An unfortunate paradox exists in the healthcare sector: while hospitals find themselves at the forefront of managing increased health risks caused by climate change, hospitals themselves are also a significant contributor to global warming . With their operations heavily reliant on fossil fuel energy, hospitals are increasingly being forced to look in the mirror and consider the role they have to play in addressing the incidence of illnesses related to global warming. Life Healthcare, a South African hospital group, has started down this journey, implementing a number of initiatives to reduce its own carbon footprint.
Managing the cause
South Africa’s National Climate Change Response Policy sets as one of its objectives, the need to make a fair contribution to global efforts to stabilise greenhouse gas concentrations in the atmosphere . Driven by this directive, and the recognition that environmental management improves its competitiveness, Life Healthcare has committed to reduce its carbon intensity (tons of carbon dioxide per patient day) by 10% over the five-year period from 2013-2018 . Through a number of initiatives including conversion to energy-efficient heat pumps, use of solar energy and the development of a new ‘Green by Design’ model for new hospitals, Life Healthcare is setting a positive example for other players in the sector to follow, while making a real impact on its bottom line:
Conversion to Heat Pumps
For every 1kW of electrical energy, heat pumps generate 3kW of heating, compared to only 1kW for conventional geysers. Since 2012, Life Healthcare has converted 32 of its 55 acute hospitals to heat pumps with a further 15 sites planned by 2018. This translated to a significant an annual saving on hot water of 4.2 million kWh or 4 600 tons of carbon.
Solar Energy at Anncron Clinic
The installation of photovoltaic (PV) panels at a pilot hospital, Life Anncron, was completed in February 2015. Use of solar energy reduced energy consumption from the national electricity grid by approximately 30% within the first two months. Throughout the rest of 2015, total PV-generated power resulted in a carbon saving of 608 tons or R2,300 per day (USD150). Following the success of this pilot, a second hospital has now been selected for the next PV installation.
‘Green by Design’ Hospitals
With the aim of making energy efficiency a part of the company DNA going forward, the engineering team has also developed the ‘Green by Design’ concept. The concept sets a new standard for building future hospitals incorporating technologies such as heat recovery, LED lighting, occupancy sensors, increased thermal insulation as well as the tried and tested heat pumps. Life Hilton, the first hospital built under this model was opened early 2016 and is already showing efficiency gains of 20% compared to other facilities.
Collectively, these efforts are definitely moving the needle on the company’s carbon intensity with emissions having reduced from 8.2 to 7.6 tons of carbon dioxide per paid patient day from 2013 to 2015.
Managing the effect
South Africa faces what is termed ‘a quadruple burden of disease’ with HIV/AIDS, chronic diseases, poverty-related conditions and injuries appearing as the leading causes of mortality . Climate change may increase this burden in a context where the healthcare system is already severely resource-constrained. While local research is limited, international studies on the effect that rising temperatures have on health risks show a range of direct impacts (e.g. heat exhaustion), as well as indirect impacts which include increased incidence of respiratory illnesses and diseases that are water-borne, vector-borne (e.g. malaria) and food-borne (e.g. salmonellosis) . Additionally, there is some evidence that changes in land use caused by altered rainfall patterns may lead to population displacement, violence and increased risk-taking behaviours, which could amplify the transmission of sexually transmitted infections such as HIV .
In line with ongoing conversations around implementing a National Health Insurance scheme, there is definitely an opportunity for a co-ordinated response from the government and private sector actors such as Life Healthcare. Conducting disease surveillance, data capturing and more focused research to better understand the health risks posed in the region would ultimately facilitate the proactive development of suitable responses . For example, research results may highlight the need to start training a different mix of healthcare professionals than the education system is currently producing.
Overall, Life Healthcare is clearly in the right direction with respect to managing the cause of climate change. What remains to be seen is whether the company will turn its attention to the next challenge: managing the effect. (740 words)
 Why We Need Hospitals to Help Lead the Fight Against Climate Change http://www.huffingtonpost.com/joshua-karliner/why-we-need-hospitals-to-_b_8210744.html
 South Africa National Climate Change Response https://www.environment.gov.za/sites/default/files/legislations/national_climatechange_response_whitepaper.pdf
 Life Healthcare Environmental Management http://www.life.co.za/Quality/Quality_Environment.aspx
 South Africa’s quadruple burden of disease http://www.who.int/bulletin/volumes/85/9/06-037184/en/
 Climate Change in 2016: Implications for Business, (Henderson, Reinert, Dekhtyar, Mgidal) Harvard Business School, 2016
 Human health impacts in a changing South African climate, South African Medical Journal http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000800029