Sustainable healthcare is an approach that seeks to minimise the environmental footprint of health services while enhancing public health outcomes. The healthcare sector, paradoxically, contributes significantly to pollution and climate change, from high energy use and greenhouse gas emissions to the generation of vast amounts of waste and heavy water consumption. 

This white paper explores how greening the healthcare sector can protect both human health and the planet. It provides an overview of healthcare’s environmental impact globally and in India, presents data-driven insights on emissions, waste, and resource use, and highlights success stories of sustainable hospital initiatives. 

Key Findings 

• The global health sector is responsible for nearly 5% of all greenhouse gas emissions, making it a top emitter 

• Healthcare activities produce both hasardous biomedical waste and large volumes of plastic and e-waste 

• Hospitals rank among the most water-intensive institutions 

However, emerging practices – from solar-powered hospitals and green building designs to better waste segregation and water recycling – demonstrate that healthcare can “do no harm” to the environment as well as patients. The paper concludes with actionable steps for policymakers and healthcare administrators, emphasising the “triple bottom line” benefits (social, environmental, economic) of sustainable healthcare. 

In short, investing in sustainable healthcare not only helps build a healthier future for the planet, but also reduces costs and improves health outcomes, creating a win-win for people and communities. 

Introduction: The Case for Sustainable Healthcare 

Modern healthcare exists to safeguard human health – yet ironically, healthcare operations can inadvertently harm health through environmental damage. Hospitals, clinics and the medical supply chain consume enormous energy, generate pollution and waste, and contribute to climate change. 

The World Health Organisation warns that climate change is the single greatest threat to global health in the 21st century, and the healthcare sector itself is a significant part of the problem. For example: 

• Powering hospitals and manufacturing medical products often rely on fossil fuels, leading to carbon emissions that drive climate change 

• Climate change brings heatwaves, floods, and disease outbreaks that strain health systems 

• Improper disposal of medical waste can spread infection or pollute air, water and soil, undermining public health 

The Green Healthcare Imperative 

The imperative behind “going green” in healthcare is to align the sector’s operations with its healing mission. A sustainable healthcare system aims to reduce its environmental footprint by: 

• Cutting carbon emissions 

• Using resources efficiently 

• Minimising waste 

• Preventing pollution 

This ensures healthcare “does no harm” not just to patients, but also to the environment and surrounding communities. 

Global Momentum 

This concept has gained momentum globally in recent years: 

• International networks like Healthcare Without Harm and Global Green and Healthy Hospitals have mobilised thousands of hospitals to adopt eco-friendly practices 

• Dozens of countries (including India) pledged at COP26 to develop climate-resilient, low-carbon health systems 

• Recognition that healthier people depend on a healthier planet 

For the general public, sustainable healthcare boils down to a simple principle: a healthier environment leads to healthier lives. From a policymaker’s perspective, greening healthcare offers co-benefits – reducing operational costs, improving community health, and contributing to national climate goals. 

Healthcare’s Environmental Footprint: Key Challenges and Data 

Energy Use and Climate Emissions 

Healthcare is an energy-intensive sector. Hospitals run 24/7 with power-hungry equipment (MRI machines, ventilators, etc.), climate control systems, and lighting – all necessary for patient care but contributing to a large carbon footprint. 

Global Impact 

• 4-5% of all global greenhouse gas (GHG) emissions come from healthcare 

• If the global health sector were a country, it would rank 5th in GHG emissions (after China, the U.S., India, and the EU) 

• In 2019, healthcare’s climate footprint was estimated at over 2 gigatons of CO₂-equivalent 

• Without intervention, health-related emissions could double by 2050, reaching 6 gigatons per year 

Country-Specific Data 

United States: 

• Healthcare activities responsible for 8-9% of total U.S. GHG emissions 

India: 

• Health sector emissions are about 1.5% of India’s total carbon emissions 

• India ranks among the top 10 countries for absolute healthcare emissions 

• India’s per capita health emissions are the lowest among major economies (only 0.03 metric tons per person) 

• Current health sector emissions roughly equivalent to 10 coal-fired power plants running for a year 

Sources of Emissions 

• 40% from energy generation (electricity and heat) for facilities 

• Large portion from production and transport of medical supplies and equipment (supply chain) 

• Manufacturing oxygen, pharmaceuticals, disposable gloves, and other supplies 

Success Stories :

UK’s National Health Service (NHS): 

• Target to reach net-zero emissions for operations by 2040 

• Supply chain net-zero by 2045 

Kaiser Permanente (USA): 

• Achieved carbon-neutral status by 2020 

• Through on-site solar power, purchasing renewable energy, and energy-saving measures 

Waste Generation – Biomedical, Plastic, and E-waste 

Healthcare activities save lives but also generate a complex stream of waste. Globally, healthcare facilities produce millions of tons of waste each year. 

Scale of the Problem 

United States: 

• Hospitals generate over 5 million tons of waste annually 

• Average in-patient produces about 33.8 pounds (15+ kg) of waste per day 

Types of Healthcare Waste 

Hazardous (Biomedical) Waste (~15%): 

• Infectious waste (blood-soaked materials, lab cultures) 

• Sharps (needles, scalpels) 

• Pathological waste (tissues) 

• Pharmaceutical or chemical waste 

• Radioactive materials 

General Waste (~85%): 

• Comparable to ordinary domestic trash 

• Paper, packaging, food waste 

• Often improperly mixed with hazardous waste 

Plastic Waste Challenge 

• 20-25% of hospital waste by weight is plastic 

• Over 90% of healthcare plastics are not recycled 

• COVID-19 pandemic dramatically increased single-use PPE waste 

• Most plastics end up in landfills or are incinerated 

E-waste Concerns 

• Growing waste stream from electronic medical devices 

• Contains hazardous components (batteries, circuit boards with heavy metals) 

• Globally, e-waste topped 62 million tonnes in 2022 from all sectors 

India’s Context 

• Generates an estimated 600+ tonnes of biomedical waste per day 

• Waste spiked during COVID-19 due to disposable PPE kits 

• Common biomedical waste treatment facilities established for safe processing 

• Challenges remain in rural areas and smaller clinics 

• Push for phasing out mercury equipment and better handling of cytotoxic waste 

Water Usage in Hospitals 

Hospitals are often water-intensive facilities, requiring water for patient care, hygiene, sanitation, facility operations, and research labs. 

Usage Statistics 

United States: 

• Healthcare facilities account for about 7% of total water used by all commercial and institutional buildings 

• Average of 570 gallons of water per bed per day 

• Hospitals rank among top 3 types of buildings for water consumption 

Comparison Context: 

• Average American at home: ~150 gallons/day 

• Average UK resident: ~44 gallons/day 

• Some water-scarce regions of Africa: ~5 gallons/day 

India: 

• Indian standards recommend around 400 liters per bed per day for hospitals larger than 100 beds 

• About 350 L/bed/day for smaller hospitals 

• Many hospitals face water supply challenges during dry seasons 

• Common to supplement municipal supply with borewell water or stored rainwater 

Conservation Opportunities 

Hospitals can reduce water waste through: 

• Installing low-flow faucets and showerheads 

• Using sensor-based taps and flushes 

• Fixing leaks promptly 

• Optimising steriliser and laundry processes 

• Water recycling systems for greywater 

• Rainwater harvesting systems 

Success Example: 

• U.S. hospitals have achieved 20-30% water use reduction through upgrades 

• Saving tens of millions of gallons annually and lowering utility bills 

Sustainable Healthcare in Practice: Strategies and Success Stories 

Green Building Design and Energy Efficiency 

Green hospital design focuses on architecture and systems that reduce resource use through: 

Key Features 

• Optimised insulation and ventilation 

• Energy-efficient lighting (LEDs, occupancy sensors) 

• High-efficiency HVAC systems 

• Maximisation of natural daylight 

• Sustainable materials (low-VOC paints, recycled content materials) 

Benefits 

• 30% or more reduction in energy consumption compared to conventional designs 

• Some achieve up to 50% savings with state-of-the-art technologies 

• Improved patient well-being (studies suggest faster recovery with natural light and nature views) 

• Cost savings: every $1 saved on energy = $20 in new revenue for nonprofit hospitals 

Case Examples 

Tata Memorial Hospital (India): 

• ACTREC in Navi Mumbai launched three-phase solar project 

• Projected to save over ₹10 million annually in energy costs 

• The first phase alone saves about ₹5 million in first year 

Fortis Healthcare (India): 

• Achieved 3.4% reduction in per-bed energy consumption 

• 8.4% reduction in per-bed water usage in one year 

• Created dedicated ESG departments in Mumbai hospitals 

Renewable Energy and Clean Power Supply 

Switching to renewable energy tackles the biggest piece of the emissions pie through 

Implementation Methods 

• On-site generation (solar PV panels, wind turbines) 

• Purchasing green power from grid or through power purchase agreements 

• Using backup generators that run on biofuel instead of diesel 

Solar Success Stories 

India: 

• “Solar for Hospitals” programs in states like Chhattisgarh and Karnataka 

• Solar panels on Primary Health Centers (PHCs) ensuring uninterrupted power 

• Assam’s solar rooftop systems on boat clinics for remote communities 

• AIIMS Delhi: 1 MW solar plant and solar water heaters 

• Holy Family Hospital Delhi: 50% reduction in lighting electricity use 

Global Examples: 

• Over 14,000 hospitals in 26 countries committed to halving emissions by 2030 

• Bhutan powers hospitals entirely on hydroelectricity 

• Norway’s hospitals mostly use grid hydropower 

Sustainable Waste Management Practices 

Managing waste sustainably means reducing generation, improving segregation, and proper treatment. 

Waste Reduction at Source 

• Switch from disposable to reusable instruments where appropriate 

• Reform procurement (bulk buying, minimal packaging) 

• Replace disposable items with reusable alternatives 

Segregation and Recycling 

• Color-coded bins for different waste types 

• Training staff from nurses to housekeeping 

• Recycling programs for paper, cardboard, and uncontaminated plastics 

• Organic waste composting (hospital cafeterias and patient food waste) 

Safe Treatment and Disposal 

• Modern autoclave-microwave shredding systems (alternative to incineration) 

• Chemical disinfection for liquid waste 

• High-temperature incineration or take-back programs for pharmaceutical waste 

Success Example – Cooper Hospital, Mumbai: 

• Started vermi-composting kitchen waste on-site 

• Significantly reduced garbage sent to dumps 

• Produces compost for landscaping 

Water Conservation Measures 

Comprehensive water conservation approaches include: 

Technical Solutions 

• Water-efficient fixtures (low-flow taps, dual-flush toilets) 

• Optimising cooling and HVAC systems 

• Laundry and sterilisation efficiencies 

• Rainwater harvesting and reuse systems 

• Water recycling plants for wastewater treatment 

Success Examples 

Apollo Hospitals, Chennai: 

• Sewage treatment plant for water recycling 

• Uses recycled water for gardening and chiller operations 

• Reduces freshwater consumption by millions of liters annually 

Vistex Hospital, Bihar: 

• Rainwater harvesting system channels rain to ground recharge pits 

• Part of comprehensive sustainability design

Sustainable Procurement and Safer Materials 

Using purchasing power to drive environmental change through: 

Green Procurement Practices 

• Choosing environmentally preferable and non-toxic products 

• Biodegradable cleaning agents 

• Products with recyclable packaging 

• Energy-efficient medical devices 

• Absence of toxic substances (PVC-free IV bags, mercury-free devices) 

Pharmaceutical Considerations 

• Lower-impact anesthetic gases 

• Transitioning to dry-powder inhalers 

• Some hospitals cut anesthesia gas emissions by 80% through substitution 

Culture of Sustainability and Education 

Building awareness and engagement among healthcare workers and administration: 

Organisational Approaches 

• “Green Teams” or sustainability committees 

• Staff campaigns and competitions 

• Integration of environmental health into “do no harm” principle 

• Patient and visitor education programs 

• Community outreach and health camps 

Case Studies: Success Stories from Global and Indian Contexts 

Vistex Hospital, Bihar (India) 

Profile: 50-bed rural hospital designed with sustainability at its core 

Initiatives: 

• 14 kW solar system meeting ~60% of energy needs 

• Green building design maximising natural light 

• Agri-biopanel materials construction 

• Two 200L composters for kitchen garden 

• Rainwater harvesting system 

Results: 

• 58% reduction in energy consumption and cost 

• Saving about ₹7.8 lakh (over USD 10,000) annually 

• Demonstrates smaller hospitals can achieve significant sustainability gains 

Private Urban Hospital, Mumbai (India) 

Phased Approach: 

1. Phase 1: Motion-sensor lights in less-used areas 

• ₹2.5 million saved in electricity costs in one year 

2. Phase 2: Hospital-wide LED lighting upgrade and AC optimisation 

• Improved patient comfort with better lighting ambiance 

3. Phase 3: Water conservation (leak fixes, aerators) 

• 8.4% drop in water use per bed 

4. Phase 4: Enhanced waste segregation training 

• 10% reduction in biomedical waste volume through better recycling 

NHS Great Ormond Street Hospital, London (UK) 

Children’s Hospital Retrofit: 

• Combined heat and power (CHP) plant installation 

• “Switch it Off” behavior change campaign among staff 

• 10% reduction in electricity consumption 

• PVC plastic recycling pilot program (IV bags, oxygen masks) 

• Demonstrates that historical, space-constrained hospitals can innovate 

Kaiser Permanente Health System, USA 

System-wide Transformation: 

• 39 hospitals and 700+ clinics achieving carbon neutrality by 2020 

• Large-scale solar installations (tens of megawatts) 

• Wind and solar energy purchases 

• $10 million saved in annual energy costs through conservation 

• 40% of waste diverted from landfills 

• Phased out single-use foam and PVC where possible 

• Integrated sustainability into healthcare quality metrics 

Key Takeaways 

1. Healthcare’s Environmental Impact is Significant 

• Global health sector: nearly 5% of GHG emissions 

• Major contributor to climate change 

• Generates over 5 million tons/year of waste in the U.S. 

• Among top water-consuming sectors (7% of institutional water use) 

2. The Problem is twofold 

Direct Operations: 

• Hospital energy use (heating, cooling, electricity) 

• Waste incineration and anesthetic gases 

Supply Chain: 

• Manufacturing of medicines, devices, equipment 

• Transportation and distribution 

• Often forms the bulk of a hospital’s carbon footprint 

3. Huge Potential for Improvement 

• 20-30% (or more) reductions in energy and water use readily achievable 

• Hazardous waste volumes can be cut through better segregation 

• 50-60% of power can be met with solar in many locations 

• Many changes pay for themselves through cost savings 

4. Sustainable Practices Benefit Health Directly 

• Reduces pollution (cleaner air, less toxic waste) 

• Safeguards resources (water availability, clean environments) 

• Improves patient experience (natural light, green spaces) 

• Better indoor air quality benefits patients and staff 

5. Global Momentum is Building 

• Over 80 countries (including India) committed to greening health systems 

• Networks like ATACH share best practices globally 

• Leading institutions setting ambitious net-zero targets 

• Sustainable healthcare becoming mainstream 

6. India’s Dual Challenge and Opportunity 

• Healthcare sector expanding to serve population needs 

• Per capita health emissions are low, but absolute footprint significant 

• Opportunity to build green infrastructure from the start 

• Solar-powered PHCs and energy-efficient hospitals proven feasible 

• Can improve healthcare access while meeting climate goals 

Recommendations and Actionable Steps 

For Policymakers, Hospital Administrators, and Healthcare Professionals 

1. Conduct a Sustainability Audit 

• Measure current energy use (per square meter or per bed) 

• Assess water use and waste generation rates 

• Calculate carbon footprint of facility or health system 

• Identify “hot spots” for improvement 

• Use benchmarking tools like Energy Star Portfolio Manager 

2. Develop a Green Action Plan with Targets 

• Create multidisciplinary green team 

• Address key areas: energy, water, waste, procurement, transport, infrastructure 

• Set specific, time-bound targets 

• Align with broader climate and cost-saving goals 

3. Implement Energy Efficiency and Clean Energy Projects 

Low-hanging fruit: 

• Swap to LED lighting 

• Preventative maintenance of HVAC systems 

• Smart controls for lighting and AC 

Renewable energy: 

• Install solar panels (start with pilot projects) 

• Investigate government schemes and incentives 

• Purchase green power where available 

• Consider efficient backup generators or battery storage 

4. Optimise Water Use 

• Retrofit with low-flow fixtures 

• Fix leaks diligently 

• Adjust laundry and sterilisation practices 

• Install rainwater harvesting systems 

• Implement water treatment for greywater reuse 

5. Strengthen Waste Management and Reduction 

• Train all staff on waste segregation 

• Use clearly labeled color-coded bins 

• Partner with authorised biomedical waste handlers 

• Move toward reusable textiles where appropriate 

• Set up recycling streams for paper, cardboard, and plastics 

• Implement take-back programs for electronics and medications 

6. Sustainable Procurement Policies 

• Source green certified products 

• Include environmental criteria in vendor selection 

• Opt for products with less toxic components 

• Buy locally manufactured supplies where possible 

• Ask suppliers about recyclable packaging and take-back programs 

7. Engage and Educate Healthcare Staff 

• Provide education sessions on environmental impact 

• Empower department champions 

• Run inter-departmental sustainability competitions 

• Include frontline clinicians in identifying greener alternatives 

• Make sustainability part of daily operations 

8. Include Sustainability in Healthcare Quality Metrics 

• Track carbon emissions per bed 

• Monitor waste reduction progress 

• Integrate into hospital accreditation standards 

• Create recognition programs for sustainability excellence 

• Make environmental performance a quality indicator 

9. Collaborate and Share Best Practices 

• Join local and international green healthcare networks 

• Share successes and challenges with peers 

• Learn from global case studies 

• Pool resources for renewable energy or waste treatment 

• Participate in industry sustainability initiatives 

10. Plan for Climate Resilience 

• Develop emergency plans for extreme weather 

• Ensure backup power systems (solar + battery) 

• Design new facilities in safe locations 

• Use materials that withstand climate stresses 

• Build adaptive capacity for changing conditions 

Conclusion 

Sustainable healthcare represents a fundamental shift toward aligning the healthcare sector’s operations with its core mission of healing. The evidence is clear: healthcare systems worldwide can significantly reduce their environmental footprint while maintaining—and often improving—the quality of care they provide. 

The journey toward sustainability offers a triple bottom line of benefits: 

• Environmental: Reduced emissions, waste, and resource consumption 

• Economic: Lower operational costs and improved efficiency 

• Social: Healthier communities and enhanced patient experiences 

As healthcare leaders embrace these practices, they join a growing global movement that recognises a fundamental truth: to heal people, we must also heal the planet. The time for action is now, and the path forward is clear. Every hospital, clinic, and healthcare system has the opportunity—and responsibility—to build a healthier future for current and coming generations. 

The transformation of healthcare into a sustainable, regenerative force is not just possible—it is essential. And as the case studies and examples throughout this white paper demonstrate, it is already happening around the world.