produced off-site represent a healthcare facility’s Scope 2 emissions. Scope 3 emissions are other indirect

emissions such as the extraction, production, and transportation emissions associated with purchased materials and fuels. In healthcare, major indirect emissions include pharmaceuticals, kitchen, laundry, employee transportation, among others. Consideration of scope 3 emissions

advantageously illustrates a better sense of the true impact of an operation. For example, if the healthcare sector is responsible for most pharmaceutical use, then making changes to improve pharmaceutical emission intensity is an efficient way to reduce the impact of the healthcare sector. By not considering Scope 3 emissions, a great emission reduction opportunity is missed. The disadvantage of Scope 3 emissions

– they are necessarily a different party’s Scope 1 emissions thus considering them results in double counting emissions.

Adapting a classical approach The Kaya Identity provides an approach for understanding, calculating, and comparing emission trends. The Kaya Identity expresses GHG emissions as the product of carbon intensity of energy consumption (CO2

e/E), energy intensity

of the economic activity (E/GDP), economic output per capita (GDP/POP), and population (POP). That is:


e = ––––––*––––––*–––––– *POP E GDP POP

( CO2 e E GDP )

The benefit of the Kaya identity is that it composes carbon dioxide equivalent emissions in terms of four macro values that researchers/statisticians can track and that policy makers can clearly understand and manage. For example, policymakers generally try to reduce energy per GDP (i.e. energy efficiency) to reduce CO2

e emissions. Using the Kaya

identity facilitates this measure.4 The Kaya Identity concept indicates

carbon emissions as the product of particular sector level characteristics. Applying Kaya Identity principles to the healthcare sector, we could express sector emissions as the product of: l The energy intensity of consumption per unit

l The number of units l The carbon intensity of energy at the country level.

The WHO worldwide GHG estimate may be understood through the lens of a ‘Healthcare Kaya Identity,’ introduced here. The Healthcare Sector Kaya Identity is:

CO2 42

= –––––––––––––*–––––––––––––*–––––– + non-hospital consumption + E consumpt bed

( CO2

consumpt bed 1

) Where E is the CO2 emissions associated

with the supply chain. In addition to providing a robust basis

for developing an estimate, the Healthcare Kaya identity makes it clear that, for groups operating within the sector such as IFHE, there are three main opportunities to drive emission reductions – reduce consumption per bed; reduce non-hospital activity; and reduce both upstream and downstream impacts of supply chain by minimising supply throughput. The other factors in the equation –

number of beds and emissions per unit of energy – are somewhat outside the control of the healthcare sector. Most countries need to increase sector activities to provide better access to healthcare. But, using relatively low energy-intensive services (i.e. prevention) in lieu of relatively high energy-intensive services (i.e. surgical procedures) can reduce overall sector demand. And, outside of developing on-site renewable energy supply systems, actors outside of healthcare must reduce CO2 cleaner energy sources.

using an estimated tons/bed from available data, multiplied by the number of beds in the country. Then, the paper took an audacious leap to use the data from the UK to establish ratios of hospital energy consumption (Scope 1 and 2) to non-hospital building energy consumption (Scope 1 and 2) and to all Scope 3 emissions. Consumption per bed is an aggregate

value indicating intensity per bed. If only energy consumption is considered (as above) then this term equates to energy use per bed. At the country level, this term is a function of types of facility, number of people accessing the facility, types of procedures available, facility standards and codes and other factors. The number of hospital beds is a

general country level statistic maintained by the WHO and other organisations.

though use of

Energy consumption Levels of energy consumption vary around the world, generally as a function of wealth of the population. Because of the difficulty of obtaining good data, the WHO analysis segregates the world into four categories for the purposes of estimating energy consumption – the United States, the rest of the high- resourced countries, the middle-resourced countries, and the low-resourced countries. For each group of countries, the paper estimated the energy consumption of each country’s healthcare system by

Emissions from energy consumption When looking at the healthcare facilities sector broadly, energy use is the main cause of GHG emissions. The GHG emissions associated with energy use are different, depending on the source of that energy. A country that is heavily reliant on coal for energy production will have relatively high GHG emissions per unit of energy; a country that is heavily reliant on hydroelectric power or nuclear power will have relatively low GHG emissions per unit of energy. The WHO analysis uses credible data from the International Energy Agency to convert the energy consumption from the healthcare sector into an estimate of greenhouse gasses. Supply chain (most indirect, Scope 3

emissions) is included as an added term (E). It is included here instead of within the multiplication because supply chain emissions are often associated with economic activity outside of the particular country and thus, subjected to a different carbon intensity factor. Energy associated


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