CSH@COP26 Day 4: Energy and the transition to sustainable healthcare

COP26 turned its attention to the issue of energy today, with the major issue of coal phase-out dominating most of the mainstream negotiations.  CSH delegates Victoria and Chantelle were joined today by Tamsin Ellis, CSH associate, GP, and Chair of Greener Practice London.

New announcements were made by 23 countries today to commit to phase-out coal power bringing the total to 40.  This comes as countries such as India, South Africa and Indonesia announced a $2 billion partnership with the Climate Investment Fund to move towards clean energy. Financing for coal was also high on the agenda, with historic commitment from countries such as Italy, Canada and the US to end public support for unabated coal by 2022, a decision China, Japan and South Korea have also taken.  This is the first COP where a global step away from channeling public funds to support coal has been taken and represents a $17.8 billion loss for the coal industry. 

Why is this important for health?

Burning fossil fuels is the main driver of climate change, which is already responsible for 400,000 deaths annually. In 2018, fossil fuels accounted for over 80% of global total energy supply-a reduction of less than 5% since 1971. According to the WHO, over 90% of the global population breathe toxic air, largely resulting from the same fossil fuels which are driving climate change. Globally, $5 trillion is spent on treating chronic diseases which are related to burning fossil fuels. Coal phase-out particularly is a classic win-win for climate and health, and any reduction in air pollution related to reducing fossil fuels is likely to bring almost immediate health benefits. Jenni Miller, Executive Director of the Global Climate and Health Alliance was able to get this health message across in an interview with BBC News this morning. Encouragingly, the health argument for climate action appears to be gaining awareness and attention at this year’s COP.

Understanding the rationale for an energy transition

CSH delegates were able to attend an IPCC session which unpacked the most recent climate change science. A particular concern which was highlighted is the potential for a 1.5m sea level rise that could occur from rapid arctic sea ice melting predicted at the point of a 2 degree temperature rise. As pointed about by representatives from Antigua and Barbuda-this would be catastrophic for small island states and coastal regions. Whilst some countries were concerned about the ‘doomsday’ scenarios put forward in the session, there is hope that the more extreme scenarios with the highest temperature rise are low likelihood due to recent and promised energy transitions, but these worst case scenarios-which could see the UK almost entirely underwater-cannot be completely ruled out. 

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Transitioning towards sustainable healthcare systems to reduce health sector carbon emissions

CSH delegates joined a fantastic event on climate-smart healthcare, chaired by Sonia Roschnik, International Climate Policy Director for Healthcare without Harm. Sonia stated that transitioning to sustainable healthcare requires three key elements; people, technology and innovation and systems. 


Fiona Godlee, editor-in-chief of the BMJ set the tone for the session and made a plea that healthcare professionals are educated to understand the crucial link between climate health, so their trusted voices can be used to influence climate policy. Rosamund Kissi-Debrah, whose daughter Ella was the first person in the world to have air pollution listed on their death certificate as a cause of death, also urged that healthcare professionals need to be educated on the health impacts of air pollution to play a key role in educating their patients and the public. IFMSA representatives presented results from a study which showed that globally, 85% of medical schools do not include climate change in the curricula. 

One of CSH’s core demands for COP26 is to develop and fund expertise and infrastructure for the transition to environmentally sustainable healthcare systems, including educating health professionals. CSH’s short courses and QI Education Project are already helping to provide education on sustainability in healthcare and build technical skills and capacity within the workforce. 


Dr Arun Tohani led a discussion on the importance of innovating in sustainability, drawing on the example of switching from polluting anaesthetic gases to those with a lower carbon footprint or even away from gas anaesthesia altogether. Ali Santore, Executive Vice President of Providence Health System which is one of the largest healthcare systems in the USA described how focusing on educating people, streamlining supplies and controlling purchasing had helped to reduce carbon emissions by 7% across the system in only 6 months. 

CSH specifically demands that the health sector leads support in prioritising research into sustainable solutions and integrating sustainability into commissioning, regulation, and legislation.  Ben Whittaker, CSH Associate and Chief Sustainability Officer’s Clinical Fellow at Greener NHS showcased the integral role of Sustainable Quality Improvement as a tool which CSH offers that is already helping to deliver this demand. 


Dr John Balbus, senior health advisor in the US emphasised that sustainable healthcare is that which aims to reduce the amount of healthcare activity being delivered -this forces us to invest in systems which address the causes of disease and ill health including tackling social and environmental inequalities as fundamental. Nick Watts, Chief Sustainability Officer for NHS England emphasised the importance of targets and leadership for achieving sustainability. Greener NHS has already shown global leadership in committing to net zero by 2040 and has already received over £300 million in funding to achieve this; an investment which is likely to see returns in as soon as 3.5 years. 

CSH’s top demand for health and government leaders at COP26 is to invest in the transition to environmentally sustainable healthcare systems to ensure all health systems are net zero by 2040. CSH is already connecting with global partners to support this leadership in other countries, and also offers trusts and healthcare providers technical support in how to reach their decarbonisation plans. 

It is clear that moving towards health system sustainability is going to be crucial for climate mitigation as well as adaptation efforts, and it is encouraging to see this issue being brought to the heart of COP26.