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Role of Health Sector In Climate Change: India Perspective

The health sector has a central role under changing climatic conditions to become both climate-smart and resilient in their operations. Paradoxically, the health sector contributes a significant amount of GHG emissions globally. Emissions through energy and water use, transport, buildings, manufacture, supply and disposal of medical and pharmaceutical products, and waste (biomedical and solid waste) generation and disposal are major contributing factors in the health sector. However, accurately accounting for the contribution of health sector through their emissions to climate change has been a challenge. Furthermore, the carbon footprint of the health sector in developing nations is far less understood as data is currently limited. Most often the figures for developing countries are derived from the GHG emissions of the developed nations. Among developed economies, the health and social care carbon footprint of England was 27.1 Mega tonnes (Mt) CO2e representing about 6.3% of the carbon footprint. In the US, the health sector contributed an estimated total of 546 million MtCO2e of which 46% could be traceable to direct activities. The U.S. hospitals alone contributed to 39% of the total U.S. health sector GHG emissions of which 80% of total global warming potential was due to carbon dioxide emissions . If we consider the U.S. healthcare sector as a country, its GHG emission would rank thirteenth in the world ahead of the U.K. Similarly, Canada’s health sector generated 33 million tonnes of GHG emissions and over 200,000 tonnes of other pollutants directly through the healthcare facilities and from other supply-chains resulting in an estimated 23,000 disability-adjusted life years (DALYs) lost annually. Compared to North America and U.K., the healthcare services in the European region are responsible for 5-15% of the carbon emissions. In the absence of sufficient data, the GHG emissions from health sector in low- and middle-income countries (LMICs) can be extrapolated from the U.S. and European figures. It is assumed that emissions from health sector in LMICs contribute between 3-5% of the country’s total GHG contribution. Considering the accounted data, the carbon footprint of the health sector in LMICs are assumed less capital-intensive. Overall, there is a need to derive the accurate healthcare global contribution to climate change.

Estimating India’s healthcare GHG emissions is a challenge. First, the national-level energy consumption data is not available in the public domain. However, an estimate can be derived from various sources and studies. The Bureau of Energy Efficiency has estimated the energy needs of government hospitals in the urban and rural area consumed which is 750-1500 kWh and 150-300 kWh per bed per year respectively. In comparison, the private hospitals consumed 1000-2000 kWh per bed every year. Converting this to a GHG emission equivalent, on an average hospitals generate 1.3 to 2.7 MtCO2e per bed per year. This is equivalent to one hospital-bed generating GHG emission equivalent to consuming 132 to 264 gallons of diesel per year. Unfortunately, the contribution of GHG emissions from health sector doesn’t end with energy use.

Hospitals produce municipal, hazardous, and bio-medical solid waste and electronic waste. On an average the quantum of waste generated in district hospitals in India is 1.5 to 2.2 kg per bed per day. Most of this hospital-generated waste ends up in municipal landfills increasing the environmental burden. Recent studies reveal that only one-third of the actual waste generated was treated while the rest gets disposed as municipal waste. In 2016, India produced 519.7 tonnes of bio-medical waste per day which is estimated to reach 775.5 tonnes per day by 2022. When compared to global estimates, the quantity of bio-medical waste generated in India is much lower. One of the reasons could be insufficiency of the data on quantification of biomedical waste generated which has much bigger ecological impacts than GHG emissions.

Water plays an important role in day to day healthcare from cleaning to use and disposal in healthcare procedures to creating a soothing environment for patients and healthcare workers. An average Indian hospital consumes 450 litres per person per day. The main source is groundwater through deep bore wells. Not only drawing groundwater is energy intensive, but also the water consumption pattern increases the water stress on already diminishing groundwater levels in India. The availability of potable water is still unmet in many communities of LMICs including in India. The water stress could have negative impacts on health indicators while also contributing to GHG emissions through the energy-use. Efficient water use and disposal in the health sector is therefore critical. Holistically, health sector emissions stand at the crossroad of health and climate. Its impact is specific to climate, some to health, and sometimes both.