helsinki, may 19, 2016 - ndf...helsinki, may 19, 2016 josh karliner, director of global projects...

Early experiences in multi-sectoral climate change and health work for international development: opportunities and finance

Helsinki, May 19, 2016

Josh Karliner, Director of Global Projects

Health Care Without Harm

Toward Low Carbon Health Care

Transform health care worldwide so that it reduces its environmental

footprint while

mobilizing its ethical, economic and political influence to create an

ecologically sustainable, equitable and healthy world.

HCWH’s Global Climate Work

Latin America 407 Hospitals and Health Centers, 26 Health Systems and 13 Organizations, representing the interest of 1427 Hospitals and Health Centers

Africa 19 Hospitals, 4 Health Systems and 2 Organization, representing the interest of 1185 Hospitals and Health Centers

Asia 78 Hospitals and Health Care Facilities, 6 Health Systems and 9 Organizations, representing the interest of 8211 Hospitals and Health Centers

Pacific 3 Hospitals, 14 Health Systems and 5 Organizations, representing the interest of 738 Hospitals and Health Centers

Europe 19 Hospitals and Health Care Facilities, 18 Health Systems and 8 Organizations, representing the interest of 6527 Hospitals and Health Centers

North America 4 Hospitals and Health Centers, 10 Health Systems and 3 organizations representing the interest of 1462 Hospitals and Health Care Facilities

Totals: As of May 2016, GGHH has 656 members from 37 countries

representing the interest of 20.590 Hospitals and Health Centers

Global 1 Health System and 3 Organizations representing the interest of 1040 Hospitals

HCWH Regional Offices

Strategic Partners

Climate change is a growing

health emergency—The Lancet 2015

Climate change is one of the greatest challenges of our time

Dr. Margaret Chan Director General WHO

Climate change is the biggest health threat of the 21st Century

The Lancet--2009

What is the role of the health sector in implementing the Paris treaty and transitioning to a low

carbon economy?

HEALTH CARE IS NOT PREPARED FOR

CLIMATE CHANGE

China USA

India

Russia Japan

Germany

Canada

South Korea

Iran

UK

Data Source: US Energy Information Agency,

2012

+

US Healthcare 8%

Health Care Contributes to GHG Emissions in Some Countries

EU Healthcare 5%?

+

In Others it Lacks Access to Energy for Basic Health Services

Low Carbon Health Care

• Reduces health care’s carbon footprint – In the care it provides – Along the supply chain – In the disposal of waste

• Saves money

• Increases access to care in energy poor settings

• Prepares health systems to become more resilient and adapt to climate change

• Positions health systems as leaders in responding to climate change

2015

By moving toward low-carbon health systems, health care can

• mitigate its own climate impact;

• become more climate resilient

• lead by example

“Access to health care can be enhanced and made more reliable through

off-grid renewable energy systems.”

Investing in Low Carbon Health

Systems

*Addresses Climate Change

*Improves Access to Health Care

*Promotes Sustainable Development

Low Carbon Health Care Key Findings

World Bank/NDF Guidance Paper (draft)

“As middle and low-income countries seek to invest in more robust health care systems, the imperative and opportunity exists to invest in and build these systems based on principles of low carbon health care.” • Imperative: For health development investments

to align with global climate goals and the transition to a low carbon economy.

• Opportunity: avoid expensive, unhealthy unproductive and carbon intensive technology and provide effective, accessible, lower cost care.

• Sustainable Development: Low carbon healthcare

can facilitate: Low carbon development Improved health outcomes Health system strengthening and

transformation strategies promoted by WBG

Low Carbon Health Care can advance the implementation of 11 of the 17 Sustainable Development Goals

LOW CARBON HEALTHCARE and the SDGS

Low Carbon Health Care Co-Benefits


• Improved health status from reduced air pollution and climate change.

• Improved health system

performance, efficiency and cost savings.

• Stimulation and anchoring of

local economies. Source: WHO, World Bank

Low Carbon Health Care 7 Key Elements


1. Building design and construction based on low carbon approaches.

2. Investment in renewable energy and energy efficiency.

3. Waste minimization and sustainable health care waste management.

4. Sustainable transport and water consumption policies.

5. Low carbon procurement policies for pharmaceuticals, medical devices, food and other products.

6. Resilience strategies to withstand extreme weather events.

7. Overall system design for coordinated care, emphasis on local providers, and driven by public health needs.

What Are the Examples of Low Carbon Health Care Today?

Sanatorio Finochietto, Buenos Aires, Argentina

Integrated Systems

• Thick thermal insulation in walls

• Sunshades and a ventilated facade system

• Geothermal interchange

• Heat exchange between exhausts and fresh air inlets

• Natural lighting

• Roof gardens and green roofs

Low Carbon Health Care Element 1. Building Design and Construction

Butaro District Hospital, Rwanda

• Hospital construction used local materials and 100% local labor.

• Reduced energy consumption by using narrow floor plates, natural daylight and natural ventilation, along with high-volume, low-speed fans and germicidal UV lights to provide energy efficient ventilation while controlling the transmission of airborne diseases.

• Rainwater harvested for flushing toilets and landscape irrigation

Low Carbon Health Care Element 1. Building Design and Construction

Yonsei University Health System, South Korea

Target to reduce GHG emissions 30% by 2020

Annual savings: USD $1.6 million

• Replaced old heating/air conditioning equipment

• Changed all lights at fire exits to LED

• Switched to high efficiency transformer

• Increased thermal efficiency of boiler and refrigerators

• Installed solar powered streetlights

• Controlled the supply of air conditioning and heating during

summer/winter seasons

• Distributed energy reduction guide and regulations

• Air conditioning system renovations

Low Carbon Health Care Element 2a– Energy Efficiency

• 53 Hospitals

• 182 Primary Healthcare facilities

• 50 Ambulance Stations

• 10 Forensic Pathology Laboratories

• 6 Nursing Colleges

Sources of data: Beds: Sinjani PDE: Sinjani KWh: Electricity accounts KVA: Electricity accounts Water: Water accounts Floor area: Public Works Note 1: Energy and power indicators are calculated using the net total area of the hospital complex - reason, the electricity is metered for the entire complex. Note 2: Hospital m2/bed and PDE/m2/year are calculated using only the hospital floor area - reason, these indicators are applicable to the hospital only. Note 3: Water is for the whole complex. Sub-metering is not in place.

COMPARATORS SANS 204:2011 does not have maximum energy and demand targets for hospitals. To facilitate comparison the following are extracted from Tables 1 and 2: Hotels: VA/m2 : 85 KWh/m2/year : 600 Offices: VA/m2 : 75 KWh/m2/year : 185 Hospitals: (SANS 10252-1:2012) Water: 450 to 550 l/bed/day



Coal and oil fired boilers serving hospitals have been

eliminated at all hospitals except GSH and TBH

Low Carbon Health Care Element 2a– Energy Efficiency

Efficient Laundries, Energy Efficient

Lighting, Heat Pumps and Direct

Electrical heating





Lentegeur Laundry: Total

Savings:

Water: 19,600,000 litres p.a.

CO2: 557 tons p.a.

Cost: US $62,000 p.a.

Region Skane, Sweden

(Nordic Solutions to Global Challenges!)

9 major hospitals

Part of a regional low carbon strategy

100% Fossil Fuel Free by 2020

• No fossil fuel use in buildings

• No fossil fuel in transport

• No fossil fuel in electricity

Low Carbon Health Care Element 2b-- Renewable Energy

Gunjaman Singh Hospital, Pithuwa Village, Nepal

Solar panels/batteries provide all power for hospital

• Includes power for x-ray and waste autoclave

• Avoids power cuts from unreliable power grid

• Power management enables use up to 18 hours per day

Low Carbon Health Care Element 2b--Renewable Energy

Solar Refrigeration

• About a dozen types of solar refrigerators for vaccine and blood storage are pre-qualified by WHO.

• Some can maintain the cold

chain for a week or more without any electricity.

• Surplus electricity from the refrigeration system is often generated and tapped for other health facility loads.

Source: WHO/World Bank

Low Carbon Health Care Element 2b– Renewable Energy

Small-scale hydroelectric power

Hospitals in Rwanda, Zambia, Uganda and the Democratic Republic of Congo (DRC) use or have developed hydropower facilities on their own or in tandem with nearby communities


Low Carbon Health Care Element 2b– Renewable Energy

• Uganda: 15% of hospitals use solar to complement grid electricity access.

• Sierra Leone, 36% of health

facilities and 43% of hospitals use solar in combination with other sources.

• Several bilateral and

multilateral aid initiatives support solar clinics.



Gundersen Health, USA

83% emissions cut since 2008. Energy independence in 2014 • 60% Clean Renewable • 40% Energy reduction

– Saves US $2-million per year

• Renewable energy – Solar power

– Geothermal energy

– Wind Turbines

– Dairy digesters

– Combined heat and power

– Biomass boiler

Photo: Gundersen Health


Hospital Albert Einstein, Brazil

Low Carbon Health Care Element 3– Sustainable Healthcare Waste Management

• GHG emissions from the anesthetic gas Nitrous Oxide contributed to 75% of Scope 1 GHG emissions and nearly 35% of their total reported GHG emissions in 2013.

• Reduced nitrous oxide use by 23%.

• Reduced GHG emissions by 41% (2007-2014)

INTRODUCTION

TITLE Location, Date

33

Low Carbon Health Care Element 5--Procurement

Moving US $5 billion in health procurement toward

Low carbon * Safer chemicals * Sustainable Resource Use

Low Carbon Health Care Element 6-- Resilience

U.S. National Institute for Environmental Health Sciences report co-authored by Health Care Without Harm.

Low Carbon Health Care Element 6-- Resilience

• Source: NIEHS/HCWH

Georgetown Hospital, St Vincent and the Grenadines

• Strengthened roof to withstand Hurricanes and volcanic ash

• Solar Panels to generate electricity

• Reduced energy consumption by over 60%

• Water storage system

• Natural lighting

• Part of PAHO Smart Hospitals Initiative

Georgetown Hospital (Photo: stlucianewsonline.com)

Low Carbon Health Care Element 6– Resilience

National Health Service (NHS), UK

Footprint: 18 million tons of CO2 per year, 26% of public sector emissions

CO2 Reduction Targets

• 10% by 2015

• 26% by 2020

• 80% by 2050

CO

2 E

mis

sio

ns (

MtC

O2)

Low Carbon Health Care Element 7– System Wide

Low Carbon Health Care Element 7– System Wide -- Kaiser Permanente, USA

Priority Area 2025 Goal

Climate change

Net positive carbon (remove more CO2 from the atmosphere than we emit)

Safer chemicals

50% of total spend on all products, building materials, and furnishings meets environmental criteria

Sustainable food

100% of purchased food is sustainable and produced without antibiotics

Waste reduction

100% of solid waste is reused, recycled or composted

Water conservation

Decrease water use intensity by 25%

Sustaining Sustainability

100% of hospitals certified ISO 14001

Collaboration Reduce risks in watersheds, foodsheds, and in chemical/waste intensive economies

Low Carbon Health Care

Recommendations World Bank/NDF Guidance Paper (draft)

Integrate low-carbon health care into strategies and policies, thereby influencing the path of health care development in low and middle income countries • Actively encourage the health sector to adopt key

elements of low carbon health care.

• Integrate low carbon health care as central to strategies for universal health care coverage.

• Provide a blueprint for low cost health promoting systems that: reduce the burden of disease, adapt to new demands of efficiency and quality, mitigate greenhouse gas emissions and local pollution, and adapt to a changing climate.

• Encourage the integration of low carbon emphasis to planning, investment, implementation, monitoring and evaluation.

6 Country HCWH Project in Planning

Phase

• Measure healthcare footprint in each country.

• Pilots in key hospitals/systems.

• Implementation tool kit

• Scale-up via national communities of practice across GGHH network

• Provide policy guidance for health ministries.

• Monitor, evaluate and measure health, economic and environmental results.

Argentina

Brazil

China

India

South Africa

Philippines

Our Next Steps

Low Carbon Health Care A Vision

5 Years After Helsinki

• A global fund on climate and health is financing critical projects.

• Green, low carbon, resilient health systems are mainstream everywhere.

• Sustainable procurement in health care

moves the global supply chain toward greater sustainability and and a healthy climate.

• Health sector is a climate leader–

deploying its economic, political and moral clout to protect public health from local pollution and global climate change.

Change in Healthcare Catalyzes Broader Change

42

Transforming the Global Economy

Transforming the Global Economy

Transforming Policy and Key

Markets – Food,

Materials, Energy, etc.

Transforming Policy and Key

Markets – Food,

Materials, Energy, etc.

Transforming the Health

Sector

Transforming the Health

Sector

Thank you!

A just transition to a clean energy future is a public health imperative

helsinki, may 19, 2016 - ndf...helsinki, may 19, 2016 josh karliner, director of global projects...

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