with provision of water for healthcare, if included, should be considered within the calculation of energy use per bed since energy associated with water extraction and transportation typically comes from within country.

Limitations of the WHO approach The WHO analysis is a significant first step towards better understanding the opportunities for improvement in the sector. However, its precision is limited by available data. The IFHE is beginning an effort to collect and update a better data set that will facilitate enhanced analysis of this question. The WHO analysis is based primarily on

hospital beds, with factors derived from the US and the UK to represent the ‘typical’ ratio of hospital to non-hospital Scope 1 and Scope 2 emissions. This ratio may not be relevant across all countries, for either numbers of non-hospital facilities nor consumption of non-hospital facilities. Similarly, the consumption of the different kinds of facilities may not reflect the consumption ratios of that in similar US and UK buildings. And, the ratio of hospital to non-hospital activity is dynamic, changing as the country’s healthcare system changes. To improve upon the WHO analysis, the

IFHE would like to collect the number and building area of hospital buildings and non-hospital buildings in each country. Where possible, the non-hospital buildings can be further divided, into primary care facilities (the point of first contact between the individual and the health system) and secondary care facilities (non- hospital referral facilities intermediate between primary care and hospitals). The WHO analysis contains data from

a few hospitals in China, India, Germany, the UK, and the US. More data is needed to better determine healthcare facility energy consumption on a broad basis.

This article extends a classical model to both assist understanding of healthcare GHG impacts and to ease provision of data for maximum estimate accuracy

IFHE is interested in collecting data from hospitals around the world to better target typical consumption data. The WHO data focuses exclusively on emissions from energy conversion


of fossil fuels. There are important other sources of greenhouse gasses from the healthcare sector. In particular, medical gasses used include nitrous oxide, both a GHG and the most serious ozone depleting substance, and halogenated ethers such as Isoflourane, Desflourane, and SevoFlourane, all with very high global warming potential. The IFHE is also collecting data on typical medical gas consumption for typical global facilities. The final, and maybe most significant

and difficult problem with the healthcare sector emission calculation is the Scope 3 emissions. The WHO analysis assumes that the ratio of Scope 3 to Scope 1, 2 emissions is the same among all countries. We have no data to better this estimate. IFHE is not optimistic but is interested in collecting better ways to estimate this factor for countries other than the UK. This lack of country level consumption

per bed data represents the greatest opportunity to improve this estimate. We need robust data from readers, IFHE members and others around the world, to improve the model and improve the estimate. Providing country level data improves

the accuracy of data associated with that country, but it also improves the overall model, helping focus sector emissions of countries with similar characteristics.

The income to emission function is not linear and likely has an inflection point. Providing country level data provides a better model. Those who want to contribute

country level data can visit the website [ GHG] to provide updated data.

Conclusion While the GHG estimate will become more robust as respondents provide additional information, the estimate, even now, provides a good guide when considering the impact of healthcare facility sector GHG emissions. The WHO analysis estimates that the healthcare sector contributes approximately 1,127 million metric tons CO2

e, representing 2.6% of

global GHG emissions. (Scope 1 and Scope 2). Considering likely growth of this sector

and increasing GHG intensity as better access to better care proliferates with rising development, we expect GHG emissions to increase by as much as 100%, unless our clean energy and energy efficiency technologies proliferate at the same or faster rates. The results of this analysis indicate that

the healthcare sector can help the world reduce GHG emissions, by reducing its own. Identifying and implementing ways to reduce emissions across the sector is an important activity and one, in which, a collaborative worldwide group like IFHE can play a particularly important role. IFHE

References 1

IPCC, 2013: Summary for Policymakers. In: Stocker TF, Qin D, Plattner G-K, Tignor M, Allen SK, Boschung J, Nauels A, Xia Y, Bex V, Midgley PM eds. Climate Change 2013: The Physical Science Basis. Contribution of Working Group I to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge University Press, Cambridge, UK and New York, NY, USA. (Available online: assessment-report/ar5/wg1/ WG1AR5_SPM_FINAL.pdf).

2 Fransen T, Bhatia P, Hsu A. Measuring to Manage: A Guide to Designing GHG Accounting and Reporting Programs. 2007, World Resources Institute.

3 Bester F. Carbon footprinting: the practical implications. IFHE Digest 2016; 31-4.

4 U.S. Energy Information Administration. International Energy Outlook 2016, Ch 9. (Available online: forecasts/ieo/emissions.cfm).


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