Introduction by Croakey: As financial markets around the world reel from the Trump Administration’s imposition of global tariffs, experts say the implications for climate action are grim.
The trade war will slow the world’s progress towards decarbonisation, writes Associate Professor Rakesh Gupta in The Conversation.
“It is a most uncertain time – both for the world’s economy, and its climate,” says Gupta, an Associate Professor of Accounting & Finance at Charles Darwin University.
Meanwhile, Alison Barrett reports below on two new publications that underscore the urgency of climate action for health:
- A detailed stocktake of the Australian health system’s contributions to the country’s total greenhouse gas emissions in 2021-22
- An examination of the health impacts of a delayed phase-out of coal under the Liberal nuclear plan.
Alison Barrett writes:
Federal, state and territory governments are being urged to support hospitals, local health services, primary care and aged care providers to transition to lower carbon models through targeted funding schemes or grants.
Professor Jennifer Martin, President of the Royal Australasian College of Physicians, told Croakey, “we urge the Federal Government to continue its role in leading the effort to decarbonise the healthcare sector by funding a Climate Friendly Health System Innovation Fund, to support sustainability initiatives at the local health service level”.
In addition, the College calls on the Federal Government to accelerate the shift to zero-emission renewable energy across all sectors, including health, by cutting emissions and supporting affected communities.
These calls to action follow the recent publication of the Estimates of Australian Health System Greenhouse Gas Emissions 2021-22 by the Interim Australian Centre for Disease Control last month. It found the Australian health system contributed to 5.44 percent of the country’s total greenhouse gas emissions in 2021-22.
“This report lays the groundwork for decarbonising Australia’s health system, but measuring emissions is just the start – we need urgent action,” Martin said.
“The report rightly calls for a shift from fossil fuels to renewables in health and aged care. This urgent transition across all sectors is key to slashing health system emissions and reducing climate-related health pressures that burden the system further.”
According to the report, the emissions estimates are a baseline for regular reporting to track progress in achieving the National Health and Climate Strategy’s objective to decarbonise the health system.
The report also found that the Australian health system’s emissions are divided between healthcare services (59% of the total), residential care and social assistance services (33%) and human pharmaceutical and medicinal product manufacturing (8%).
The estimate of Australian health system greenhouse gas emissions includes:
- scope 1 emissions (7%), which are direct emissions, for example, natural gas and liquid fuels from stationary fuel use, anaesthetic gases or fuel use in vehicles owned or leased by the health system
- scope 2 emissions (20%), which are indirect energy-related emissions from purchased energy to support operations
- scope 3 emissions (68%), which are other indirect emission, primarily from purchased goods and services, such as pharmaceuticals and chemicals, food and catering, water, laundry and maintenance.
This report also includes outside scopes (6%) from patient travel to and from health facilities.
Martin said that all stakeholders should use the findings of the report to identify high-impact areas for reduction and work towards addressing these as a priority.
She added that while decarbonisation is a shared responsibility the Federal Government must take the lead on coordination to ensure that progress doesn’t stall.
Adjunct Associate Professor Rebecca Haddock, Executive Director of Knowledge Exchange at Australia Healthcare and Hospitals (AHHA), echoed these sentiments. She told Croakey that the scale of the healthcare sector’s greenhouse gas emissions requires national leadership alongside local and regional action.
She said the findings of the 2021-22 emissions report highlight “an urgent need for policy, funding and practice shifts across the sector”, which should include national sustainability standards for healthcare and incorporating emissions reduction targets into funding models and regulatory frameworks.
Haddock said, “support must also be provided to general practices, community health services and hospitals in adopting lower-emission models of care, including digital health, low-carbon treatments and waste reduction initiatives”.
AHHA calls on the Federal Government to consider sustainability in health policy by:
- setting emissions reductions targets for the health sector and align funding models to incentivise sustainable practices
- strengthening data and accountability through the development of a national framework for monitoring and reporting healthcare emissions, ensuring transparent tracking of progress toward net-zero goals
- building workforce capability through training and provision of resources to integrate sustainability into clinical practice, including guidance on low-carbon treatment pathways.
“Australia’s health system must lead by example in reducing emissions while maintaining high-quality, patient-centred care. The time to act is now,” Haddock said.
Local context important
The report emphasised the importance of understanding local energy practices and fuel availability when developing targeted strategies to reduce emissions and improve energy efficiency in Australia’s health sector.
For example, variation in fuel use across geographic locations significantly affects the emissions profile.
Some rural and remote health facilities still rely on diesel-powered generators as a primary energy source due to a lack of consistent and reliable access to the electricity grid. Victoria relies on natural gas for heating and energy far more than other jurisdictions.
Other challenges noted in achieving a net zero health system include:
- Energy density and heat requirements – for example, boilers in hospitals often need to use high energy density fuels to generate the heat required for sterilisation, space and heating. Adapting renewable energy sources to meet hospitals’ needs is a major focus of current innovation efforts, according to the report.
- Infrastructure and investment – significant up-front investment is required to build the infrastructure for renewable energy.
- Backup and energy security – robust backup systems are required to handle power outages and ensure uninterrupted operation.
The report highlights that desflurane use has reduced in recent years, including by public hospitals in Western Australia in October 2023 and in New South Wales in March 2024. It is being phased out in some private healthcare also.
The report identified gaps in data including on emissions from a wider range of anaesthetic gases, beyond nitrous oxide and fluorinated anaesthetics.
On scope two emissions, the report highlighted the significant amount of energy required to support operations.
“The indirect emissions resulting from purchased energy are a key opportunity for health system emissions reduction, through grid decarbonisation coupled with strategies such as electrification, energy efficiency measures and investment in renewable energy including on-site renewables,” the report said.
On scope three emissions, the report said that the Australian Government has joined a consortium with England, United States, Ireland and Norway to collaborate on decarbonising health system supply chains.
Food and catering are significant contributors to scope three emissions (5.78% of total health system emissions), with meat and dairy products contributing the most, highlighting the opportunity to reduce health system emissions by transitioning to a lower-emissions diet, also associated with improved health.
The COVID-19 pandemic disruptions to supply chains likely affected the estimates for scope three emissions, according to the report.
Further analysis of carbon hotspots
This report builds on previous work by Associate Professor Arunima Malik, Professor Manfred Lenzen, Dr Scott McAlister and Associate Professor Forbes McGain that provided the first overall estimate of greenhouse gas emissions – of seven percent – from the Australian health sector in 2014-2015.
The Interim Centre for Disease Control report notes that different methodologies adopted between the two studies is likely to account for the different emission estimates.
For example, Malik and colleagues calculated their estimates based on how much is spent on the health system, rather than what the health system spends money on (such as consumption of goods and services) combined with emissions estimates from activity-based data sources, as per this report.
Dr Eugenie Kayak, anaesthetist, Enterprise Professor of Sustainable Healthcare at the University of Melbourne and Convenor of Sustainable Healthcare for Doctors for the Environment Australia, told Croakey, “seven years after the carbon footprint of Australia’s healthcare sector was first estimated by Malik et al, a more detailed and updated analysis of greenhouse gas emissions is both welcomed and vital to direct and prioritise the increasingly important imperative to cut the sector’s emissions”.
Kayak added that many parts of the health sector have been working towards their decarbonisation commitments since the Malik et al study, including individual health services and health organisations advocating at state, territory and national levels – such as the call by Doctors for the Environment Australia and the Australian Medical Associations for a net zero healthcare sector by 2040.
Kayak said that “integral to guiding effective, evidence-based decarbonisation of the healthcare sector will however require further analysis of ‘carbon hotspots’ than outlined in the recent Estimates of Australian Health System Greenhouse Gas Emissions, 2021-22 Report”.
She said this included state and territory health departments assisting with more granular estimates for individual health services across all three emission scopes, in conjunction with the necessary legislation and regulations to address these emissions.
In 2025, only all-electric hospitals, with no gas infrastructure, supplied by 100 percent renewable energy and with no nitrous oxide – which contribute over two percent of estimated healthcare service emissions – reticulated piping should be built, according to Kayak.
“However, while there are exemplars of these effective interventions to cut emissions, unfortunately, neither are standard practice across the nation,” she said.
Coordinating efforts
Michelle Isles, CEO of the Climate and Health Alliance, echoed sentiments about targeting carbon hotspots, particularly the 68 percent scope three emissions, and the role of state and territory health departments in reaching net zero.
“Coordinated efforts between public state and territory procurement policies and cooperation with the private and NGO health sectors could align emissions reductions with value of care through procurement,” she said. “We could see significant progress and co-benefits realised including reducing harmful plastics and chemicals from our care.”
Isles told Croakey that many leading suppliers and service providers are at the table working on solutions with government. “For suppliers that are slow to move, clear requirements need to be set by government who have the power to act.”
She said Australia is well positioned to drive emissions reductions within health and provide leadership to other sectors, as it is a highly regulated sector with a workforce that care about safeguarding health.
The report acknowledges that emissions estimates will need to be further refined within industry sectors, and that state and territory breakdowns will also be provided. Isles said this will be critical to gain buy in from health system actors.
“Coordination is key and we need this be resourced – through staff that have the capability and capacity to focus their effort – in regions, where decisions are made based on value of care,” Isles said.
Isles told Croakey that building capacity to track and report progress is also essential and this includes accessible and engaging communications that shows the outcomes of reducing emissions.
“CAHA, through our Global Green and Healthy Hospitals program, has seen the power of amplifying a powerful project that can demonstrate what is possible and how it is contributing to a larger goal and effort. We can see the impacts, we know the opportunities. Let’s act as if our health depends on it,” Isles said.
“Health is on the frontline of climate change impacts and health leaders have a significant stake in driving down the emissions to deliver health services. We value evidence and data to inform our work in health and therefore this new Estimates of Australian Health System Greenhouse Gas Emissions 2021-22 is a welcome report that will improve understanding of our impact.”
Limitations
The 2021-22 health system emissions report highlights some limitations in its methodology, including that the health system emission estimates are based on 2021-22 data when the COVID-19 pandemic was particularly challenging for the health system, affecting workforce, service delivery and supply chains. It is likely that estimates in future years may differ significantly, the report states.
They also note other limitations, which include capital depreciation, the potential for double counting of some emissions which may be counted in another part of footprint calculation, such as social assistance services, and mixed funding arrangements, such as costs involving both construction and the health sector.
The report says future work will focus on addressing the identified limitations to refine emissions estimation methods.
It is also anticipated that future work will involve state and territory governments, and with private providers, to align approaches to health system greenhouse gas emissions estimation and use of the estimates in national reporting.
Health impacts from prolonging coal
Meanwhile, academics have found that under the Liberal’s proposed nuclear plan, the prolonged use of coal-fired electricity will lead to substantial preventable harms to human health across Australia.
Dr Thomas Longden, Senior Research Fellow at Western Sydney University, and Professor Martin Hensher, Henry Baldwin Professorial Research Fellow at Menzies Institute for Medical Research, estimate that prolonging the phase-out of coal under the nuclear plan will result in between 3,000 and 10,000 additional premature deaths, between 3,500 and 9,800 additional premature births/low birthweight deliveries, and between 14,000 and 214,000 additional asthma attacks in children and young people between 2025 and 2050.
“By locking in current levels of coal-fired generation until around 2040, a nuclear future would cause a decade of avoidable death and health damage by failing to reduce air pollution,” Longden and Hensher wrote in a briefing note for a Healthy Conversation webinar hosted by Climate and Health Alliance last week.
At the CAHA event, Ben Munro, Founding Director of Adapta Climate Consulting, said the nuclear transition plan is too slow and too risky for several reasons.
Australia currently does not have a nuclear industry, and uranium and its waste products cannot legally be extracted, handled, enriched or recycled. A nuclear transition plan will require coal and gas investment to be extended into the 2040s or beyond, Munro also said, which as highlighted by Hensher and Longden, will result in significant preventable harms to human health.
“To run with this plan here [in Australia] would be to run the gauntlet with community safety, health and our own utilities,” Munro said at the webinar.
He wrote in a briefing note that it “reportedly takes an average of 15 years to build an SMR [small modular reactor] without any prior requirement to first build a nuclear industry and governance capacity”.
Extending coal and gas will “blow out” Australia’s long-term national emission targets “amidst a global effort to reduce emissions and manage climate change”.
It is possible that the proposed nuclear plan would result in government funding from mitigation and adaptation capacity building to be redistributed, he writes.
Munro says that pivoting to nuclear now would be detrimental to existing renewable project investment, time and future foreign investment. Small modular reactors also require very large volumes of fresh water to operate daily and would likely require additional water infrastructure investment.
Munro also notes that the plan is absent of a detailed feasibility assessment, stakeholder engagement, and consideration of social licence.
Australian Energy Market Operator is currently implementing a renewable energy transition plan and amendments to that plan would be time-consuming and resource intensive.
“It would take years to formally address the feasibility and impacts of the existing nuclear plan from all aspects and jurisdictions from a sitting start – government, technical, commercial, environmental and social,” he writes.
To become more resilient, Australia’s renewable energy policy needs to be more consistent between government changeovers.
“Australia has a vested interest in removing climate pollution, and in the outcomes of global action on climate change because of our people’s increasing exposure to extreme weather and the risks to health,” Munro writes.
Many opportunities exist for Australia to phase out coal and gas and focus on transition to renewables. As of 2025, 40 percent of Australia is powered by renewables, and four million people (15%) have rooftop solar.
New operating schemes including the Future Made in Australia Innovation Fund, Capacity Investment Scheme, Small-scale Renewable Energy Scheme and the Large-scale Renewable Energy Target should enable more investment into renewables, according to Munro.
See CAHA’s ‘Too Risky, Too Slow’ campaign toolkit here.
See Croakey’s archive of articles on healthcare sustainability
