Sustainability and environmental protection in hospitals

It is everyone’s job to reduce carbon emissions in hospitals and to reduce the environmental impact of healthcare management.



Every 5 June is celebrated worldwide as Environment Day. This date is an excellent opportunity to remember what is at stake, to highlight, to rethink and to act.

In this new ETKHO post, we want to talk to you about the adaptation and evolution of hospitals to contribute to the health of the planet. Faced with the climate emergency, the deterioration of ecosystems and atmospheric pollution, the threats to the planet are many. 

These elements have a variety of consequences for people all over the world, including the emergence of associated infectious, cardiovascular and respiratory diseases, as well as for animals.


“What is the role of healthcare ecosystems and what is the environmental impact of healthcare?”






The environmental impact of hospitals

Hospitals are truly complex microcosms, structures composed of huge numbers of interrelated elements that ultimately have a strong influence on the environment. In this respect, hospitals’ environmental commitment has two basic objectives:

  1. The transformation of infrastructures and processes, increasing waste reduction and recycling, optimising energy and water consumption, modernising architecture and engineering to make it sustainable and zero-emission.
  2. The profound educational and cultural transformation of managers, professionals, patients and society to improve daily uses and behaviour in the hospital environment.


The stakes are high. The environmental impact of healthcare facilities is very high, as it encompasses everything: infrastructures, services and sectors, hospitalised patients, outpatients and ambulances, residents, restaurants, kitchens, car parks, etc. 

Let’s put it in figures. In Spain alone there are more than 10,000 health centres, as well as around 800 public and private hospitals. According to the specialised energy consultancy Ipsom, a hospital can consume on average between 20-60 thousand kWh per bed (20 average tonnes of CO2).  Per m2, this would be between 150 kWh and 50 kWh. This implies an energy consumption of 2% of the total energy consumption of a country like Spain. A hospital consumes 24/7/365, about 8,800 hours of annual consumption with special incidence on climate, ventilation, lighting and hot water supply.




Between obligation and commitment

The implementation of environmental policies in healthcare environments can be voluntary, necessary or compulsory. 

Each centre is committed to adopting international environmental management criteria such as the various AENOR environmental management standards or the ISO 14001 standard, as well as its UNE-EN-ISO 14001 version, in addition to general Community guidelines such as the Green Paper, Directive 2010/31/EC on energy efficiency, etc. But they also come up against national legislation, as in the case of the law on waste and contaminated soils. 

On the other hand, sustainability policies in the hospital already affect all levels: from the services and structures under the management of the hospital management to the subcontractors and suppliers of each hospital.





Reducing the carbon footprint

Imagine for a moment that the health sector were a country – where would it rank among the top greenhouse gas emitters? In fifth place. According to the Climate Footprint of the Health Sector report by the international organisation Health Care Without Harm, 71% of the health sector’s climate footprint is attributed to its supply chain, the production, packaging, transport and disposal of purchased goods and services. 

Therefore, this report focuses on two very important points.

  1. The first is the Green Hospital Building Standard, which sets out recommendations on what and how to install, operate and maintain systems to reduce the carbon footprint and build resilience.
  2. Secondly, there are recommendations on how to minimise the carbon footprint, i.e. the total amount of greenhouse gases emitted directly or indirectly. In this sense, the figure of the hospital engineer emerges as a decisive factor when deciding on the location, energy management in all its phases, the purchase of energy-efficient hospital equipment, etc. 


The aim is none other than to achieve zero emissions in the healthcare sector by 2050. The health sector alone generates the equivalent of 4.4% of global net emissions, or in other words, two gigatonnes of carbon dioxide (CO2), which is the amount emitted into the atmosphere by 514 coal-fired power stations per year to generate electricity. 

As an example, one of the most common measures is the improvement of electrical installation and lighting by switching to LED lights.





Health trends and best practices

Within the amalgam of solutions to improve the environmental impact of the health system, we find:

  • Better maintenance and a commitment to hospital engineering to implement the best sustainable systems, adapting and complying with regulations, etc. 
  • Thermal use of biomass as auxiliary energy to reduce polluting emissions and water heating costs. 
  • Install photovoltaic panels.
  • Reuse of dialysis water and use of timed taps or taps with movement sensors.
  • Improve healthcare waste management and recycling.
  • Optimise the use of anaesthetic gases and inhalers.
  • Digitalisation and telemedicine.
  • Raise public awareness with more initiatives and communication campaigns.





What is a green hospital? How does it work?

In order to reduce the environmental footprint of the sector, the organisation Health Care Without Harm created the Global Network of Green and Healthy Hospitals more than a decade ago. Currently, waste management and sustainable procurement are the main focus areas, as well as reducing the use of pollutants such as chlorine and mercury.

These green hospitals have no definition per se. They are a concept, a commitment to health-promoting healthcare facilities that continuously reduce their environmental impact and eliminate their contribution to the disease burden. To give it a comprehensive approach, the NGO developed the so-called ‘Global Agenda for Green and Healthy Hospitals’, a document that provides a comprehensive framework for hospitals to operate in a more sustainable way and contribute to improving public environmental health. 



Circular economy, ESG criteria and best practices in sustainability

One concept is clear to everyone: the healthcare sector needs to move towards a more widespread implementation of the SDGs (Sustainable Development Goals), adopted by the UN in 2015.  

While there are hospitals and healthcare centres that have already made great strides in implementing environmental, social, good governance and hospital sustainability criteria, implementation is very uneven.

It is becoming increasingly necessary to take measures and actions towards a more sustainable healthcare system. We need to rethink the model that currently works. One of the main problems is that many hospitals, most of them, have infrastructures that are too old and too long-lived from an energy point of view.

It is no longer enough to maintain old electrical installations, hospital equipment from the last century, and so on. In addition to innovative design, renewable materials, energy efficiency, waste separation and transfer, we must rely on the most innovative hospital technology and equipment for 100% sustainable hospital management. 

In this regard, one of the most common measures in recent times, especially due to the increase in construction and logistics costs, is to focus on the circular economy in the management of materials used in hospitals.



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