Healthcare sector's hidden carbon footprint: urgent action needed to combat climate change in South Africa

Nearly 5% of the world’s carbon emissions come from the healthcare sector, says a report launched at COP29, the UN’s annual climate change conference on Tuesday – and money for dealing with the disastrous effects of changing weather patterns on people’s health is “urgently needed”. 

But South Africa is not yet a member of a World Health Organization (WHO) group called the Alliance for Transformative Action on Climate and Health, for which plans were put in place in 2021 at COP26 in Glasgow, as a way to help countries make their health services greener. 

Keeping hospitals running adds to the rising level of greenhouse gases in the air, because of the electricity used to power buildings and equipment, fuel needed to transport patients and get supplies delivered and dealing with waste, says Azeeza Rangunwala, coordinator for Africa at Global Green and Healthy Hospitals, a network of people who help healthcare facilities across the world to be more environmentally friendly. 

Burning fuels like coal and oil to generate electricity and making products releases a lot of carbon dioxide into the air. This forms a layer in the atmosphere that traps heat rising up from Earth’s surface after being baked hot by the sun all day. Because the heat can’t escape, the air heats up – much like in a greenhouse – and over time, the air gets warmer and warmer.  

In fact, last year the air temperature was 1.45°C higher than about 150 years ago when the world started burning coal and oil at a large scale to run factories and transport systems such as cars and planes. It’s dangerously close to the 1.5°C rise in temperature that 196 countries, including South Africa, who signed a legally binding agreement in Paris in 2015, pledged not to exceed in order to avoid the catastrophic consequences of more floods, droughts and illness.

But in South Africa, rules about how many types of modern healthcare products are used are essentially blocking simple ways in which hospitals – of which the government runs about 395 – can cut down on how much greenhouse gases caring for patients put into the air. 

Here’s why this is a problem.

Waste from hospitals 

The amount of greenhouse gas the South African economy produces is close to 400 million metric tonnes of carbon dioxide per year (a metric tonne is 1,000kg) and makes up about 1% of the world’s carbon emissions. As a signatory to the Paris Agreement, the country has committed to reducing its carbon emissions to between 350 and 420 million metric tonnes by 2030. 

Research shows that hospital buildings are big energy users because they need a constant power supply to keep the lights and equipment on, keep wards and theatres at the right temperature and to heat water. 

In South Africa, coal for generating electricity makes up 70% to 80% of the fuel the country needs to run, adding about 188 million metric tonnes of carbon dioxide to the air per year. 

Another big contributor to carbon emissions is waste from hospitals, says Rangunwala, because it gets collected from facilities by trucks, travels over long distances, and then, by law, is normally incinerated at high temperature. Both of these things run on diesel. Such items include waste like needles, medicine vials and bandages that have come into contact with blood.

Food and supply deliveries, together with transport for staff to a health facility, add still more greenhouse gas emissions. 

And food that’s left uneaten or thrown away, and which can make up 20% to 30% of a hospital’s waste, adds extra pressure. Not only were the emissions from making and delivering the food unnecessary, but the waste has to be collected and driven away by trucks and then usually gets dumped on landfill sites. Here it breaks down and releases methane, another powerful greenhouse gas, into the atmosphere. 

What is South Africa doing about it? 

Research from the Food and Drug Administration shows that devices such as forceps used during biopsies, drill bits and bite blocks for dental work and some fittings attached to instruments used in surgeries done by camera can be safely sterilised and reused. 

But the South African Health Products Regulatory Authority (Sahpra) does not allow this because the manufacturers’ instructions say that the devices can be used only once.

John Lazarus, head of urology at the University of Cape Town, has, together with other healthcare workers, called for reusing these devices. But without support from the regulator, he says “our hands are tied”.

“Hospitals and individual clinicians would not want to work outside the rules,” he says, and despite the group having met Sahpra on the issue, the regulating body “has been slow to make a decision”.

Another way to lower the health sector’s carbon emissions is to build so-called green hospitals. These are buildings that run on, for example, solar power instead of electricity generated from coal, or have been designed to benefit from sunlight instead of switching on lights, or using materials that keep buildings naturally cool in summer and warm in winter. 

New public facilities like the Khayelitsha and Mitchells Plain hospitals in the Western Cape are examples where this works.

Spokesperson for the province’s health department, Dwayne Evans, says that through their energy-saving programme at pilot sites such as the Red Cross Children’s Hospital and Paarl Hospital, the department has saved about 4,000 tonnes of carbon dioxide emissions since 2022 — equal to about 13,750 homes not having to rely on electricity from coal for a year.

But getting the health sector on board to change how they work and so help slow climate change may prove difficult. 

Says Lazarus: “In general the motivation to transform health for sustainability is not well established in South Africa.” DM

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.