Reducing the Health Care Sector’s Contribution to Climate Change Makes Good Business Sense

When people think about the relationship between climate change and health, their minds often turn to questions focused on minimizing any impact of the former on the latter—for example, “What can we do to keep more people from contracting malaria as rising average temperatures support a proliferation of disease-carrying mosquitoes?” 

But the flip side of the issue—“What can be done about the health sector’s impact on climate change?”—is just as important to consider. Despite the burgeoning recognition of both aspects of the challenge in recent years, health systems continue to be ill prepared to respond to the rapidly changing health needs induced by climate change while also significantly contributing to global greenhouse gas (GHG) emissions themselves.  

GHGs, primarily carbon dioxide (CO₂), are the main driver of human-caused global warming, which threatens to have catastrophic consequences on health and reverse decades of progress in human rights, health security, and the World Health Organization’s Sustainable Development Goals. The health sector accounts for 4.6% of global GHG emissions, with pharmaceutical manufacturing and the supply chain being major contributors, according to The Lancet Countdown 2023.  

That figure illustrates the importance of health care industry stakeholders learning to view their activities, policies, and processes through a climate lens to find avenues for reducing their own carbon footprints to protect the planet and its inhabitants. 

In taking the Hippocratic Oath when embarking upon their careers, doctors explicitly recognize a central tenet of their profession—a duty to avoid causing needless pain, suffering, or injury to their patients. It is similarly incumbent on health care systems around the world to ensure that they keep their contributions to climate change and its negative impacts on the earth and on global health to a minimum. But doing so does not have to cost those systems money or reduce their efficiency; rather, they may find that becoming more climate friendly can be good business. 

Ukraine’s experience 

The government of Ukraine, with assistance from the USAID-funded Safe, Affordable, and Effective Medicines (SAFEMed) for Ukrainians Activity implemented by Management Sciences for Health (MSH), provides an inspiring example of how climate action can be incorporated into seemingly unrelated business decisions. This has proven true even amid Russia’s full-scale invasion of Ukraine, which since 2022 has caused untold death and destruction along with significant negative climate impacts. 

Like many countries throughout the world, Ukraine has prioritized efforts to ensure the uninterrupted supply of essential drugs and medical provisions to health care facilities, and a primary mechanism for doing so is to optimize the shipping process. To that end, the country’s Ministry of Health (MOH) and its partners identified three approaches for strengthening the supply chain: finding more direct trucking routes, consolidating shipments into fewer trucks, and making deliveries to multiple facilities on a single trip. MSH then tested those approaches by contracting with a Ukrainian private-sector logistics company called Farmasoft to handle the transportation of certain essential medicines on the last leg of their journey.  

During that pilot, the number of vehicles making trips dropped from 50 to 5 and the total distance driven fell from nearly 9,700 km to under 1,100 km—all between 2018 and 2019. The route optimization also reduced related carbon emissions from 2,290 kg to 160 kg during the same period.  

This experience convinced the MOH to support scaling up the initiative, and private providers now optimize deliveries for life-saving medicines while simultaneously reducing carbon emissions in more than a third of the country. 

The partnership with Farmasoft has had other positive effects on the environment—especially on GHG emissions—as well, given that the company has doubled down on its commitment to environmental sustainability in recent years. “As a responsible organization, we continuously take active steps to integrate green technologies into our operations,” Farmasoft said in a statement. “We recognize the importance of reducing our environmental impact, especially in the health care sector.” 

For instance, Farmasoft in 2024 replaced 40% of its gasoline-fueled vehicles with electric ones, thereby reducing its fleet’s CO₂ emissions by 272 tons, according to the company. Farmasoft also has equipped its warehousing facilities with energy-efficient LED lighting and smart thermostats and implemented an energy monitoring system to help identify opportunities for further efficiency improvements. 

The war itself has also been a catalyst for climate-friendly changes. When frequent power outages compromised its ability to maintain stable temperatures in its warehouses, Medical Procurement of Ukraine (MPU)—the government agency tasked with acquiring, storing, and distributing medical products throughout the country—identified solar/battery systems as the best solution to its power problem. The MPU is now actively seeking international donors and exploring additional funding sources to support the procurement, import, and installation of solar panels. 

As for the MPU’s delivery fleet, it already must adhere to strict Euro-5 and Euro-6 standards, which ensure that the trucks expel minimal harmful emissions. Nevertheless, the MPU aims to further modernize its vehicles with CO₂ absorption technology, thereby setting new benchmarks for eco-friendly transport. The agency also plans to implement digital warehouse management system technology to further improve routing efficiency.  

“We are focused not only on ensuring the uninterrupted supply of medicines but also on making our logistics more efficient and environmentally friendly,” said Oleg Klots, Acting General Manager of the MPU. 

The tip of the iceberg 

The actions Ukraine has taken so far represent just a couple of the many ways the health care industry can work to reduce its negative environmental impacts. 

Ukraine and other countries use a multidisciplinary evaluation process called Health Technology Assessment (HTA) to determine the best value for the goods they need to run their health systems—such as drugs, medical devices, and diagnostic tests—and therefore make the best choices for where to spend their limited health care funds. As stakeholders work together through professional groups such as HTAi to craft guidance for incorporating GHG emissions into those HTAs, countries can commit to moving swiftly to adopt any resulting recommendations for taking climate friendliness into account when making medical procurement decisions.  

Another area ripe for making a more environmentally sound health care sector is waste management. Current disposal practices consist mainly of burning or incinerating medical waste and/or dumping it into landfills, both of which come with significant costs to the environment—burning results in the emission of CO₂ and landfills release methane, an even more potent GHG than CO₂ in the near term. 

Reducing the amount of waste in need of disposal in the first place—such as by replacing single-use medical supplies with equipment that can be reprocessed and reused—has the potential to improve the carbon footprint of health care systems while saving them money in the long run. Also, incinerating any waste that is produced can vastly reduce its volume and thus the amount of material that ultimately finds its way into landfills, but doing so using waste-to-energy technology could have the added benefit of supplanting grid electricity that may have been produced by highly polluting fossil-fuel-fired generators. 

What’s next? 

Ukraine is not done, though. Now that it has seen the impact it can have on reducing GHG emissions, even in wartime, country leaders are ready to invest in green solutions as they work to rebuild their health system in the years ahead. To that end, Ukraine approved a strategy in April 2024 outlining key initiatives aimed at addressing climate change, ensuring sustainable development, and reducing GHG emissions. Among other things, the strategy stresses the need to address emissions coming from all sectors of the economy—including the health sector. 

But in getting here, Ukraine has learned a valuable lesson that can be embraced by other countries as well—tackling climate change does not have to take a backseat to efficiency or cost effectiveness. In fact, they can go quite comfortably hand in hand. Governments, and the health systems they oversee, therefore have every reason to embrace their own version of the commitment made by doctors worldwide: first, do no harm.