Environmental sustainability

Climate change is affecting health

The World Health Organisation has called climate change the 'single biggest threat facing humanity' and The Lancet Countdown Report 2022 states climate change 'is undermining every dimension of health monitored'.

Why environmental sustainability is important

Climate change is affecting our ability to deliver healthcare

One in 12 healthcare buildings in England operate in flood risk zones and 176 flooding incidents occurred at NHS sites across the UK between April 2021 and March 2022. Heatwaves in 2022 caused multiple issues with hospital IT systems, as well as health impacts on hospital staff and patients.

The delivery of healthcare contributes towards environmental impacts, including climate change

If the global healthcare sector were a country, it would be the fifth largest contributor to climate change (Health Care climate footprint report). The carbon footprint of the NHS in England is equivalent to that of the whole of Croatia (Delivering a ‘Net Zero’ National Health Service report). 

Supporting sustainable healthcare can benefit both patients and the wider system

Benefits include reduced environmental health risks, reduced costs and increased resilience of health systems and workforce (WHO's Environmentally sustainable health systems: a strategic document).

How does the environment affect our health and how does healthcare affect the environment?

Environmental impacts arise from production of healthcare materials and from healthcare provision itself. These impacts include:

  • greenhouse gas emissions
  • air pollution
  • water pollution (including with chemicals and pharmaceuticals)
  • reduced biodiversity
  • waste production.

These impacts contribute to increased health risks, including:

  • acute and chronic respiratory conditions (such as asthma and lung cancer)
  • cardiovascular conditions (such as heart attacks and strokes)
  • neurological conditions (such as epilepsy)
  • mental health conditions
  • widening of health inequalities
  • deaths related to adverse weather events (such as flooding)
  • deaths due to extreme hot and cold weather, particularly in vulnerable groups such as babies and older people (for example, there were around 3,000 excess deaths during the heatwaves of 2022 in England).

Commissioners and providers have a moral and legal responsibility to promote an environmentally sustainable health and care system, and engage with the adaptations required for the health infrastructure to cope with the effects of climate change (Health and Care Act 2022).

Support for making healthcare more sustainable increased as participants learned more about healthcare’s contribution to climate change and recognised that environmentally sustainable actions can help reduce burdens on the NHS.

Our commitment to sustainability

Environmental sustainability at NICE is about reducing environmental harms both through how we operate as an organisation and through the information we produce.

Operating as an environmentally sustainable organisation

In 2011, the government made a commitment to include sustainability in all it does, setting targets to reduce emissions across all departments.

We adhere to these Greening Government Commitments to:

  • reduce carbon emissions
  • minimise waste
  • reduce water use
  • make sustainable choices about procurement
  • support biodiversity and nature recovery
  • adapt to climate change
  • reduce the environmental impacts of digital working.

We report our progress in these 7 areas to the board annually.

Eco-NICE is our staff network and platform to examine and improve NICE’s internal environmental sustainability. Eco-NICE has been set up by staff, for staff. Membership is open to all NICE staff.

Supporting an environmentally sustainable health and care system

We’ve developed an asthma inhalers decision aid explaining the carbon footprint of different inhaler options for people who would like to think about reducing the environmental impact of their asthma treatment.

We ran a deliberative public engagement dialogue exploring views on our role in making healthcare more environmentally sustainable. The findings have been used to develop recommendations on how we can support the NHS net zero target and environmentally sustainable healthcare. See our NICE Listens page for more information.

We’re producing an evidence summary on the clinical and resource impact impacts of using desflurane – a general anaesthetic agent with a significant global warming potential – compared with other agents in two populations. The purpose of the evidence summary is to support the implementation of the national policy to stop routine use of desflurane in anaesthetic practice in the NHS in England by early 2024.

We’re conducting an options appraisal to understand the feasibility, benefits and risks associated with different ways that we might request and use product-level environmental sustainability data.

We’re examining how environmental sustainability considerations should be included in a new framework for prioritising topics across NICE.

We regularly engage external stakeholders to share learnings, disseminate our work, and contribute to discussions of direct relevance to NICE’s system sustainability work.

For example, we’re members of the NHS Medicines Sustainability Board, a group which identifies and drives cross-system action to support the delivery of medicines sustainability priorities.

We’re also members of the Environmental Learning Group of the International Network of Agencies for Health Technology Assessment, a forum for sharing knowledge and experiences with international peer agencies.

We’ve published peer-reviewed articles, including a paper examining different approaches that an agency like NICE can use to take environmental information into account in healthcare decision making.

Supporting national net zero targets

Our work supports:

Photo looking up at a tree canopy from the ground