PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

98 Acting early on NCDs The Partnership for Health System Sustainability and ResilienceHealthcare’s environmental footprint Health systems across studied countries are beginning to recognise their substantial carbon footprint, though systematic measurement and management remain underdeveloped. Authoritative estimates reveal healthcare’s carbon footprint ranges from 3.8% to 7.6% of national emissions across studied countries, with per capita emissions varying more than twofold, from 996 kg CO 2 equivalent in Japan to Greece to 172 kg in Poland (Romanello et al., 2024; Figure 20). These variations reflect fundamental differences in care delivery models, technology utilisation, and system efficiency rather than simply healthcare spending or quality. Figure 20: Healthcare carbon footprints, total and per capita, 2022 Source: Romanello et al., 2024. The higher emissions intensity in countries like Japan and Germany correlates with technology- intensive, hospital-centred care models (Quitmann et al., 2024; ExpertInnenrat Gesundheit & Resilienz, 2025), intensive resource use, and reliance on advanced medical technology. By contrast, Southern European countries achieve lower emissions through greater reliance on community-based care and less intensive diagnostic technology use, though this may also reflect underinvestment in some areas. In Canada, hospital electricity consumption (~30%), pharmaceutical and medical device lifecycles (~25%), and environmental contamination from disposal together account for over half of healthcare emissions (Eckelman et al., 2018; Smith & Severn, 2023). However, the relative contributions vary with resource mixes. This growing awareness has not yet translated into comprehensive measurement systems. Neither Greece nor Poland has developed frameworks for assessing the carbon footprint of specific diseases, treatments, or care pathways. Japan excludes healthcare from its otherwise comprehensive “Green Growth Strategy” for achieving carbon neutrality by 2050, despite the sector’s substantial contribution to national emissions (Cabinet Secretariat et al., 2021). This exclusion reflects the perception that healthcare is too essential to constrain with environmental considerations, missing opportunities for efficiency improvements that could enhance rather than compromise care quality. Canada 20.1 259Japan 124.8 996France 21.3 316Germany 56.3 677Greece 2.7 251Italy 24.6 412Poland 10.5 172Spain 14.4 304HCF (Mt CO2 eq) HCF per capita (kg CO2 eq)