6.7 Climate-resilient and sustainable healthcare

Health facilities require practical tools to assess their vulnerability to climate risks and to plan corresponding actions. The WHO has developed checklists for assessing vulnerability to various climate change events, including floods, storms, sea-level rise, droughts, heatwaves, wildfires and cold waves (WHO, 2021a). These checklists evaluate the impacts of climate events on health workforce, water, sanitation, healthcare waste management, energy services, infrastructure, technologies, products and processes. They also provide recommendations for enhancing climate resilience in these areas. For instance, ensuring an adequate number of skilled human resources with decent working conditions is essential for climate resilience. Additionally, health workers need to be empowered and informed to effectively respond to environmental challenges (WHO, 2020b).

In 2017, the WHO, in collaboration with the Pan American Health Organization, introduced the Smart Hospitals Toolkit, which integrates the structural and operational safety of hospitals with green interventions (Green + Safe). This toolkit comprises the hospital safety index, the green guide and a baseline assessment tool (WHO, 2017). The hospital safety index evaluates structural, non-structural and functional factors determining a health facility’s ability to operate during emergency situations. It categorises health facilities into three groups: Category A facilities are considered capable of functioning effectively during emergencies; Category B facilities can operate but have critical services at risk; Category C facilities pose risks to their clients during emergencies.

The green guide provides a checklist to help health facilities assess how they can minimise their contributions to climate change. It examines areas such as water, energy, atmosphere, indoor environmental quality, hazardous materials, pharmaceuticals, food services and waste management (see case 2). The aim is to identify low-cost measures, often non-structural, to reduce greenhouse gas emissions.

The baseline assessment tool helps to identify specific gaps in developing a smart health facility, covering components of the building/property, energy conservation, water conservation, indoor environmental quality, occupant survey and land use.

Some countries, including the US (US Department of Health and Human Services, 2014) and Canada (Health Canada, 2022; Canadian Coalition for Green Health Care, 2015), have also developed their own guidelines for constructing climate-resilient healthcare facilities.

Case 2: Healthcare waste management

Although there is a lack of a global green solution in healthcare waste management, it is clear that low technology disposal leads to harms (Kenny & Priyadarshini, 2021). Disposable consumables benefit infection control, but their contribution to greenhouse gas emissions can no longer be ignored. In recent years, the ‘five Rs’ rule (reduce, reuse, recycle, rethink and research) has attracted increasing attention in the healthcare sector (Lattanzio et al., 2022). The Global Green and Healthy Hospitals network sustainability agenda calls for reducing toxic waste while adopting environmentally sound waste management and disposal options.