PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

10 Acting early on NCDs The Partnership for Health System Sustainability and ResilienceEnvironmental sustainability CURRENT LANDSCAPE: Healthcare contributes 3.8–7.6% of national carbon emissions across studied countries. Some countries show leadership, France’s 2023 healthcare sustainability roadmap encourages low-carbon and local supply chains and aims to develop methodologies to assess the carbon footprint of medicines and devices, while Spain’s Health and Environment Strategic Plan focuses on climate impacts to NCDs such as air and water quality, chemical exposures, and urban health. Italy’s Heat Health Watch Warning Systems enable 72-hour forecasts for healthcare preparation. However, most countries lack comprehensive measurement of health system emissions, and adaptation planning for climate impacts on NCD patients remains underdeveloped. Environmental health interventions risk exacerbating inequities when benefits concentrate in wealthier communities. RECOMMENDATIONS: ■ Develop comprehensive emissions measurement across care pathways: Create standardised methodologies for calculating healthcare emissions from pharmaceutical lifecycles to service delivery and patient travel. Demonstrate how better patient outcomes reduce environmental footprint, supporting the case for improved care pathways and guideline adherence. Enable industry benchmarking to track progress in reducing environmental impact at source through innovation. ■ Build climate-resilient NCD services: Systematically assess climate vulnerabilities for NCD patients who face disproportionate risks from extreme weather. Develop adjusted clinical protocols for heatwaves and other climate events, ensure medication security during power outages, and translate heat warnings into modified care advice for chronic disease patients. Create protocols for maintaining service continuity during climate-related disruptions. ■ Quantify and value environmental co-benefits: Calculate emissions avoided through prevention programmes, community-based care, and virtual consultations, despite these benefits currently being unquantified in resource allocation. Incorporate environmental co-benefits into investment decisions, systematically pursuing synergies rather than managing assumed trade-offs between health and environmental objectives. ■ Integrate health and environmental governance: Create formal mechanisms linking health and environmental agencies beyond current fragmented approaches. Establish joint planning for health and climate strategies, shared accountability frameworks, and coordinated response protocols for climate-related health events. Move from policy frameworks to operational integration enabling systematic action. ■ Address environmental health inequities in adaptation: Ensure climate adaptation measures explicitly target vulnerable populations, as current approaches can disproportionately benefit those with greater resources. Direct environmental health interventions including air quality improvements and cooling infrastructure to populations facing multiple disadvantages. Provide rural and remote communities with adaptation planning and basic infrastructure despite their particular vulnerabilities. Conclusion The eight health systems examined demonstrate both significant achievements and persistent challenges. They have built robust infrastructure, achieved high rates of health coverage, and made substantial progress in reducing age-adjusted NCD mortality. Yet the principal barriers to acting early are temporal, institutional and incentive-based rather than technical. Prevention requires upfront costs with benefits beyond electoral cycles; workforce and infrastructure concentrate in urban centres while need is greatest in underserved areas; and payment systems reward activity