Reimagining Tomorrow’s Hospitals

How to Reduce the Carbon Fingerprint to Achieve Harmony Between Health and Sustainability

Hospitals protect public health but are responsible for 4.4% of global greenhouse gas emissions. Sustainable practices, such as using ScopeCO2 to measure carbon footprints, allow hospitals to identify their impact sources, structure a strategy to reduce their carbon footprint and transition towards a more environmentally sustainable facility. Practical strategies adopted by La Paz Hospital in Madrid include renewable energy, sustainable mobility and waste management improvements, and aligning operations with climate goals.

Key Points

• Hospitals account for 4.4% of global greenhouse gas emissions, requiring urgent action.
• Measuring carbon footprints is vital for identifying and reducing emissions in healthcare.
• Sustainable practices include renewable energy, waste management and mobility plans.
• Tools like ScopeCO2 help hospitals track and mitigate their environmental impact.
• Decarbonisation aligns healthcare with climate resilience and global sustainability goals.

Sustainability is a priority in the current context, where healthcare systems face significant challenges related to climate change, resource depletion and the increase in waste generation. In this scenario, hospitals play an essential role in society by taking care of people's health; however, they paradoxically contribute significantly to the global environmental footprint. The healthcare sector is estimated to generate approximately 4.4% of global greenhouse gas emissions.

Embracing sustainability in hospitals represents both an opportunity and a responsibility to mitigate their environmental impacts while ensuring the continued delivery of essential services. This article explores the importance of integrating sustainable practices into healthcare institutions. By understanding a hospital's carbon footprint, we can adopt better practices aimed at reducing that footprint. This approach also improves care quality, lowers operational costs and strengthens the resilience of healthcare systems.

Introduction

Sustainability has become an increasingly relevant topic in today's world. As we face environmental and social challenges, it is essential to seek ways to transform our lifestyles and systems to ensure a sustainable future for generations to come. Drawing from the definition of sustainable development outlined in the “Our Common Future” report by the Brundtland Commission, sustainable development is understood as “meeting the needs of the present without compromising the ability of future generations to meet their own needs.” (World Commission on Environment and Development 1987) This concept takes on different nuances depending on the focus, scope and political context in which it is addressed.

From a business perspective, the emphasis is on efficient resource management. The environmental approach prioritises the conservation of ecosystems, the responsible use of natural resources and the minimisation of pollution. Meanwhile, the social dimension focuses on improving quality of life, ensuring access to education and healthcare and promoting equitable development. Therefore, a comprehensive approach to sustainable development requires it to be economically viable, environmentally responsible and socially just.

Thus, a sustainable hospital, within the framework of sustainable development, should conduct its operations in an economically viable, socially responsible and environmentally respectful manner (minimising its environmental impact through the efficient use of natural, energy and material resources). To achieve this, it must adopt measures to reduce its carbon footprint, promoting sustainable practices that ensure its contribution to the well-being of the community and the planet.

Towards Sustainable Healthcare Centres: The Importance of Understanding the Carbon Footprint

Hospital infrastructure and its daily operations require significant energy consumption to ensure the continuous functioning of their systems. Medical activities involve the use of specific inputs such as medications, medical equipment, medical gases, chemicals, textiles, office supplies and furniture, among others. This generates a variety of waste, including pathogenic, hazardous or chemical materials, as well as common urban-like waste from administrative activities, kitchens and green area maintenance.

In 2025, with the entry into force of the Kyoto Protocol, net Greenhouse Gas (GHG) emission reduction targets were established for the first time for major developed and transitioning countries. The primary GHG is carbon dioxide (CO₂), whose emissions have increased globally by an average of 1.9% annually over the past 30 years, mainly due to the use of fossil fuels such as coal, oil or natural gas, as well as other industrial processes. In addition to CO₂, other notable GHGs identified in the Kyoto Protocol include methane (CH₄), nitrous oxide (N₂O), hydrofluorocarbons (HFCs), perfluorocarbons (PFCs) and sulfur hexafluoride (SF₆) (Gusi Gil et al. 2024).

For this reason, governments and international institutions are reaching global agreements to guide progress in this area, such as the 2030 Agenda and the Sustainable Development Goals (SDGs), the United Nations Framework Convention on Climate Change (United Nations 1994) (Ministry for Ecological Transition and the Demographic Challenge n. d.) and the Paris Agreement.

The carbon footprint is a parameter that represents the total emissions of CO2 and other greenhouse gases (GHGs) released into the atmosphere, expressed in mass of CO2 equivalent, caused directly or indirectly by a product, organisation service or event throughout its lifecycle. It is important to measure it in order to quantify the main sources of emissions, gain a comprehensive understanding of the organisation’s impact on climate change and serve as the first step in implementing an emissions reduction plan.

Therefore, one of the initiatives of the Strategic Plan for Health and the Environment 2022–2026 Spain (Ministry of Health of Spain 2021) focuses on reducing the health impact of major environmental factors and their determinants. This initiative aims to decrease the burden of diseases caused by them, identify new related threats and facilitate the development of policies on environmental health. A key aspect of this effort is the study of the carbon footprint in the healthcare sector. The goal of the initiative is to reduce morbidity and mortality associated with climate change-related events.

To this end, a tool has been developed to allow stakeholders in the healthcare sector to identify their carbon footprint and devise strategies to reduce GHG emissions and improve their environmental performance as organisations.

The tool, ScopeCO2, is based on Scopes 1, 2 and 3 of the Greenhouse Gas (GHG) Protocol and complies with all methodological criteria necessary to register calculations in the Carbon Footprint Registry of the Spanish Office for Climate Change (MITERD) (Ministry of Health of Spain n. d.). These scopes are listed here:

Scope 1: Direct emissions from sources owned or controlled by the hospital, such as:

1. Consumption of fossil fuels for heating, domestic hot water (DHW), backup generators, kitchens, steam generators etc.
2. Consumption of fossil fuels in vehicles owned by the entity for the transportation of materials, products, waste, employees etc.
3. Consumption of anesthetic gases.
4. Consumption of fire extinguishing gases.
5. Consumption of refrigerant gases (PFCs, HFCs, SF6) due to leaks. Regulation (EU) 2024/573 establishes the periodic inspection of leaks (European Parliament 2024).

Scope 2: Indirect emissions from the consumption of purchased electricity, steam, heating or cooling.

Scope 3: Broader indirect emissions, such as those associated with the supply chain (water, paper, other supplied goods and services), purchases of IT equipment and real estate, waste disposal, transportation-related activities and subcontracted means (e.g., ambulances): staff travel, employee commuting, transportation of purchased materials and sold products, etc.

The calculation is carried out using the framework of the standard "The Greenhouse Gas Protocol, a Corporate Accounting and Reporting Standard” (World Ressources Institute 2004),which is the most widely used standard for calculating and preparing greenhouse gas (GHG) emission inventories. Emissions are calculated based on activity data for the calculation year, applying validated emission factors (e.g., kg of CO₂ per kWh of electricity consumed). In this way, the carbon footprint is determined by multiplying the activity data by the corresponding emission factor.

The primary sources for the emission factors used are updated with those applied by the Spanish Office for Climate Change and the National Commission on Markets and Competition (CNMC) for electricity. These factors are updated annually by the CeroCO2 initiative.

The ScopeCO2methodology enables the identification, quantification and prioritisation of environmental impact areas, assisting hospitals in designing effective strategies to reduce their emissions. This not only contributes to sustainability but also supports resource optimisation and regulatory compliance in the fight against climate change.

Case Study: Carbon Footprint Measurement at La Paz Hospital (Madrid)

La Paz University Hospital is one of Spain's leading healthcare centres, renowned for its excellence in medical care, teaching and research. Located in Madrid, it is part of the Madrid Health Service (SERMAS). Since its inauguration in 1964, the hospital has been a cornerstone of healthcare in the region and the country.

With an approximate area of 170,000 square meters, the hospital features 1,052 beds, 49 operating rooms and specialised units such as ICUs, neonatology, oncology, transplant services and other specialities. It is a leader in several fields, including cardiology, oncology, neurology, neurosurgery, solid organ and tissue transplants, and paediatrics.

In teaching and research, the hospital is affiliated with the Autonomous University of Madrid, facilitating medical training and research projects. It is also a pioneer in healthcare technologies and advancements in medical treatments.

The hospital is undergoing comprehensive renovation under the "Health City" project, which will expand its facilities to over 300,000 square meters. The project includes new infrastructure with private rooms, state-of-the-art operating rooms and enhanced emergency department capacity.

La Paz University Hospital is recognised nationally and internationally for the quality of its care, innovative approach and contributions to medical advancement. This hospital carried out the work of measuring its carbon footprint during 2024, with the results presented in the following Table 1:

Carrying out this exercise has allowed the hospital to establish a strategy for emission reduction, contribute to the SDGs and climate change mitigation as well as optimise its strategy by prioritising actions in specific areas, such as:

• incorporating renewable energy to self-supply the hospital and minimise the carbon footprint;
• establishing a sustainable mobility plan for employees and hospital-associated staff,
• creating a protocol for the disposal of certain anaesthetic gases,
• reducing some in-person consultations, awareness and sensitisation campaigns, etc.

As a result of this emission reduction plan, the hospital aims to reduce its emissions by 2% over the next four years.

Initiatives for the decarbonisation of hospitals

Healthcare companies and the pharmaceutical industry are working on decarbonisation and energy efficiency processes at a rapid pace: by 2030, Europe is committed to reducing emissions by 60%. To support this initiative, actions are being taken to train and raise awareness among professionals about the importance of participating in environmental efforts. Hospitals are implementing various strategies, including obtaining quality certifications like ISO 14001, which require the establishment of an Environmental Management System. This system focuses on material savings, improving environmental practices in the supply chain and reducing waste. Additionally, the incorporation of renewable energy is a key initiative being adopted by hospitals today.

Similarly, there are initiatives like "Sanidad #PorElClima" (Health for the Climate) in Spain, which currently includes nearly 90 hospitals, health centres and health services from various autonomous communities. Another programme is the ATACH (Alliance for Transformative Action in Climate and Health), which seeks to realise the ambition set at COP26 to build climate-resilient and sustainable health systems. It aims to leverage the collective power of WHO Member States (“Member States”) and other stakeholders to drive this agenda forward at pace and scale, as well as to promote the integration of climate change and health nexus into respective national, regional and global plans. Additionally, the MAPIC+s (Environment and Clinical Processes + Sustainable) project focuses on reducing the carbon footprint generated by the National Health System (SNS) and achieving a more sustainable healthcare system (Diariofarma 2024) (World Health Organisation 2022).

Currently, the Ministry of Health is developing an information system for the healthcare carbon footprint. This tool will allow the registration and consultation of results from calculations made by various healthcare centres. The goal is to evaluate the temporal consistency of the data, interpret the results and develop specific strategies and actions for mitigating and preventing greenhouse gas (GHG) emissions (Ministry of Health of Spain n.d.).

Conclusions

Initiatives aimed at the sustainable transformation of hospitals must stem from the need to reduce the use of fossil fuels and improve energy efficiency in hospitals and Primary Care centres. Medical products must be as sustainable as possible, as well as mobility, with the need for staff, patients and visitors to travel in the most sustainable way possible, attending centres as close to their homes as possible to minimise the carbon footprint impact without compromising care.

Hospitals must establish Sustainability and Climate Change Units, structures that become references, catalysts and coordinators of the various measures, plans and actions implemented in these areas. Healthcare centres must also be prepared and capable of addressing the health conditions that will arise as a response to climate change.

This change should lead to an organisational shift and greater efforts toward innovation to adapt to new situations. In this process, healthcare professionals must have the knowledge and capacity to participate and serve as models for these changes and measures.

Conflict of Interest

None