Net-Zero Emissions Accountability Act. Under this new legislation, the government is required to incrementally establish five-year targets to reduce greenhouse gas emissions beginning in 2030. Though the plan currently lacks specifics on implementation and enforcement, its ultimate goal is to achieve net-zero emissions by 2050 in accordance with the international targets outlined in the Paris Agreement, to which Canada has committed.
However, if Canada’s lackluster track record in meeting similar targets over the past three decades is any indication, the country’s ability to meet this newest goal is far from certain. Canada failed to achieve the 2012 target made under the Kyoto Protocol and is currently on track to miss both its 2020 and 2030 targets to reduce greenhouse gas emissions by 17% and 30%, respectively, below 2005 levels. The Government of Canada acknowledges it will need “support and engagement from all parts of society, including provinces, territories, Indigenous Peoples, youth, and businesses” if it is to have any chance at achieving net-zero emissions by 2050.
Though not explicitly identified, Canada’s healthcare sector, which had the third highest greenhouse gas emissions per capita globally in 2019, has a key role to play in helping the country meet this target. Healthcare-related carbon emissions arise largely from supply chains and service models; they are collectively responsible for 5% of Canada’s total greenhouse gas emissions, and result in 23,000 disability-adjusted life years lost annually. The 2019 policy briefing for Canada in the Lancet Countdown Report on Health and Climate Change articulated an urgent need for the development of a sustainable, national initiative to achieve net-zero emission healthcare by 2050. In establishing a framework to reduce emissions which will work alongside the new legislation, Canada’s healthcare sector can take inspiration from the United Kingdom.
Source: Government of Canada
In response to England’s own broad target of reaching net-zero carbon emissions by 2050, the National Health Service (NHS), which has long been actively working to reduce its carbon footprint, ramped up its efforts with a commitment (first announced earlier this year) to eventually eliminate all net carbon emissions under its direct control. The NHS fleshed out the logistics of this commitment and revealed its intention to reach net-zero carbon by 2040 in a report published last month, making it the first healthcare system to execute a national plan to reduce emissions.
The news could not have come at a more opportune time, as more research coming out of the COVID-19 pandemic points to climate change as a driver of adverse health effects and health inequalities. In fact, air pollution is the leading cause of environmentally related morbidity and mortality worldwide, responsible for one in eight deaths globally. Health systems will need to respond to the increasing number of (disproportionately inflicted) climate-change related health impacts, but they can also play a more proactive role by seeking to mitigate their own, not insignificant, contributions to climate change. Accordingly, the direct action taken now by the NHS to address the carbon emissions associated with the activities identified in Figure 1 below will benefit public health and health equity in the long-run.
Figure 1: Sources of carbon emissions by proportion of NHS Carbon Footprint Plus
Source: National Health Service
The NHS plans to eliminate all emissions generated in the NHS Carbon Footprint Plus. This includes the emissions from travel by patients and visitors, and the 3 scopes presented in Figure 2 (below):
Scope 1: Direct emissions from owned or directly controlled sources, on site
Scope 2: Indirect emissions from the generation of purchased energy, mostly electricity
Scope 3: All other indirect emissions that occur in producing and transporting goods and services, including the full supply chain
Figure 2: Greenhouse gas protocols scopes in the context of the NHS
Source: National Health Service
The NHS’ sustainability interventions for each scope include:
Estate and facilities: Using on-site renewable energy and heat generation, optimizing building usage, upgrading buildings, and improving building insulation, lighting and heating
Travel and transport: Electrification of NHS transportation, increased virtual care and preventative care, and using active transit
Supply chain: More efficient use of supplies, using low-carbon substitutions and product innovation, and by ensuring suppliers are decarbonising their own processes
Anaesthetics & Medicines (25% of emissions within the NHS): Optimizing prescribing, substituting high carbon inhalers and anaesthetic gases for low-carbon alternatives, and improvements in production and waste processes
“The climate emergency is a health emergency.
NHS, 2020”
Along with these interventions, the NHS envisions a new service model - one that is:
focused on preventative care to reduce demand for healthcare services and benefit patients throughout their life course;
digitally-enabled to support patients through virtual care and monitoring. Not only will this reduce the emissions caused by travel to and from healthcare facilities, but patients may benefit (albeit to varying degrees given the digital divide) from greater access to care and the increased efficiency that results from fewer unnecessary hospital visits and admissions;
equity-based to focus efforts on reducing air pollution and improving access to green spaces in racialized and poorer neighbourhoods, which are disproportionately affected by air pollution and already at greater risk of poor health outcomes.
The NHS recognizes that “The climate emergency is a health emergency.” The healthcare sector has a responsibility to address climate change due to the significant effects it has on population health and in worsening health inequalities. Going net-zero comes with a variety of benefits, including promoting health, reducing air and water pollution, and saving costs. Even more significant is the projected amount of lives (5,770) which will be saved per year by 2040 in the United Kingdom due to reductions in air pollution. Although it is difficult to quantify the outcomes of this plan, these early projections show promising potential benefits for health.
The healthcare community has a tremendous opportunity to take a lead role in mitigating the threat to human health brought about by climate change. The NHS has set a strong example by laying the groundwork for a realistic and effective plan to reach net-zero carbon emissions by 2040. Canada’s healthcare sector must follow suit if the country is to achieve net-zero carbon emissions by 2050 - an ambition that must be met to protect the health of Canadians and the planet.
About the author:
Vivian Tseng (BHsc) is a first year Master of Public Health (MPH) student at the Dalla Lana School of Public Health, University of Toronto. She holds a bachelor's degree in Psychology and Health Studies from the University of Toronto. Vivian is interested in health equity, specifically how to shape policies and programs to ensure equitable access to the social determinants of health necessary to improve population health outcomes.
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