ANALYSIS
assessments. We also need further epidemiological modelling of a wider range of health outcomes, including mental health, and a greater understanding of compound and cascading risks, and the effectiveness of various response strategies. 43 The implementation of standardised frameworks for metrics and indicators, combined with coordination and integration of datasets, would substantially strengthen the work already being done on risk and adaptation monitoring and modelling. For example, national observatories on health and climate change could evaluate progress and inform research and decision making. 343 The resilience of health services to the climate emergency, and climate related morbidity and mortality need to be monitored as part of the UNFCCC (United Nations Framework Convention on Climate Change) global goal on adaptation. 44 This requirement provides an opportunity to improve monitoring of the health benefits of climate action as part of future rounds of the UNFCCC global stocktake. 3
A necessary component of UK health resilience will be to ensure the ability to accurately track the health impacts of the climate crisis. Integration of electronic health information systems with climate data and incorporating climate sensitive health risks and diagnoses into existing databases or registries will allow more accurate prediction of health risks in the coming decades. This strategy will ensure services and clinical pathways can be built to minimise disruption from the pressures of the climate crisis. How can the NHS adapt and mitigate against the climate emergency? We identify six key areas of focus for mitigation and adaptation within and around the NHS. These areas have been drawn from a conceptual framework for climate resilient and sustainable health systems compiled using key papers and reports 1545 -49 (fig2).
Fig 2 | Conceptual framework that comprises the building blocks for delivering sustainable healthcare compiled by integrating elements of the ATACH (Alliance for Transformative Action on Climate and Health) framework, 45 the World Health Organization operational framework for building climate resilient and low carbon health systems, 46 Greener NHS guidance on delivering a net zero NHS, 1549 NHS England ’ s Sustainable Development Unit, 48 and research on integrating planetary health into healthcare. 47 The framework guides the structure of the analysis in this article
return on investment owing to energy cost savings. Within the NHS, more could be done to support evidence driven approaches to tackling emissions hot spots. For example, operating rooms are three to six times more energy intensive than other clinical areas of the hospital, primarily because of heating, ventilation and cooling requirements, and the need for tightly controlled heating and humidity conditions. 5354 Shutdown checklists and switching off ventilation systems overnight have been shown to be effective strategies for reducing energy use. 19 A lead for sustainability, with appropriate training on the impact their decisions have on the wider population's health, should be in place for any areas of procurement or facilities. The transport system, pivotal for primary and secondary care, is heavily reliant on fossil fuels, contributing substantially to the NHS ’ s carbon footprint. Transitioning to electric and hybrid vehicles, along with encouraging telemedicine where feasible, has shown a
Infrastructure As one of the world's largest healthcare systems, the NHS faces the critical challenge of aligning its facilities, infrastructure, energy use, and transport approach with sustainability goals across scope 1-3 emissions (fig 1). Presently, NHS infrastructure consists of ageing and modern facilities, with varying degrees of energy efficiency and environmental impact. On average, 76% of the organisation ’ senergy use is from fossil fuels. 50 In facilities with poor sustainability ratings, fossil fuels are the predominant source of energy. Evidence from various health systems globally indicates that sustainable healthcare facilities can substantially reduce carbon emissions without compromising patient care. 51 52 Practices such as the use of renewable energy sources, green building design, retrofitting of existing facilities to improve energy efficiency, and waste reduction strategies have proven effective and provide good
the bmj | BMJ 2024;385:e079259 | doi: 10.1136/bmj-2024-079259
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