Climate change is affecting health
The World Health Organisation has called climate change the 'single biggest threat facing humanity' and The Lancet Countdown Report 2022 states climate change 'is undermining every dimension of health monitored'.
Why environmental sustainability is important
Climate change is affecting our ability to deliver healthcare
One in 12 healthcare buildings in England operate in flood risk zones and 279 serious flooding incidents occurred at NHS sites across the UK between April 2022 and March 2023. Heatwaves continue to cause multiple issues with hospital IT systems, as well as health impacts on hospital staff and patients.
The delivery of healthcare contributes towards environmental impacts, including climate change
If the global healthcare sector were a country, it would be the fifth largest contributor to climate change (Health Care climate footprint report). The carbon footprint of the NHS in England is equivalent to that of the whole of Croatia (Delivering a ‘Net Zero’ National Health Service report).
Supporting sustainable healthcare can benefit both patients and the wider system
Benefits include reduced environmental health risks, reduced costs and increased resilience of health systems and workforce (WHO's Environmentally sustainable health systems: a strategic document).
How does the environment affect our health and how does healthcare affect the environment?
Environmental impacts arise from production of healthcare materials and from healthcare provision itself. These impacts include:
- greenhouse gas emissions
- air pollution
- water pollution (including with chemicals and pharmaceuticals)
- reduced biodiversity
- waste production.
These impacts contribute to increased health risks, including:
- acute and chronic respiratory conditions (such as asthma and lung cancer)
- cardiovascular conditions (such as heart attacks and strokes)
- neurological conditions (such as epilepsy)
- mental health conditions
- widening of health inequalities
- deaths related to adverse weather events (such as flooding)
- deaths due to extreme hot and cold weather, particularly in vulnerable groups such as babies and older people (for example, there were around 3,000 excess deaths during the heatwaves of 2022 in England).
Commissioners and providers have a moral and legal responsibility to promote an environmentally sustainable health and care system, and engage with the adaptations required for the health infrastructure to cope with the effects of climate change (Health and Care Act 2022).
Support for making healthcare more sustainable increased as participants learned more about healthcare’s contribution to climate change and recognised that environmentally sustainable actions can help reduce burdens on the NHS.
Our commitment to sustainability
Environmental sustainability at NICE is about reducing environmental harms both through how we operate as an organisation and through the information we produce.
Operating as an environmentally sustainable organisation
In 2011, the government made a commitment to include sustainability in all it does, setting targets to reduce emissions across all departments.
We adhere to these Greening Government Commitments to:
- reduce carbon emissions
- minimise waste
- reduce water use
- make sustainable choices about procurement
- support biodiversity and nature recovery
- adapt to climate change
- reduce the environmental impacts of digital working.
We report our progress in these 7 areas to the board annually.
Eco-NICE is our staff network and platform to examine and improve NICE’s internal environmental sustainability. Eco-NICE has been set up by staff, for staff. Membership is open to all NICE staff.
Supporting an environmentally sustainable health and care system
We’ve developed an asthma inhalers decision aid explaining the carbon footprint of different inhaler options for people who would like to think about reducing the environmental impact of their asthma treatment.
We ran a deliberative public engagement dialogue exploring views on our role in making healthcare more environmentally sustainable. The findings have been used to develop recommendations on how we can support the NHS net zero target and environmentally sustainable healthcare. See our NICE Listens page for more information.
We’ve produced an evidence summary on the clinical and resource use impacts of using desflurane – a general anaesthetic agent with a significant global warming potential – compared with other agents in two populations. Our evidence summary informed NHS England’s desflurane decommissioning and clinical use guidance.
In 2023, we conducted an options appraisal to examine the feasibility, benefits and risks associated with different ways that we might request and use environmental sustainability data, with engagement from key system stakeholders. Our findings reconfirmed that the data and analytical standards around environmental impact data about individual healthcare products are not yet sufficient for us to consider sustainability routinely in all NICE technology evaluations. However, we identified several potentially impactful activities worth further consideration in the short term.
One such activity is being taken forward within our Health Technology Assessment Innovation Laboratory (HTA Lab). We’re exploring the feasibility of evaluating the environmental impacts of competing medicines or health technology products that have little or no expected difference in health or cost outcomes. In such circumstances, it may be sensible to prefer the least environmentally harmful option. This kind of evaluation would be consistent with the findings of our NICE Listens dialogue. If we can identify a suitable approach, we’ll look to conduct a pilot evaluation.
We’ve included an environmental sustainability domain in our new NICE-wide topic prioritisation framework. This will ensure that environmental considerations feed into our process for identifying and prioritising new guidance topics and updates to existing NICE guidance.
We regularly engage external stakeholders to share learnings, disseminate our work, and contribute to discussions of direct relevance to our system sustainability work.
For example, we’re members of the NHS Medicines Sustainability Board, a group which identifies and drives cross-system action to support the delivery of medicines sustainability priorities.
We’re also members of the Environmental Learning Group of the International Network of Agencies for Health Technology Assessment, a forum for sharing knowledge and experiences with international peer agencies.
We’ve published peer-reviewed articles, including a paper examining different approaches that an agency like NICE can use to take environmental information into account in healthcare decision making.
Supporting national net zero targets
Our work supports:
