Awareness of the urgency of climate change has been growing in recent years, and this is also true in the hospital sector, where green initiatives are multiplying. The Shift Project carried out its first carbon assessment of the French healthcare sector in 2021, estimating that the sector accounts for almost 8% of French greenhouse gas (GHG) emissions. At the same time, in October 2021, the Ministry of Solidarity and Health announced the creation of new positions for Energy and Ecological Transition Advisors in Healthcare. These involve 150 positions funded by the General Directorate for Healthcare (DGOS) and the National Solidarity Fund for Autonomy (CNSA). The people recruited will be tasked with supporting 5,000 health facilities and medico-social establishments in reducing their carbon footprint. In this article, Alcimed looks at four areas for action to reduce the emission of greenhouse gases in hospital systems, while maintaining quality of care as a priority.
Lever n°1: implement a responsible purchasing approach for more sustainability in the hospital environment
The first and perhaps most important lever for hospitals and other health facilities is purchasing. On average, purchasing accounts for over 50% of a hospital’s greenhouse gas emissions. Medicines account for 33% of carbon emissions in the French healthcare sector, while medical devices account for over 20%.
Very few life-cycle analyses are currently carried out on drugs, and the issues surrounding their end-of-life are complex, which hinders hospitals wishing to implement a responsible purchasing approach.
Proposition 7.1 of the Citizens’ Climate Convention (Convention Citoyenne pour le Climat) suggested strengthening environmental clauses in public procurement contracts, which would entail the introduction of indicators to enable offers to be compared from an ecological point of view. This proposal was taken up in the French Climate Act, which now requires public purchasers to take environmental factors into account. However, the Climate Law (Loi Climat) did not include the notion of “the most environmentally advantageous offer”, which could have complemented the notion of “the most economically advantageous offer” currently applied in public procurement transactions. Nevertheless, central purchasing bodies are gradually including these criteria in their selection of suppliers, and including new green offers in their catalogs such as clean vehicles, organic products and compostable, biosourced, plastic-free disposable tableware.
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Lever n°2: reduce atmospheric emission of anaesthetic gases
Anaesthetic gases have a high global warming potential. For example, Desflurane, used in hospitals, has a global warming potential 10 times greater than that of other anesthetic gases, which can be prescribed in the same way to most patients. A number of health facilities, including Grenoble University Hospital, have already succeeded in lessening their use of this type of high-emission anaesthetic, without lowering the quality of care. It is also interesting to note that only part of the gas given to the patient is actually inhaled, the rest being sucked out of the operating room and released into the atmosphere. A number of innovations have been developed to recover and recycle this gas, but these have not yet been deployed in France. Lowering the flow of fresh gas or using masks that deliver only on inhalation are other solutions that have no impact on the patient, but can lower the quantity used.
Lever n°3: minimize food loss and waste
A third important lever for improving hospitals’ carbon footprint is food. A report by the French Environment and Energy Management Agency (ADEME) estimates that the average rate of food loss and waste in collective catering is 20%. According to this study, hospitals throw away 230,000 tonnes of food. This rate of waste is not lower or higher than that of other collective catering (schools, restaurants, company canteens, etc.), but the rate is much higher than in French households. The Egalim law has made it mandatory to combat food waste in collective catering, with the obligation to carry out a diagnosis since 2020.
At the Hospital Center of Perpignan, for example, a number of actions have been taken, enabling a 75% reduction in the number of still-wrapped trays thrown away in 3 years . To achieve this, caregivers reorganized the food offer, defining new menus and improving the taste and weight of portions. For their part, the Civil Hospices of Lyon give priority to local produce and short distribution channels. They have also introduced a system for donating undistributed meals to local associations.
Lever n°4: train and mobilize healthcare professionals to reduce greenhouse gas emissions in hospitals
Training staff in sustainable practices is another key issue. Indeed, a solid training program in this area is a prerequisite for mobilizing teams and reducing the emissions of greenhouse gases in hospitals.
Today, however, it would appear that three-quarters of healthcare students are not trained in environmental issues. Yet the demand is there, with 84% of students believing they should be trained. Nevertheless, progress is being made in training healthcare professionals in environmental issues. From the start of the new academic year, medical students will have the opportunity to receive specific training program in environmental health. This training will give students a better understanding of the challenges of ecological transition and sustainable development, and their impact on the healthcare systems. On the other hand, online training courses and educational content on these subjects are increasingly numerous and accessible, enabling healthcare professionals to train throughout their careers.
There are many ways in which hospitals can reduce their carbon footprint. Here, we have exemplified the gains that can be made in purchasing, anaesthetic gases and food, but we could also have mentioned energy and waste management, which are also priority areas for reducing greenhouse gas emissions in hospitals. New regulations, technological innovations and individual initiatives are the driving forces behind a transition that is gathering pace, provided that healthcare professionals are trained in sustainability issues. Alcimed can help you identify the opportunities that will enable you to meet tomorrow’s challenges. Don’t hesitate to contact our team!
 Decarbonizing Health for Sustainable Care, The Shift Project (2023)
 Décarbonation, l’hôpital agit pour le climat, La Veille Acteurs de Santé (2021)
 Ryan, S. M., & Nielsen, C. J. (2010). Global Warming Potential of Inhaled Anesthetics. Anesthesia & Analgesia, 111(1), 92 98.
 Etat des lieux des masses de gaspillages alimentaires et de sa gestion aux différentes étapes de la chaîne alimentaire, ADEME (2016).
 Reducing food waste in hospitals. Optigede, Ademe (2019)
About the author,
Clémence, Consultant in Alcimed’s Innovation and Public Policy team in France
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