Decarbonizing Health Systems Through Smarter Procurement and Clinical Choices

The report shows that most healthcare emissions come from complex supply chains, and that transforming procurement, clinical practices and product use is essential to achieving a low-carbon, resilient health system. It highlights global examples proving that strategic purchasing, waste reduction and low-carbon clinical alternatives can cut emissions significantly while improving care and reducing costs.

Climate change is reshaping global health, even as research from the World Health Organization, NHS England, the Alliance for Transformative Action on Climate and Health (ATACH), the National Academy of Medicine, the Irish Health Service Executive, the Norwegian Hospital Procurement Trust, Unitaid, and several academic institutions reveals a striking contradiction: healthcare is responsible for about 5% of global greenhouse gas emissions, most of which, up to 80%, originate in the supply chains that manufacture medicines, devices, equipment and everyday consumables. These emissions intensify climate risks that, in turn, strain health systems. The report argues that decarbonizing supply chains is no longer optional but a core strategy for strengthening health resilience and protecting future access to essential care.

Purchasing Power as a Climate Tool

The document frames procurement as one of the most influential levers for driving down emissions. With health systems acting as major global buyers, even modest policy shifts can reshape supplier behaviour. UNICEF’s move to transport vaccines by sea rather than air, cutting emissions by up to 78% and logistics costs by as much as half, demonstrates the potential of coordinated action. Unitaid’s mapping of carbon hotspots in antiretroviral drug manufacturing shows how targeted collaboration can reduce emissions without affecting the availability of lifesaving medicines. The WHO proposes a tiered set of procurement criteria ranging from early-stage to advanced maturity, encouraging suppliers to publicly report emissions, set reduction targets, conduct product-level carbon footprinting and ultimately demonstrate measurable climate progress.

Countries Setting the Pace

Several national health systems have already converted climate ambition into policy. NHS England now requires suppliers on major contracts to publish carbon reduction plans, covering more than 90% of its spending. Norway is finalizing a national net-zero supplier roadmap aligned with international standards, while France has integrated a simplified medicine-specific carbon footprint method into public tenders. Ireland’s Green Procurement Strategic Framework extends sustainability expectations across high-impact categories. These examples illustrate how coherent procurement signals can influence global markets, reduce administrative burden for suppliers and accelerate innovation toward low-emission healthcare products.

Changing How Healthcare Uses What It Buys

Transforming the supply chain also depends on how products are used inside clinics and hospitals. Waste reduction emerges as an immediate, low-regret opportunity. Campaigns targeting excessive glove use, poor medicine stock management, food waste and nitrous oxide pipeline leaks consistently deliver cost savings and emissions reductions. Médecins Sans Frontières’ Wear with Care initiative in Lebanon, which cut glove use by 40%, shows how behaviour-change interventions can reduce emissions while improving clinical practice. Reusable alternatives offer another promising pathway. NHS facilities that replaced single-use gowns with reusable versions achieved substantial reductions in carbon emissions and long-term procurement costs. However, the report stresses that circularity requires supportive infrastructure, from sterilization facilities to revised tendering models that reward durability rather than disposability.

Phasing Out High-Emission Clinical Products

Some of the fastest emission reductions come from switching to low-carbon clinical alternatives. Pressurized metered-dose inhalers rely on propellants with extremely high global warming potential, yet dry-powder inhalers often provide equivalent therapeutic benefits. Desflurane, an anaesthetic gas with an exceptionally large carbon footprint, is already being phased out in multiple countries. Norway has gone further, eliminating high-GWP inhalers from hospital tenders altogether. These interventions reduce emissions, lower waste and in many cases, improve patient technique and clinical outcomes.

The report ultimately concludes that decarbonizing the healthcare supply chain is a structural transformation touching regulation, procurement, clinical practice, research, and professional culture. It calls for harmonized guidelines, investment in innovation, whole-life costing approaches and robust monitoring to track progress. By aligning climate action with the mission to deliver safe, effective and equitable care, health systems can reduce emissions while improving resilience and cost efficiency, ensuring they remain capable of protecting population health in a climate-altered world.