Leading the Global Climate Challenge: Galician Health Service as a Climate Champion

The Galician Health Service (SERGAS) is a global leader in sustainable healthcare, pioneering a Circular Economy strategy to achieve net-zero emissions by 2040. Recognised as a European Climate Champion, it focuses on reducing environmental impact, fostering innovation and training healthcare professionals. Through collaborations and pilot projects, SERGAS integrates sustainability into its operations, aligning with global climate goals and promoting resilient, eco-friendly healthcare systems.

Key Points

• SERGAS leads sustainable healthcare with a Circular Economy strategy for net-zero by 2040.
• It is recognised as a European and global Climate Champion for eco-focused healthcare reforms.
• The strategy includes resource efficiency, eco-design and reducing environmental impact.
• SERGAS partners with global organisations for innovative, eco-friendly healthcare solutions.
• Healthcare training ensures sustainability becomes central to medical practices in Galicia.

What Are Our Reasons to Embrace the Circular Economy?

For over twenty years, the Galician Health Service (SERGAS) has been on a trajectory to transform into a sustainable and resilient health system that meets the future needs of the Galician population. This effort includes a strong commitment to rethinking health through the lens of circularity by developing its own circular economy strategy and achieving net-zero emissions by 2040.

The Galician Health Service is the public health system for the Autonomous Community of Galicia in Spain. It serves a population of approximately 2.7 million residents, along with a transient population of people who visit Galicia throughout the year. These visitors come for various reasons, such as the Camino de Santiago, tourism and seeking refuge from the climate due to the area’s favourable weather conditions. This influx of visitors makes the population multiply exponentially, a factor that must be considered in planning to meet the healthcare needs of both the Galician community and beyond.

The climate crisis is the biggest health challenge that humanity faces today. We are experiencing an unprecedented global situation where air pollution, heatwaves and food security risks are putting our lives at risk. Record temperatures over the past ten years have led to devastating extreme weather events, rising sea levels and melting ice, all driven by unprecedented levels of greenhouse gases. It is worth noting that 2024 was the warmest year on record, with temperatures exceeding pre-industrial levels by 1.5°C.

Climate change is clearly a global public health issue. The well-being of people is the primary goal of the health sector. Therefore, we must also focus on the health of the planet. Urgent action is required across all sectors, including healthcare.

The healthcare sector significantly impacts the environment. At the Galician Health Service, we recognise this issue, which is why we have opted for the Circular Economy as a management model. This approach aims to reduce environmental impact, increase efficiency and reduce greenhouse gas (GHG) emissions, among other initiatives. Our goal is to ensure sustainability in both the healthcare system and our planet.

SERGAS is the largest company in Galicia, operating 365 days a year, 24 hours a day. Taking responsibility for its significant environmental impact, it actively pursues innovative initiatives that promote sustainability.

How Did We Get Here?

The journey of Galician healthcare towards a sustainable and resilient health system began in 2004 with the introduction of the computerised medical record system (IANUS). It continued with the SERGAS strategy for 2010–2014, which marked a paradigm shift by placing the patient at the centre of the healthcare system. Two key projects emerged during this period: Hospital 2050 and InnovaSaúde, the first national initiative for Innovative Public Procurement, with a budget of €90 million.

Starting with the development of eco-hospitals, these efforts continued with the SERGAS strategy for 2015–2020, which focused on improving citizens’ health. In 2018, another step forward was taken with the strategy of humanising healthcare, followed in 2019 by adopting the Circular Economy as a management model. This model aimed to develop the framework for combating climate change and to ensure the sustainability of the Galician healthcare system, highlighting the importance of circularity initiatives that began more than 20 years ago. In June 2023, the Government of the Xunta de Galicia officially approved this strategy.

The SERGAS Circular Economy Strategy serves as a roadmap that highlights the sustainability and resilience of the Galician public health system. It is an open and participatory initiative aimed at people living in Galicia and beyond. The main lines of action outlined in the strategy will position the Galician Health Service at the forefront of policies to be developed by 2030. These policies will promote a new health model based on the circular economy, improving people's lives without harming the planet.

The legislative framework for this strategy is informed by the European Union’s Circular Economy measures and the Circular Economy Strategies of the Governments of Spain and Galicia. This initiative is linked to the global action plan that began in 2015, coordinated by the United Nations under the 2030 Agenda.

As a methodology, we have opted for an open and participatory strategy, forming two working groups: one internal, consisting of representatives of the seven Health Areas and Central Services, and an external group that includes representatives of the three Galician universities (University of Santiago de Compostela-USC, University of A Coruña-UDC and the University of Vigo- UVigo) together with the Clúster Saúde de Galicia (CSG), the Dirección Xeral de Calidade ambiental, sostenibilidade e cambio climático, the Axencia Galega da Industria Forestal (XERA) and the Clúster de la Madera y Diseño de Galicia (CMD).

The start of the strategy was conditioned by the impact of the COVID-19 pandemic, which transformed the working practices into a telematic format. Health professionals had to prioritise patient care while addressing at the same time the pandemic’s impact on healthcare itself. This involved participation in different projects and collaboration with international working groups, including the World Health Organisation (WHO), the Green Hospitals Network (GGHH), Health Care Without Harm (HCWH), the European Commission, the British Embassy and the Spanish Government.

In order to design the strategy, we first conducted a diagnosis of the existing sustainable projects and initiatives in the different health areas. This assessment aimed to highlight these efforts and help promote a culture of sustainability and circularity among health professionals, patients, their families, companions and suppliers—all focused on achieving circularity.

The essence and justification for the Circular Economy Strategy of the Galician Health Service are based on an open strategy that suggests a network of actions and interconnections among pilot projects. These projects have already begun implementation tailored to the specific idiosyncrasies of each health area, hospital or health centre to achieve a homogeneous implementation throughout the Galician health system. As part of the strategy's design, various pilot projects have been proposed across different health areas, both in hospitals and health centres. These projects aim to facilitate replication and consolidate the defined lines of action.

The actions to be followed within the various strategic axes have been clearly defined, adopting a circular approach rather than a compartmentalised one. This facilitates feedback that can drive progress and help create new paradigms in healthcare. Implementing circularity in the healthcare sector is a priori complex. Still, the diverse projects developed alongside relevant legislation will pave the way for an efficient, sustainable, forward-looking health circularity without waiting too long.

Given the complexity of the healthcare system, a multidisciplinary and holistic strategy has been established to facilitate the transition to circular healthcare. This is an unavoidable challenge that the Galician Health Service has undertaken to ensure the sustainability of the health system as a path towards a healthy and balanced environment for both the planet and its inhabitants.

The strategy is based on five strategic pillars: resources and raw materials, waste and environmental impact, eco-design of processes, research and innovation, and responsible social behaviour.

What Is the Vision of Galician Healthcare?

Our vision is to create a comprehensive healthcare system for Galicia that improves the health of individuals at home, in the workplace and within the community while fostering a healthier planet. The Galician Health Service is leading a project grounded in the WHO's ONE Health concept, aligned with the 2030 agenda to integrate healthcare into all policies. We emphasise the importance of social determinants of health and the impact of climate change, viewing health professionals as agents of change.

We see the health system as the backbone and driver of cultural and social transformation based on sustainability, inclusion and beauty. We rely on initiatives like the United Nations Race to Zero and the New European Bauhaus, which are developments that can be replicated in other regions to achieve social cohesion. Our leadership unites different actors with the same objective: to establish a new way of living, bringing the Green Pact closer to citizens through a holistic vision of health. Notably, the Galician Health Service is the only health service in Europe participating in this initiative of the European Commission.

We are therefore committed to establishing a Circular Health Service that adopts a holistic, resilient and restorative approach. This approach involves implementing the circular economy as a path towards a balanced and healthy environment. It also ensures resilience against extreme climate events to protect people's health and demonstrate leadership in sustainability practices.

In 2019, SERGAS participated in COP25 in Madrid, where it presented its trajectory during the event titled “Resilient Galicia, Community and Climate”. During COP26, SERGAS was involved in a working group within the WHO, contributing to the development of recommendations to address climate crisis as a health crisis. We continue to advocate for the elimination of fossil fuels due to their detrimental impact on health, with SERGAS being the only institution in Spain to sign this charter.

Since 2020, SERGAS has participated in the United Nations “Race to Zero” campaign, aiming for a 60% reduction in emissions by 2030 and achieving net-zero emissions by 2040. It is the only health system in Spain participating in this initiative.

Additionally, since 2019, we have been members of Health Care Without Harm and the global network of green and healthy hospitals. We actively collaborate on projects such as Low Carbon in the Mediterraneanregion, Plastic-free Healthcare in Europe 2.0, Life Resystal, Cool Food Pledge, Procure4health and the Climate Challenge, earning various recognitions over the years. We are proud to have been recognised as a European Climate Champion and one of the seven Climate Champions of the world, as well as having received gold awards for resilience and climate leadership.

What Does It Mean to Be a Climate Champion?

Being Climate Champions in Healthcare in 2024 celebrates our commitment to the Health Climate Challenge. It also gives us an impetus to continue promoting climate-focused policies that protect people's health amid the evolving challenges of a warming world.

This recognition is a testament to the dedication of our entire team, whose passion and hard work continue to drive us towards a more sustainable healthcare future. We aim to lead the way towards a low-carbon, resilient and healthy future, fostering communities that care for people without harming the planet.

The Health Climate Challenge empowers healthcare facilities to commit to climate action and implement tangible strategies that reduce their carbon footprint. We look forward to building on this momentum in 2025 and beyond, joining the global health community to lead the way towards a low-carbon, more resilient and healthier future for all. Our commitment is to create communities that care for people without harming the planet.

We reinforce SERGAS' firm dedication to sustainable development across all areas: social, economic and environmental. This holistic approach is the only way towards a healthy and balanced environment for our planet and its inhabitants.

As the Climate Champion of Europe and one of the seven climate champions globally, we take pride in our efforts, which drive us to continue promoting our work. This complex task requires transversality, which is why we are developing collaborations with other health systems, such as the NHS, and working alongside various agencies, including the Department of Environment and Climate Change. Our goal is to achieve a Climate Neutral Galicia in 2040 in partnership with such organisations as Health without Harm, Green Hospitals, Health for the Climate or the Medical Alliance against Climate Change, among others.

This recognition rewards the dedication of the entire Galician health department in striving for a more sustainable future.

What Are the Next Steps?

We are currently working on certifying SERGAS' carbon footprint using the GHG protocol. Our goal is to actively reduce the carbon footprint of healthcare while preparing for the increasing impacts of extreme weather conditions and changes in the disease burden.

In 2025, we will initiate two new projects. The first of them focuses on the optimisation of the care process for Chronic Obstructive Pulmonary Disease (COPD) from an eco-design perspective. This involves field research on the COPD patient journey, considering clinical, technological, organisational and environmental impacts, while leveraging quantum-inspired technologies and advanced artificial intelligence to enhance the COPD clinical process. The second project is an Interreg initiative aimed at closing the loop on circular medical textiles, facilitating the transition to a circular economy under the name CEMTex.

One of the key pillars to introduce circularity in the DNA of the organisation is the training of healthcare professionals, patients, relatives, suppliers and users in general. We have already initiated training for health professionals on the vital intersection between health and climate change, adopting a tiered approach to sustainability in healthcare. This year, we will expand the programme to include more sector-specific training.

Our goal is to implement train-the-trainer courses so that this knowledge reaches all actors involved. We have started with specific training for anaesthesiologists, pulmonologists and primary care physicians, focusing on inhalers and anaesthetic gases due to the role they play in greenhouse gases emissions and global warming.

Conflict of Interest

None