ANALYSIS
Fig 1 | NHS greenhouse gas emissions per scope; the goal is net zero by 2040 for scope 1 emissions, and 2045 for scope 2 and 3 emissions 15
in decarbonisation and climate adaptation in the NHS, in relation to achieving net zero targets and making financial sense. Where the NHS is viewed as a global leader in sustainable healthcare, there is an opportunity and responsibility to model best practice internationally. In doing so, the NHS might begin to tackle the ongoing injustice whereby low and middle income countries feel the worst of the effects of climate change and biodiversity loss, despite high income countries having almost exclusively driven these processes. 21 Preparing for shocks and stressors The climate crisis and biodiversity loss are not stories of tomorrow; the impacts are palpable today, including in the UK (box 1). Mitigation efforts, while necessary to prevent worsening climate and health impacts, are insufficient on their own. Immediate adaptation is required to deal with present and increasingly substantial health impacts of climate change. Box 1: Where is the critical impending need for adaptation? Extreme temperature and heat waves
A truly sustainable and resilient health system must operate within safe planetary and ecological bounds, 1617 not contributing excessively to pollution, degradation, or emissions, while being resilient and responsive to the health needs that result from the impacts of climate and environmental change. These impacts include the fallout of extreme weather events, changing patterns of disease, and the movement of people. 7 Climate friendly and sustainable interventions have the added benefit of being cost saving. For example, the cost to the NHS of people not taking prescribed drugs correctly is estimated to be £500m a year. 18 A review of surgical interventions found financial savings in every identified example of greening surgical care over the past 20 years, 19 realised across several areas including reducing material use, reuse of medical products, and waste management procedures. Renewable energy has rapid financial returns: Castle Hill Hospital in Hull is saving between £250 000 and £300 000 each month after installing solar panels. 20 Leaders should build on the growing body of evidence and recognise investment in environmental sustainability as a mechanism for achieving long term financial sustainability. Governance and leadership structures must show, through policies and systems, the value of investment
the bmj | BMJ 2024;385:e079259 | doi: 10.1136/bmj-2024-079259
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