DECARBONISATION
events, and shifts in the availability of clean water, air, and other resources. Climate change also worsens air quality and increases health conditions such as respiratory diseases and heat-related illnesses. The combustion of fossil fuels releases a variety of pollutants, including particulate matter, nitrogen oxides (NOx
), sulphur dioxide (SO2 ), and volatile organic
compounds (VOCs). These pollutants can have direct harmful effects on human health, causing respiratory and cardiovascular diseases, and exacerbating conditions such as asthma and chronic obstructive pulmonary disease (COPD). Hospitals, being centres for health and healing, should lead by example in reducing their environmental impact. By transitioning to all-electric systems and eliminating on-site combustion of fossil fuels, hospitals can significantly reduce their emissions of both greenhouse gases and air pollutants. This will not only help mitigate climate change but also improve air quality and public health in the communities they serve.
Goals and mandates for decarbonisation in the healthcare sector Recognising the urgent need for action, various organisations and governments have set ambitious goals for decarbonisation. The White House-HHS Health Sector Climate Pledge, launched in the spring of 2022, is a voluntary commitment to reduce emissions and improve climate resilience. Signing organisations agree to cut their greenhouse gas emissions by 50% by 2030 and achieve Net Zero emissions by 2050. The healthcare sector, accounting for 8.5% of U.S. emissions, plays a crucial role in advancing these goals. This commitment aligns with President Biden’s aim to reduce nationwide greenhouse gas emissions by 50-52% by 2030 and reach Net Zero emissions by 2050.
In addition to national goals, various US states and municipalities have enacted their own climate policies and targets, which often include specific requirements for the healthcare sector. For example, California has set a target to achieve carbon neutrality by 2045, while New York City has mandated that large buildings, including hospitals, reduce their carbon emissions by 40% by 2030 and by 80% by 2050. These policies provide a strong drive for hospitals to transition to all-electric systems and adopt other measures to reduce their carbon footprint.
Key areas of electrification
n Space heating Traditional fossil-fuel-based systems for space heating are widespread in hospitals. These systems typically involve burning natural gas to generate heat, which is both carbon-intensive and inefficient. For instance, in hospitals, a significant portion of thermal energy is used for reheating air to meet ventilation requirements. This practice results in high energy consumption and carbon emissions. In contrast, electric alternatives such as heat pumps offer a more efficient and sustainable solution. Heat pumps use a refrigeration cycle to move heat from one location to another, extracting heat from a low-temperature source and releasing it at a higher temperature. They use electrical power to move heat rather than combusting fossil fuels, which reduces carbon emissions. The efficiency of heat pumps is measured by their coefficient of performance (COP), the ratio of energy output over energy input. Heat recovery chillers may have a COP of 3 or more, as they deliver three units of heating energy for every unit of electrical energy input – compared to combustion equipment that operates with a COP of less than one.
Heat pumps come in various types, including air-source
heat pumps (ASHPs), water-source heat pumps (WSHPs), and ground-source heat pumps (GSHPs). ASHPs extract heat from the outside air, while GSHPs and WSHPs utilise water as a heat source. GSHPs, in particular, are highly efficient and can provide both heating and cooling, making them ideal for hospital applications. They involve installing a network of pipes underground, through which refrigerant or water circulates to store excess heat in the ground and extract it when needed.
n Heat recovery chillers Heat recovery chillers recover energy from a building chilled water system, making both chilled water and hot water simultaneously. In traditional cooling systems, a chiller absorbs heat from returned chilled water and vents it into the atmosphere. However, heat recovery chillers repurpose this heat for other heating needs, maximising efficiency. These chillers can utilise heat from various sources, including IT cooling equipment, refrigerators, freezers, and medical equipment, integrating them into the chilled water loop. Recovered heat can be used for space heating, domestic hot water, or other thermal needs within the hospital. By recovering and repurposing heat that would otherwise be wasted, these systems can significantly reduce energy consumption and emissions. In addition to reducing carbon emissions, heat recovery
chillers can improve the overall efficiency and resilience of hospital energy systems. By using the same type of equipment for both heating and cooling, they can eliminate combustion boilers and reduce maintenance costs.
n Cooling systems In cold weather, buildings use cold outside air for ‘free’ cooling, known in the US as ‘economiser’ mode, where dampers modulate the blend of outside air and return air to deliver cool air without using a cooling coil
November 2025 Health Estate Journal 27
Decarbonising hospitals is an essential step towards a low-carbon future and meeting global climate goals.
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