CSH Sustainable Guide to Public Health

This guide intends to provide information, guidance and best practices for sustainable Public Health. The study of sustainable healthcare is an emerging and constantly evolving field, and information in this guidance is checked and updated regularly, but please see our wide range of resources, projects and academic articles for latest developments in specific fields.

Table of Contents

Introduction
Sustainable healthcare
- What is sustainable healthcare?
- What are the CSH Principles Of Sustainable Healthcare?
Sustainable public health
Appendices/Further Reading

Introduction

Climate change is not just a threat to the planet, it is also a significant risk factor for human health too, with over 250,000 excess global deaths a year directly attributed to it.

All healthcare institutions and professionals across the sector have a duty to mitigate the impact of climate change on human health and incorporate more sustainable methods into their daily practice. For this reason, CSH has developed this Sustainable Guide to Public Health to give all professionals the tools, information and inspiration they need to make healthcare more sustainable.

Sustainable healthcare

What is sustainable healthcare?

Sustainable healthcare meets the needs of our populations, without damaging the health or ability to meet the healthcare needs of vulnerable people now or in the future.

Our health depends on natural systems, which provide a stable environment, air, water, food and other ingredients essential to life. The global climate and nature crisis is a health crisis, and healthcare is part of the problem. To be sustainable, healthcare systems must not only look after their workforce and spend wisely; they must stop harming nature and keep within environmental limits.

We can work towards sustainable healthcare by improving Sustainable Value: maximising positive health outcomes and reducing inequity, while minimising negative environmental, social and financial impacts.

What are the CSH Principles Of Sustainable Healthcare?

The CSH Principles of Clinical Practice are used to guide improvements to healthcare design, delivery and best practice. These include:

Prevention – promoting health and preventing disease by tackling the causes and inequalities
Patient self care – empowering patients to take a greater role in managing their own health and healthcare
Lean service delivery – streamlining care systems to minimise wasteful activities
Low carbon alternatives – prioritising treatments and technologies with lower environmental impacts,

The fifth principle is included when referring to the wider healthcare sector, and is known as The CSH Principles of Sustainable Healthcare.

Sustainable operational resource use – efficient management of buildings, equipment, energy, water and waste.

CSH Principles have shaped and directed thinking in sustainable healthcare, broadening the initial scope from simple buildings, estates and energy use, and highlighting the synergy between improving sustainability and other aspects of care,

As well as being used by CSH as part of the SusQI approach, these principles have influenced frameworks including Care Without Carbon’s ‘Green Impact’, the Greener NHS Framework and many more.

It is these guiding principles on which CSH can help shape legislation, policy and best practice in the wider healthcare industry, and how we can offer advice to specific healthcare professions and specialties on how they can make their own practice more sustainable.

Sustainable public health

Who are public health professionals?

Public health professionals are health, care and social care workers who work to help people and communities live healthier lives. They are comprised of a wide variety of skill sets and roles, and can be found throughout the health and social care sectors at every level.

What Is sustainable public health? 

Public health is a discipline focused on the health and well-being of populations, rather than individuals. It involves the science and practice of protecting and improving the health of communities through education, policy-making, research, and the promotion of healthy lifestyles. Public health aims to prevent disease and injury by addressing a wide range of factors, including environmental, social, and behavioural influences on health.

Sustainable public health is simply a way to adopt more sustainable practices into daily routines, policies and procedures to improve the health of the planet as well as society as a whole.

Sustainable public health is the practice of improving and protecting community health and well-being through sustainable and equitable policies, practices, and initiatives.

Why does sustainable public health matter?

Sustainable public health addresses the root causes of health issues, reduces healthcare costs, and improves the overall quality of life by focusing on preventive care and health promotion. This holistic approach not only benefits the environment but also enhances social and economic outcomes.

Public health bodies and their role

Public health organizations play a crucial role in promoting sustainability by developing guidelines, conducting research, and advocating for policies that support sustainable practices. They are instrumental in setting standards and providing resources for implementing sustainable public health initiatives.

Introduction to sustainable legislation and guidance

The UK is committed to achieving a net-zero National Health Service (NHS) by 2040. Key legislation and guidance driving this mission include the Climate Change Act 2008, which mandates an 80% reduction in greenhouse gas emissions by 2050, and the NHS Long Term Plan, which emphasizes the importance of sustainability in healthcare. Additionally, the Greener NHS campaign, launched in 2020, sets out specific goals for reducing the carbon footprint of healthcare services. The NHS Carbon Reduction Strategy and the subsequent NHS Net Zero Plan outline comprehensive measures for achieving these targets, including improvements in energy efficiency, waste management, and sustainable procurement.

What sustainable guidance do public health professionals need to know about?

The Sustainable Development Unit (SDU) is an organisation founded by NHS England and Public Health England to work across the entire health, public health and social care system.

The SDU’s Sustainable Development Strategy for the Health, Public Health and Social Care System was launched in 2014, with the aim to reduce carbon emissions, protect natural resources and promote healthy lifestyles and environment.

The Sustainable Development Management Plan published by the SDU every four years aims to provide a roadmap to improve the social, environmental and financial performance of Public Health England, whilst aligning with the National Cross System Sustainable Development Strategy for the NHS, Public Health and Social Care System.

It sets out five guiding principles that will form the basis for all government policy settings across the UK to be considered as sustainable. These include:

Living within environmental limits

Ensuring a strong, healthy and just society

Achieving a sustainable economy

Promoting good governance

Using sound science responsibly

Public Health England also publishes regular Sustainability in Public Health England Reports that highlight Public Health England’s carbon footprint, its impact on the environment and what steps it is taking to minimise that impact.

Understanding sustainability in public health 

To bring sustainability and healthcare together in a comprehensive way, it must be addressed at the level of public health measures. When efforts to reduce carbon impact and increase sustainable practices across environmental, social and economic factors, then holistic solutions can be found to improve outcomes for the patient and the planet.

The role of public health professionals in sustainable healthcare

Public health professionals are dedicated individuals working across various roles to safeguard and enhance the health of populations. These professionals come from diverse disciplines and contribute to the field in unique ways, but they all share the common goal of preventing disease and promoting health within communities.

Epidemiologists play a critical role in understanding the patterns and causes of diseases by studying how they spread and identifying risk factors. They conduct research, analyze data, and collaborate with policymakers to develop strategies and interventions to prevent disease outbreaks.

Public health educators focus on raising awareness and educating the public about health issues through programs and campaigns. They create educational materials and organize workshops to promote healthy behaviors like vaccination and physical activity.

Environmental health specialists assess and manage environmental factors affecting human health, such as pollution and food safety. They conduct inspections, enforce regulations, and advocate for policy changes to reduce health risks from environmental exposures.

Biostatisticians apply statistical methods to analyze health data and evaluate the effectiveness of public health programs. They design studies and interpret results, providing evidence-based insights that inform public health decisions.

Health policy analysts research and evaluate policies impacting public health and advocate for changes to improve health outcomes. They analyze legislation and collaborate with government agencies and advocacy groups to ensure policies are evidence-based and equitable.

Community health workers serve as liaisons between health professionals and the community, providing outreach and education. They help individuals access healthcare services and address cultural and social factors affecting health.

Public health nurses deliver healthcare services focused on prevention and wellness, conducting health screenings and administering vaccinations. They work directly with individuals and communities to promote healthier lifestyles through personalized care and education.

Global health professionals address health issues affecting populations worldwide, especially in developing countries. They implement health programs, conduct research on global trends, and respond to health emergencies to promote equitable access to healthcare.

Public health professionals are ideally positioned to lead sustainable changes by educating communities, advocating for sustainable policies, and implementing eco-friendly practices. They can influence policy, conduct research, and design programs that integrate sustainability into public health.

Implementing sustainable practices in public health settings

Basic Principles

Prevention

Public Health professionals should focus on preventive measures to reduce the incidence of diseases and promote healthy lifestyles. In some cases this may require societal or governmental policy change, but for those who work in a public facing role, preventive medicine and health promotion are vital. Some examples of preventive measure include:

Promotion of Active Transportation: Encourage walking, cycling, and the use of public transportation over private vehicles. Public health campaigns can promote the health benefits of active transportation, such as reduced obesity and improved cardiovascular health. Reducing reliance on cars decreases greenhouse gas emissions, contributing to cleaner air and a healthier environment. This also leads to fewer respiratory illnesses, reducing healthcare burdens.

Healthy and Sustainable Diets: Promote diets that are both healthy and environmentally sustainable, such as plant-based diets whilst maintaining patient choice. Public health professionals can run campaigns highlighting the benefits of eating healthier, eating more fruit and vegetables and supporting local food production. A shift towards plant-based diets can reduce greenhouse gas emissions from livestock production, conserve water, and decrease deforestation. This contributes to climate mitigation while reducing diet-related diseases like heart disease and diabetes.

Promote social prescribing: Social prescribing is essential to a true person centred care approach to healthcare, and can link patients to a wide range of local charities, activities, groups and services in their local area that can help improve their mental and physical health, reducing the individual need for further NHS services and reducing the financial and logistical burden on the NHS at the same time.

Promote Public Gyms and Exercise: Regular exercise has been proven to reduce the risk of a wide variety of diseases, including heart disease, diabetes, stroke and a wide variety of cancers. It can also help improve a range of mental health conditions such as anxiety or depression, improve mood and confidence and increase general health and wellbeing. Doctors or other healthcare professionals can refer patients tp any one of the many exercise referral schemes throughout the UK, and this is something that should be encouraged far more widely.

Promote Green Social Prescribing: Green social prescribing is all about supporting people to engage in nature based interventions. Activities such as walking or hiking in the fresh air are proven methods for improving mental and physical health, and are easily accessible and cost effective for the majority of people.

Urban Green Spaces: Advocate for the development of parks and green spaces in urban areas. These spaces can be used for community activities and exercise programs, which promote physical and mental health. Urban green spaces help to cool cities, reduce the urban heat island effect, and improve air quality. They also encourage physical activity, reducing chronic disease rates and associated healthcare costs.

A useful resource is the UK Tree Equity Score developed in partnership with CSH’s own NHS Forest project. This free online tool has been developed to help people across the UK identify neighbourhoods that can benefit most from increasing tree cover.

Green Spaces On Healthcare Sites: The NHS and other UK healthcare providers are uniquely positioned to help address low tree and vegetation cover within the communities they serve by developing green spaces on their own land. The NHS Forest project run by the Centre for Sustainable Healthcare supplies fully funded trees and advice to UK healthcare sites. The project also aligns with food security and healthy eating strategies through the planting of orchards on healthcare sites.

Education

Public health professionals have an essential role in educating the public about sustainable health practices and the importance of a healthy environment and can do so through many different routes.

Climate and Health Literacy Programs: Public health professionals have a vital role in helping to develop educational programs that link climate change with health outcomes, emphasizing the importance of sustainable practices. Public health professionals are often directly public facing, and can utiise workshops, online courses, and community seminars to reach diverse audiences. Improved literacy in this field can help individuals understand the interconnectedness of climate and health, leading to behaviour changes that reduce carbon footprints, such as conserving energy and choosing sustainable products.

Public Awareness Campaigns on Environmental Health: Public health professionals can help launch and deliver message specific campaigns that educate the public about the health impacts of climate change, such as air pollution and extreme weather events. Through these campaigns, they can provide tips for reducing personal environmental impacts and will help change behaviours in subtle ways through increased awareness, leading to more environmentally conscious actions such as reducing energy consumption and waste. This contributes to climate mitigation efforts and fosters healthier communities.

School-Based Education on Sustainability: Integrate sustainability topics into school health curricula, teaching students about the impact of climate change on health and the importance of sustainable living practices. Educating young people installs sustainable habits early on, leading to long-term environmental stewardship and health benefits, such as reduced chronic disease prevalence.

Collaboration: Work with other sectors to address the social determinants of health and promote a holistic approach to community well-being

Partnerships for Sustainable Infrastructure: Work with urban planners, government agencies, and private sectors to develop sustainable infrastructure, such as green buildings, renewable energy projects, and efficient public transportation systems. Sustainable infrastructure reduces carbon emissions and enhances resilience to climate impacts, leading to healthier communities with improved air quality and reduced exposure to climate-related health risks.

Community Engagement in Climate Action: Engage community members in climate action plans that focus on health co-benefits, such as reducing emissions through local food production or enhancing green spaces. Community involvement ensures that climate actions are relevant and supported, leading to greater adoption and success of sustainability initiatives. This creates healthier, more resilient communities.

Environmental Sustainability 

Reducing Waste:

Reducing waste in the public health sector is critical for minimizing environmental impact. Effective waste reduction strategies begin with proper waste segregation. Public health facilities can implement comprehensive training programs to educate staff on identifying and separating different types of waste, such as organic, recyclable, and hazardous materials. Clearly labelled bins should be placed in accessible areas to ensure that waste is disposed of correctly. By doing so, facilities can significantly reduce the amount of waste sent to landfills and improve the efficiency of recycling efforts. Additionally, public health facilities can implement robust recycling programs by partnering with local recycling companies. These partnerships ensure that recyclable materials, such as paper, plastic, and glass, are collected and processed regularly. This approach not only conserves resources and energy but also supports the local recycling industry. A significant component of waste in healthcare settings comes from single-use plastics, such as gloves, syringes, IV bags, and packaging materials. To combat this issue, healthcare facilities can explore alternatives like biodegradable or reusable options. For example, glass syringes and metal instruments can be sterilized and reused, reducing reliance on disposable plastic items. In non-clinical areas, such as cafeterias, replacing single-use plastic meal containers and cutlery with reusable or compostable alternatives can make a substantial difference. Public health professionals can play a crucial role by conducting workshops and seminars to educate their peers about the environmental impact of waste and advocating for regulations that support waste reduction initiatives in healthcare settings.

Energy Efficiency: Promoting energy efficiency in public health facilities is essential for reducing greenhouse gas emissions and lowering operational costs. One of the most effective ways to achieve this is by investing in energy-efficient technologies. Facilities can conduct energy audits to identify areas where upgrades are needed, such as lighting, heating, ventilation, and air conditioning systems. Switching to LED lighting and installing energy-efficient HVAC systems can significantly reduce energy consumption. Furthermore, public health facilities can explore the use of renewable energy sources, such as solar panels, wind turbines, and geothermal systems. By securing funding and grants to support the installation of these systems, facilities can decrease their reliance on fossil fuels and reduce their carbon footprint.

Public health professionals can encourage energy efficiency by modelling energy-saving behaviours in their daily operations. Simple actions, such as turning off lights and equipment when not in use and optimizing building temperature settings, can lead to significant energy savings. Training sessions on energy efficiency can help staff understand the importance of these practices, and offering incentives for departments that achieve energy-saving goals can further motivate staff to adopt these practices. By leading by example and promoting a culture of sustainability, public health professionals can make a substantial impact on reducing energy consumption in their facilities.

Sustainable Procurement: Sustainable procurement is an integral part of achieving environmental sustainability in the public health sector. Procurement practices directly affect a facility’s environmental footprint, as they determine the types of products and services used in healthcare delivery. Public health facilities can prioritize purchasing eco-friendly products, such as non-toxic cleaning supplies, recycled paper, and sustainable medical supplies. By establishing relationships with suppliers who adhere to environmental and social responsibility standards, facilities can ensure that their procurement decisions support sustainability goals.

Social Sustainability 

Health Equity: Public health professionals can promote equitable access to healthcare services for all population groups, and address disparities in health outcomes by ensuring that vulnerable and marginalised communities receive the care they need.

Culturally Competent Care: Providing care that respects the cultural, social, and linguistic needs of diverse communities is essential, and public health bodies and healthcare providers can provide the tools, information and training that professionals need to deliver culturally sensitive care.

Community Engagement: Engaging communities in public health initiatives involves conducting community needs assessments to tailor programs to specific health priorities. Educational campaigns can spread awareness about sustainable practices and healthy behaviours through social media, community workshops, and local events. Partnerships with local organizations, including nonprofits, schools, businesses, and faith-based groups, are essential to leverage resources and enhance outreach. The public health sector can improve by fostering collaboration among public health agencies, community organizations, and the private sector, using technology like mobile health apps and telemedicine, advocating for policies that support sustainable practices, and focusing on equitable access to health services.

Economic Stability 

Cost-Effective Practices: Public health professionals are ideally placed to implement practices, optimise resources and reduce unnecessary procedures across the healthcare sector that can reduce the financial burden on healthcare systems whilst maintaining high levels of patient care and make the sector more sustainable. Telemedicine, remote consultations and digital health tools can enhance patient monitoring and reduce the necessity for in-person visits, thereby decreasing hospital admissions and associated costs. Additionally, shifting the focus from hospital-based care to community care can significantly impact cost-effectiveness. By investing in community health programs and primary care services, healthcare providers can address health issues early on, preventing the escalation of conditions that require expensive hospital treatments. Community care models emphasize preventive measures, health education, and chronic disease management, reducing the strain on hospitals and allowing resources to be allocated more efficiently.

Financial Incentives: Those public health professionals who are involved in policy decisions and management can advocate for and implement financial incentives for sustainable practices. Policymakers can support programs that offer financial rewards to hospitals and clinics that achieve specific sustainability benchmarks, such as reducing energy consumption, minimizing waste, and improving patient outcomes through preventive care. The UK’s Carbon Trust for example offers loans and grants to hospitals that implement measures to reduce energy consumption and carbon emissions.

Public health professionals have a vast and still largely untapped potential to make a difference in making the healthcare sector more sustainable, but to do so the focus must shift from what can be done, to what is being done.

Government and public health agencies are well-positioned to implement policies and allocate resources effectively, and have the expertise and infrastructure to deliver targeted interventions; academic institutions can provide evidence-based research and training programs, while community leaders understand local needs and can mobilize community resources. By working together, a practical and realistic approach to sustainable healthcare can be implemented, therefore improving sustainable value: maximising positive health outcomes and reducing inequity, while minimising negative environmental, social and financial impacts.

Developing a Sustainable Action Plan

Setting Goals and Objectives: Goals for any sustainability initiative should be realistic, clear and measurable. Any plan set out to achieve these goals should ensure that all key objectives are specific, achievable, relevant, and time-bound, and those implementing them should be accountable to that criteria.

Effective Planning: Effective planning involves several steps. First, a needs assessment identifies the health needs of the community. Strategic planning then sets goals and objectives based on this assessment. Implementation then requires detailed action plans to achieve these goals, and evaluation monitors and assesses the effectiveness of the interventions.

Identifying Key Stakeholders: Public Health professionals work across the entire health and social care sector at every level and it is not only crucial to identify the right professionals to plan and implement specific public health policies, but also to identify and seek out help and partnerships from wider industries and sectors, including the public and private sector. Healthcare providers, such as hospitals and clinics, play a crucial role. The education sector, including schools and universities, can support health education. Non-profit organizations focused on health and wellness, the private sector through funding and resources, and local governments implementing local health policies are also key partners. All can play a vital role in making healthcare more sustainable.

Monitoring, Reporting and Evaluating Sustainability

Tracking Progress

Regular Audits: Conduct regular audits to assess progress. Audits can include evaluating energy use, waste management practices. For example, an energy audit might involve inspecting buildings for energy efficiency, identifying areas where energy is wasted, and recommending improvements.

Data Collection: Collect data on key sustainability metrics. Metrics might include energy consumption, waste generation, water usage, and greenhouse gas emissions. This data should be collected regularly and stored in a centralized database. Public health departments can use software tools to manage and analyse this data, helping them to identify trends and areas for improvement. Data collection should be overseen by a dedicated sustainability coordinator or team to ensure accuracy and consistency.

Reporting and Review

Transparency: Share progress reports with staff and stakeholders.

Continuous Improvement: Regularly review and update the sustainability plan based on feedback and audit results.

Integrating Sustainability into Public Health Education and Training

Curriculum Development: There are a wide variety of professionals within the education sector that are ideally placed to Incorporate sustainability into public health education programs and ensure that sustainability is at the core of all healthcare training and education. Public health education professionals can ensure that students are trained in sustainable practices and understand the importance of sustainability in healthcare. Curriculums throughout the medical, nursing, pharmaceutical or other professions for example can all easily incorporate topics such as environmental health, sustainable healthcare systems, and the impact of climate change on public health, giving students a deeper and wider breadth of knowledge and understanding.

Training: This initial formal education, incorporated into fundamental curriculums, can be further strengthened by a continuous level of professional development and training that public health professionals can both devise and implement. Workshops, seminars, and online courses for example are just some of the easiest ways to keep public health professionals updated, and specific training can be delivered by various public health bodies and entities. Academic institutions, such as universities and colleges, can offer courses and degree programs focused on sustainability in public health, and employers themselves, including public health departments, healthcare organizations, and NGOs, can offer in-house training and professional development opportunities.

The future of sustainable public health

The future of sustainable public health is promising, with a growing recognition of the need to integrate sustainability into health policies and practices. This involves a shift towards preventive care, reducing the environmental footprint of healthcare facilities, and addressing social determinants of health that contribute to environmental degradation. Innovations in technology and data analytics will also play a crucial role in monitoring and improving public health outcomes in a sustainable manner.

Current legislation is increasingly reflecting the importance of sustainability in public health. Policies aimed at reducing carbon emissions, promoting renewable energy, and enhancing environmental protections are being integrated into public health frameworks. For instance, the UK’s NHS has committed to becoming the world’s first net-zero national health service by 2040¹. Such legislative changes are crucial as they provide the regulatory support needed to implement sustainable practices on a large scale. These policies also encourage collaboration between different sectors, fostering a holistic approach to health and sustainability.