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Chapter 1: Climate change and the NHS

Chapter 1: Climate change and the NHS
By Victoria Vaughan, Editor
28 March 2024


Countdown to Net Zero
Climate change and the NHS
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about Climate change and the NHS

Chapter 1
Climate change and the NHS
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about Climate change and the NHS

Chapter 2
Decarbonising medicines  
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about Decarbonising medicines  

Chapter 3
Increasing the efficiency of NHS estates
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about Increasing the efficiency of NHS estates

Chapter 4
Greening NHS transport
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about Greening NHS transport

Chapter 5
Managing NHS waste sustainably
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about Managing NHS waste sustainably

Chapter 6
Expert views on NHS Net Zero
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about Expert views on NHS Net Zero

It is evident that our health and the environment we live in are inextricably linked. From the air we breathe, to the weather we’re experiencing – we are increasingly, emphatically, being made aware of how the human impact on the planet is rebounding back to affect our lives and our health.

In England the NHS, responsible for 4% of CO2 emissions, has set out an ambitious plan to reach net zero by 2040. As the world’s fifth largest employer it holds a key position globally in the fight against climate change.

Global agreement

To prevent the worst impacts of climate change – floods, droughts, heatwaves and the risks to health that follow – the international community, in 2015, agreed to limit global temperatures to 1.5°C above preindustrial levels.

Since then global temperatures have continued to rise, with 2023 the planets’ warmest on record and 2022 being the warmest in the UK, where a record temperature of 40.3°C was recorded at Coningsby, Lincolnshire.

At the latest annual UN climate change conference, COP28, held in Dubai, United Arab Emirates, at the end of last year, nearly 200 countries agreed a deal to transition away from fossil fuels to renewables, such as wind and solar power. The deal was criticised for not including an explicit commitment to phase out, or phase down fossil fuels.

The leaders also agreed to maintain the overarching aim to keep the global temperature limit of 1.5°C within reach, although the International Panel on Climate Change has calculated it is likely to be breached between 2030 and 2052 if temperatures continue to increase at the current rate.

Domestic picture

Prior to this, Prime Minister Rishi Sunak received significant criticism in September 2023 when he set out his new approach to delivering net zero which included delaying the plan to ban the sale of new petrol and diesel cars from 2030 to 2035 and to delay the phasing out of gas boilers from 2026 to 2035. Although he maintained the commitment to the international target of reaching net zero by 2050.

NHS target

As a step towards this target the UK’s largest employer, the NHS, became the first national health system in the world to commit to net zero carbon emissions, launching its National Programme for a Greener NHS in October 2020.

There are two targets:

  • NHS Carbon Footprint:  For the emissions the NHS controls directly it will reach net zero by 2040, with an ambition to reach an 80% reduction by 2028 to 2032;
  • NHS Carbon Footprint Plus: For the emissions the NHS can influence it will reach net zero by 2045, with an ambition to reach an 80% reduction by 2036 to 2039.

This was backed up on 1 July 2022, when the NHS became the first health system to embed net zero into legislation, through the Health and Care Act 2022 – the same act which brought integrated care boards into being.

As a result the Delivering a Net Zero National Health Service report is issued as statutory guidance meaning there is now a duty on NHS England, all trusts and ICBs to contribute towards statutory emissions and environmental targets.

Every ICB is required to meet this duty through their green plans led by a board-level net zero lead.


Progress has been made on reducing the NHS Carbon Footprint with an estimated 62% reduction in emissions, significantly exceeding the 37% requirement for 2020 as outlined in the Climate Change Act. And in terms of the wider scope of the NHS Carbon Footprint Plus there has also been a ‘meaningful improvement’ with an estimated reduction of 26% by 2020.

However to reach net zero the report stated that the NHS still needs to remove 6.1 MtCO2e from the NHS Carbon Footprint and 24.9 MtCO2e from the NHS Carbon Footprint Plus, roughly equivalent to the emissions profile of Croatia.

When looking at the areas responsible for emissions supply chain, estates and facilities, pharmaceutical and medical devices and travel are all areas of concern. It is more challenging in primary care where premises are small and disparate and getting consensus across the sector is more hard won.

Source: Delivering a Net Zero National Health Service

Health and the environment

That the climate emergency is a health emergency is not in doubt. The World Health Organization reports that between 2030 and 2050, climate change is expected to cause approximately 250, 000 additional deaths per year, from undernutrition, malaria, diarrhoea and heat stress alone and it puts the costs to health at between US$ 2–4 billion (£1.6bn to £3.2bn) per year by 2030.

In the UK the Met Office has warned that heatwaves like the ones seen in 2018, which resulted in an estimated 863 excess deaths, are now 30 times more likely to happen due to climate change and by 2050 are expected to happen every other year.

NHS England highlights that the situation is worsening, with nine out of the 10 hottest years on record occurring in the last decade, more than 2,500 people were killed by heatwaves across the UK in 2020.

‘Without accelerated action there will be increases in the intensity of heatwaves, more frequent storms and flooding, and increased spread of infectious diseases such as tick-borne encephalitis and vibriosis,’ it states.

Delivering Net Zero says that ‘Reaching our country’s ambitions under the Paris Climate Change Agreement could see over 5,700 lives saved every year from improved air quality, 38,000 lives saved every year from a more physically active population and over 100,000 lives saved every year from healthier diets’.

It also highlights research that suggests that up to one-third of new asthma cases might be avoided as a result of efforts to cut emissions.

Indeed, GP practices in London are now being alerted to episodes of high air pollution to help them protect patients against the dangers of poor-quality air, under a scheme launched in March.

Health inequalities and net zero

NHS England also acknowledges that through its effort to reduce emissions by 30%, ‘we have learnt that many of the actions needed to tackle climate change directly improve patient care and health and wellbeing.

‘This is because many of the drivers of climate change are also the drivers of ill health and health inequalities,’ it states.

It has been shown that disadvantaged communities are more vulnerable to the impacts of climate change. A 2021 report from the UK Health Security Agency and the NHS highlighted that the unequal distribution of covid mortality in England showed that disadvantaged communities ‘can be among the most vulnerable to the effects of systemic shocks and extreme events….climate change also has the potential to widen existing health inequalities within the UK via both its direct and indirect impacts on health’.

‘This is due to individuals and communities having different degrees of exposure and vulnerability to the adverse impacts of climate change and often facing different barriers to adaptation. Greater exposure to impacts may particularly affect poor and marginalised groups, meaning climate change threatens to further widen social and health inequalities, exacerbate existing vulnerabilities, and potentially create new ones, unless these risks and interactions are addressed’.

With tackling health inequalities at the core of Integrated Care Boards’ remit, addressing sustainability holds benefits beyond the NHS net zero target.

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