Sustainability in Sexual Health

The NHS is responsible for an estimated 5% of the country’s carbon footprint and approximately 40% of the UK’s public sector greenhouse gas (GHG) emissions. The health system itself contributes to the  climate health crisis and all specialties can reduce the harm they cause. The NHS England’s Delivering a ‘Net Zero’ National Health Service plan, identifies reduction of healthcare-related carbon emissions as a ‘key responsibility of all staff’.

Genitourinary medicine (GUM) encompasses integrated sexual health, contraception, and HIV services. Emerging evidence demonstrates the profound effect climate change will have on GUM, driving illness through increasing risky sexual behaviours and HIV vulnerabilities as well as perpetuating pre-existing health inequalities. Therefore it is our responsibility as clinicians to take preventative measures and transform the way we work now, in order to protect our future.

Sustainable Quality Improvement within GUM

Encouragingly there is already a drive within the speciality to incorporate climate friendly initiatives, many of which adopt the four principles of sustainable healthcare as outlined by the Centre for Sustainable Healthcare (CSH).

  1. Prevention

    The concept of tackling ill health through preventative strategies is already a cornerstone of GUM. Vaccinations, pre-exposure prophylaxis (PrEP) and contraceptives have transformed the opportunity for better health and empowerment of the population.

    Within HIV, since the advent of less toxic antiretroviral (ART) medication and drive for increased testing, approximately 97% of people living with HIV (PLWH) in England are on ART and virally suppressed, meaning their HIV is untransmittable. As clinicians managing an increasingly ageing population of PLWH our focus now turns to preventing and managing common comorbidities including cardiovascular disease, diabetes and declining liver and kidney health. By identifying risk factors early, managing comorbidities effectively and preventing further complications we can avoid further environmental, financial, and social costs. 

    Source: The ‘triple bottom line’ framework for sustainable quality improvement, Centre for Sustainable Healthcare

  2. Patient self-care

    The COVID-19 pandemic and recent Mpox outbreak created new treatment challenges, and resulted in greater levels of patient self-care and remote management. Within sexual health, home-testing kits eased the pressure on services and allowed the public to test, and in some cases receive treatment, for non-complex sexually transmitted infections without having to travel into clinic. This has also empowered asymptomatic patients to test outside of the pressures and demands of their local sexual health centre. 

  3. Leaner systems

    Another sustainable remnant from pandemic-related transformations was the rise in remote consultations and telemedicine. However, as services return to normal processes longer-term leaner pathways should be explored and embedded.

    An example of this is the winning initiative of the 2022 CSH Green Teams Competition by Northamptonshire Integrated Sexual Health and HIV services (NISHH). They proposed a novel care pathway for ‘very stable’ PLWH proposing annual rather than six-monthly follow-up. It was estimated that this change could result in a potential annual carbon saving of 25,958kgCO2e (equivalent to almost 75,000 miles driven in a car), financial saving of approximately £45,000 and social saving of 200 hours of doctor’s time per year. 

  4. Low carbon alternatives

    Medicines, medical equipment, and supply chains are responsible for the largest proportion of GHG emissions of the NHS. Within GUM, consumables are commonly incorporated in sexual and reproductive health provisions such as contraceptive implants and coil use. 
    In a search for lower carbon alternatives a return to re-usable speculums is being trialled in some sexual health centres. Life-cycle analyses have already established the environmental benefits of reusable stainless steel rather than single-use plastic specula. Feasibility and acceptability of metal specula by patients and clinicians has also been positively received.

    These climate-friendly changes could provide significant carbon, as well as financial and social, savings. Creating a network for like-minded GUM healthcare professionals to collaborate and share experiences on sustainable initiatives could help further and coordinate efforts of implementing greener initiatives nationally. The British Association for Sexual Health and HIV (BASHH) conference in June 2023 may provide a stepping-stone for this.

Source: A driver diagram applying sustainable clinical practice principles within sustainable GUM initiatives, Centre for Sustainable Healthcare

Key Resources 

  • Greener NHS: Aims to share ideas on how to reduce the impact on public health and the environment, save money and reach net carbon zero
  • UK Health Alliance on Climate Change: Aims to coordinate action, provide leadership, and amplify the voice of health professionals across the UK

Learning Opportunities 

Free e-learning modules are available in the UK for all staff groups. NHS England’s e-Learning for healthcare offers 30-minute modules with certification. 

Eight-hour training courses provide mentoring to develop the skills and motivation to implement a low-carbon project in your setting. Courses relevant to GUM include:

A free step-by-step guide to implementing a quality improvement project that includes financial, social and environmental metrics is available at It also offers case study examples.

Meet Your Peers

Peer networks enable international exchange and collaboration on sustainability in healthcare topics.

Learn from Case Studies

The Green Team competition is an award-winning leadership and engagement programme in which teams within a healthcare organisation identify, develop, run, and measure outcomes of SusQI projects. Examples relevant to GUM include:

Climate change poses real and current health risks to the population. It is our collective responsibility as health care professionals to innovate and implement positive change within our workspaces to mitigate this. Considering the four principles of sustainable healthcare; prevention, patient self-care, leaner systems and lower carbon alternatives in future quality improvement and research projects, even when environmental value is not the focus, will help deliver a net-zero NHS.

Guest Author, Dr Ayoma Ratnappuli