When most people ponder healthcare, what usually comes to mind is a trip to the doctor’s office, waiting in line, receiving proper treatment and medicine, and ultimately, eventual relief from one’s pain.
What many overlook is the waste generated from each clinic or hospital visit, and the sheer amount of energy that keeps the healthcare sector’s wheels turning around the clock.
While vast amounts of energy are needed for energy-intensive medical equipment, general heating and cooling purposes, and to keep the lights on day and night, the main energy culprit is Scope 3 emissions, or those that directly stem from the sector’s supply chain, and waste that is improperly disposed of.
This includes the production of medical supplies and pharmaceuticals; waste such as personal protective equipment and disposable tools like syringes; the transportation required to ship pharmaceuticals and medical supplies to the clinic; and even the transportation that nurses, doctors, and patients take.
Globally, this sees the healthcare sector responsible for up to 5 per cent of total carbon emissions – exceeding those of the aviation and shipping industry. If left unaddressed, the World Economic Forum forecasts that the healthcare sector’s carbon footprint could triple by 2050.
A large chunk of healthcare emissions stems from Asia.
While emissions from the medical industry comprise around 8.5 per cent of the United States’ total and roughly 5 per cent of Europe’s emissions, Asia’s healthcare sector accounts for about 30 per cent of the region’s gross carbon emissions.
There are some reasons for this: the region’s aging population – set to host two-thirds of the world’s population above the age of 65 by 2030 – combined with steady economic growth in recent years driving increased health spending.
The lack of proper waste management infrastructure in the region, coupled with the immense amount of medical waste generated during the Covid-19 pandemic and resultant ongoing medical practices, has also led to unprecedented quantities of medical refuse.
Asia is also particularly vulnerable to climate-related health risks. The growing frequency and intensity of heat-related illnesses, injuries and risks is sending more individuals to clinics and hospitals, with vulnerable populations often bearing the brunt.
This unending cycle of climate-induced suffering, treatment, and resultant medical waste and emissions is unsustainable, said John Graham, group chief executive officer of healthcare solutions provider Zuellig Pharma.
“The escalating impact of climate change has had an undeniable impact on the health of societies – extreme weather events, air pollution, and increased incidence of vector-borne infectious diseases because of rising temperatures are all evidence of this,” Graham said.
Decarbonisation challenges
Ensuring that vaccines and medication maintain their efficacy while being shipped is one reason why reducing emissions within the healthcare sector remains challenging, Graham notes.
“For instance, ensuring the integrity of temperature-sensitive vaccines and drugs is paramount to ensure they arrive uncompromised and in their intended state for end-users,” he said.
There is also energy-intensive equipment relied on to diagnose and treat patients – think machines such as magnetic resonance imaging (MRI) and computed tomography (CT) scanners – and heating, ventilation, and air conditioning systems needed to maintain sterile environments.
Another challenge is the lack of personnel to oversee emissions and waste, says Manjit Sohal, regional climate manager, Southeast Asia, Health Care Without Harm (HCWH), a non-profit that promotes sustainable healthcare practices.
This, Sohal notes, makes it difficult to track and measure Scope 3 emissions, which is key to reduction efforts in the long term. “Healthcare facilities may lack standardised methods to collect accurate data such as patient travel habits, or waste management procedures conducted by third parties,” she said.
The large number of individuals involved in the healthcare supply chain also complicates efforts, as it involves numerous suppliers, manufacturers, and distributors. This makes tracking and reducing emissions a daunting task, Sohal notes, adding that 70 per cent of healthcare emissions originate from the supply chain alone.
Because stakeholders within the healthcare supply chain are “dispersed” in nature – meaning that they are geographically spread out or not confined to one location – emissions are more difficult to track and reduce, Graham adds.
“This involves those from clinical trials, supply chain, all the way to distribution,” he said, pointing to the coordination needed between suppliers, distributors, healthcare providers and regulators across Asia and around the world to drive down Scope 3 emissions.
The need for national policies
Despite calls to reduce healthcare emissions, such as those by the World Health Organisation, which encouraged countries to commit to developing climate-resilient health systems at the 2021 United Nations’ Climate Change Conference in Glasgow (COP26), there are currently no legally binding laws globally or in Asia that mandate emissions or waste reductions in the healthcare sector. There are, however, some frameworks and roadmaps aimed at reducing carbon footprint.
One is the United Nations-backed Race to Zero campaign led by HCWH, where healthcare institutions representing over 14,000 facilities have pledged to halve emissions by 2030 and reach net zero by 2050. Another is the Global Road Map for Health Care Decarbonisation initiative, also led by HCWH and design and engineering firm Arup, which provides a structured approach for the healthcare sector to reduce emissions.
While these initiatives signal some progress, the healthcare industry may not see true change until mandates at a national level come into play, argues Sohal.
“Progress needs to extend beyond individual facilities – it has to become a systemic endeavour. National governments and health ministries need to mandate emissions reporting, monitoring, and the transition to sustainable, low-carbon alternatives within the entire healthcare system,” she said.
“A tertiary public health facility in the Philippines, for example, cannot independently decide to transition, as such decisions typically come with resource implications that need to undergo national government approval. This ‘centralised’ decision-making process is common across many Southeast Asian countries, where healthcare systems are heavily influenced by national policies and regulations.”
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The escalating impact of climate change has had an undeniable impact on the health of societies – extreme weather events, air pollution, and increased incidence of vector-borne infectious diseases because of rising temperatures are all evidence of this
John Graham, group chief executive officer, Zuellig Pharma
Taking waste and emissions into account
The lack of regulation puts the onus on healthcare solutions companies to find ways of reducing their own emissions and waste.
For example, Zuellig Pharma reduces its Scope 3 emissions by implementing greenhouse gas emissions tracking and monitoring into its processes and evaluates the sustainability of business partners through compliance-based questionnaires.
This ensures that the company prioritises working with suppliers and partners who have demonstrated progress in reducing their carbon footprint, Graham notes, adding that the company has also introduced more electric vehicles within its fleet, and technology to insulate cold trucks and reduce air-conditioning energy use by up to 30 per cent.
Doing so, he adds, has helped to reduce transportation and fuel costs, packaging waste, and led to improved inventory management and lowered emissions.
“We also optimise our load to maximise the capacity of each delivery, and use a blended model of contracted, owned and brokered trucks to ensure that the fewest number of vehicles are used while ensuring a continued supply of critical healthcare products,” Graham explained.
Zuellig Pharma has also found ways of recycling medical packaging waste. The company partnered up with the Business Council for Sustainable Development (BCSD) Malaysia and Baxter Healthcare in 2022, launching an initiative called the “Jom Recycle – Plastic Recycling in Homecare” that sees them recycling non-contaminated renal dialysis bags from patients’ homes for recycling into secondary raw materials.
Graham notes that the initiative has diverted more than 500 kilogrammes of high-grade plastic waste from landfills to recycling facilities in Malaysia. More than 260 metric tonnes of recyclable, non-clinical plastic waste fill up Malaysia’s landfills each year.
Zuellig Pharma has recorded a 24 per cent reduction in landfill-destined waste in the last two years and is on track to achieve zero waste by 2030, according to its 2023 sustainability report.
The delicate balance
With the focus firmly pinned on patient health, the region must resort to quick and easy decarbonisation wins while looking for longer-term solutions. This can start with facilities being sustainably built from the ground up, Sohal says, noting that features like ample ventilation and natural lighting, and energy-efficient machines can go a long way.
Existing healthcare facilities can also consider telemedicine, or remote and real-time patient-doctor video consultations, to reduce their Scope 3 emissions. Patients can then pay for the consultation and prescribed medications online, which are either delivered directly to the patient’s home or made available for pickup at a pharmacy or healthcare facility.
One 2021 study found that every virtual medical consultation can reduce between 0.70 and 372 kgs of carbon dioxide equivalent.
“Every time someone goes to the hospital, this results in emissions from transport or supplies such as single-use plastics or products used to examine outpatients. Some of these consultations can be conducted remotely or online, which can avoid emissions associated with patients going to the hospital,” Sohal says.
“As demand for healthcare services grows, transitioning to telemedicine for outpatients who do not require hospital visits is a viable option.”
But until there are firmer regulations that mandate healthcare emission reductions, the region’s industry must continue striking a careful balance between safeguarding patient health and keeping waste and emissions low.
“The [healthcare] industry needs to continue working together to innovate and invest in solutions that reflect modern priorities, and continue to build and invest in strategy, material policies and technology. This way, sustainability can be incorporated into an organisation’s purpose, governance, decision-making process, and every facet of its operations,” Graham said.
“We must continuously improve the accessibility of quality healthcare without compromising the societies we operate in and the planet that we inhabit.”
