At the CleanMed Europe Conference, a session focused on one of the most pressing challenges of our time: how to rapidly and effectively reduce greenhouse gas emissions from health systems. With the acceleration of global warming, it is essential that healthcare contributes to decarbonisation at a scale and pace aligned with the Paris Agreement. The session highlighted practical experiences from two countries—Ireland and Belgium—that have begun implementing the Operation Zero methodology. Their journeys demonstrate both the barriers faced and the progress possible when health systems commit to carbon reduction with clear planning and stakeholder engagement.
Taking Climate Action in the HSE
Roisin Breen presented Ireland’s strategy to drive climate action within its public healthcare system, the Health Service Executive (HSE). As programme manager for the HSE’s climate action initiative, Breen has helped lead the development and implementation of a comprehensive climate action strategy. This strategy includes an infrastructure decarbonisation roadmap focused on emissions from the built environment and supports national targets: a 50% improvement in energy efficiency by 2030, a 51% reduction in energy-related emissions by 2030, and net zero by 2050.
The HSE’s approach is structured around six priority areas: sustainable buildings and green environments, transport and mobility, sustainable procurement, greener models of healthcare, water and waste management and climate adaptation. Ten strategic objectives underpin these areas, with specific frameworks already published for green spaces, sustainable transport, mobility, water conservation and waste. “We’re absolutely delighted to be at the point where we have tangible recommendations (…) and a standardised, systematic approach,” Breen said.
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A significant step was establishing a 2019 baseline for emissions. The results revealed that Scope 3 emissions dominate, accounting for 70.5% of the total footprint. Within Scope 3, pharmaceuticals represented 19%, medical instruments and equipment 7%, and food and catering 6%. The HSE is now moving toward creating region-specific sustainability plans to implement the national frameworks, supported by over 150 local green teams.
Procurement, identified as a major emissions source, is an area of active collaboration and reform. The HSE is participating in an international healthcare procurement group initiated by the NHS and the US, alongside partners in Norway and Australia. Projects within procurement include transitioning to real-time food ordering, offering sustainable diets and adopting more sustainable linens and mattresses.
Greener models of care are also in development, with seven high-level themes to guide care pathways—emphasising prevention, integrated services, local access and low-carbon alternatives. There is a strong training component as well. A mandatory one-hour online module on climate change is being launched for all HSE staff via the HSE Land platform, followed by specialised 30-minute modules for different healthcare settings such as emergency departments and laboratories. Leadership training is also being prioritised, with 170 key leaders already involved.
Breen acknowledged challenges in funding, measurement systems and cultural change. “It can be very difficult to navigate (…) data. Access to data is crucial, and it cuts across all elements of the organisation,” she explained. A partnership with Healthcare Without Harm and Arup produced a detailed emissions baseline and is now informing the development of a national decarbonisation roadmap. The HSE has also launched staff engagement campaigns and participates in the Irish Climate and Health Alliance, whose charter is now signed by 34 health organisations.
Operation Zero – Belgium
Judith Lambert (Project Coordinator, Ministry of Health and Environment, Belgium) presented Belgium’s use of the Operation Zero methodology to develop a national baseline, action plan and roadmap for decarbonising its healthcare sector. Following Belgium’s COP26 pledge to achieve a carbon-neutral health sector by 2050, the initiative was integrated into the third National Environmental Health Action Plan. This plan, published in 2021, includes a specific domain focused on building a resilient, sustainable and carbon-neutral health system.
A working group representing both healthcare and environmental authorities from different Belgian governments coordinated the process. Gathering reliable, representative data proved to be a major hurdle. “We hadn’t foreseen that it would be so difficult to access the data, especially representative data,” Lambert noted. Disparities between regions and inconsistency in data presentation further complicated the process.
Despite these difficulties, the baseline established that healthcare accounts for 9,900 kilotons of CO₂ equivalent annually—about 5% of national emissions. Scope 3 emissions dominate at 86%, with pharmaceuticals accounting for 31%, business services 16.6%, medical equipment 13.7% and food and catering 8%. Hospitals, though responsible for just 35% of healthcare spending, produce 55% of sectoral emissions, underscoring their emission intensity.
The roadmap projected a 61.6% increase in emissions by 2050 under a business-as-usual scenario. Proposed interventions could reduce emissions by 45%, but full neutrality will require further action. Scope 3 remains the largest area of concern and opportunity, as illustrated by a visual model showing supplier decarbonisation as the most impactful intervention.
The accompanying action plan provided detailed recommendations across seven action areas, as well as guidance for improved monitoring and evaluation. However, Lambert warned that budget constraints and divided competencies across Belgian regions present serious challenges. Limited manpower and the need to prioritise actions complicate progress. Still, she emphasised local momentum: “There is already so much being done locally within the healthcare sector… we try to broadcast those, amplify their voice.”
Decarbonising health systems is both urgent and complex. As demonstrated by Ireland and Belgium, success requires strong leadership, clear baselines, stakeholder alignment and coordinated planning. While technical, financial and governance challenges are significant, the Operation Zero methodology offers a replicable framework. With targeted actions, enhanced data collection and sustained collaboration, health systems can become leaders in climate action—working not only to treat illness, but to protect planetary health itself.
Source & Image Credit: CleanMed Europe 2025
