The green hospital: A view from Germany
An innovative concept for a climate-neutral future for the healthcare system
This interview originally appeared in the German-language Pneumologie journal. I’ve translated it with the original publisher’s permission.
The impact of the climate crisis on respiratory health increases every day. The latest Lancet Countdown Report emphasised that the measures being taken around the world to adapt to climate change and to mitigate its consequences are inadequate.1 The need for action is particularly necessary in the health system. In Germany, 5.2% of greenhouse gas emissions come from the health system.2
One measure to reduce greenhouse gas emissions is presented in the concept of the ‘green hospital’. Its aim is to achieve a transformation to climate neutrality. The Havelhöhe community hospital in Berlin is a pioneer in this area, and aims to become “a climate-friendly hospital by 2030”. To gain a better overview of this innovation and to find out about the various challenges associated with it, we spoke to Dr Christian Grah, head of the project and senior physician in pulmonology at the lung cancer centre in Havelhöhe hospital and co-lead of the ‘Climate change and health’ taskforce at DGP [Deutsche Gesellschaft fuer Pneumologie und Beatmungsmedizin – the German Respiratory Society].
Dr Grah, what is the definition of a ‘green hospital’?
A ‘green hospital’ is a healthcare facility that, alongside caring for its patients, also takes responsibility for sustainability and the protection of the environment. The definition of a green hospital is not standardised, but there are organisations such as Health Care Without Harm (HCWH) that have developed policies and networks to encourage facilities like these. An example is the Global Green and Healthy Hospitals (GGHH) network, which has identified ten areas in which hospitals can reduce their greenhouse gas emissions. These areas encompass leadership, chemicals, waste, energy, water, transportation, food, pharmaceuticals, buildings and purchasing.
The goal of a green hospital is to offer healthcare within the planetary boundaries, that both protects the health of today’s patients and takes into account the future health impacts of climate change. Another important aspect is adapting to the health consequences of climate change, such as the creation of hospital systems that can cope with rising temperatures. The KliMeG network for climate-resilient medicine and health facilities was formed to promote these goals. This network offers many free materials and workshops to interested healthcare facilities to support them in taking the first steps towards becoming climate friendly. KliMeG also organises the largest congress on sustainability in healthcare, Clean Med Berlin (this year it was held on 28 May 2024).
As an individual, what can one do to start the transformation to a green hospital?
A good start would be to share information on our initiatives, for example in a newsletter, or in conversations, and to win over the hospital’s management. For a successful transformation, willingness to support it and personal commitment is essential. In order to receive materials and workshops from the KliMeG network, you can express interest in developing into a green hospital with a ‘letter of intent’ and become a member.
However, the transformation can only be successful if it is not just something done voluntarily in free time, but it actually becomes part of the hospital’s work. It often makes sense to start with the so-called low-hanging fruit: projects involving energy saving measures or renewable energy can save a lot of CO2 emissions and can also save the clinic a lot of money. Projects on climate-friendly food can lead to the so-called co-benefits of a healthier diet for staff and patients, and therefore also to higher employee satisfaction. In the beginning, there are a few hurdles to overcome, so it makes sense to set small goals at the start, for example, how can you achieve a large CO2 saving using simple means? For example, you could agree with the person in charge of the cafeteria or the chef, that the order of the menu is changed, so that a vegetarian or vegan option is the first on the menu and a meat option is provided in second or third position.
What have you already achieved at Havelhöhe? What challenges are still to be overcome?
We have expanded the ten areas of the Global Green Healthy Hospitals to include four further areas (training, activities, public relations, air) and built various processes on those. We would like to be the first hospital to become climate neutral for heat and energy by 2030: a zero-emission hospital, based on the international reference year of 1990. We are currently at a 70% reduction in CO2 emissions for heat and energy, compared to 1990.
A hospital is an establishment that requires an enormous amount of electricity. To meet this energy requirement, we would like to use various sources of energy generation, such as photovoltaic systems on roofs and other surfaces and wind energy. Our goal is to show that a zero-emission hospital is possible, in order to encourage other hospitals to also work towards being zero-emission hospitals.
In our economised healthcare system, will the transformation be seen as cost effective?
In the energy transition, there are no safer measures than investing in this transformation. A kilowatt hour (kWh) produced using renewable energy is currently up to three times cheaper than the kWh produced by conventional electricity providers. This is a point that can convince even the commercial management of a hospital.
Are the other areas of action, such as food or purchasing, also cost effective?
That is a difficult question. When it comes to energy, it is clear, and that is a foundation that shouldn’t be skipped over. My recommendation is to start with the low-hanging fruit. When it comes to food, it is a bit more complex.
Since 2017, at the Havelhöhe hospital, we have gradually changed our provision of food to align with a climate-friendly and healthier diet. Mealtimes now include a variety of plant-based dishes. Organic meat is available twice a week and once a month there is fish from an inland fishery. For us, the change was cost-effective, because cheap factory-farmed meat was more expensive than vegetables and pulses. The proportion of organic food increased by 20% to a total of 60% (in 2023) within five years. To facilitate this, the daily spend on meals was increased from 2019, from 4.75 euros to 5.50 euros.
The first change, to vegetarian food, is cost-effective. For the further steps we spend a little more money, and for that we can offer our staff and our patients good nutrition, as part of holistic care. And for us, the additional cost is definitely worth it. Furthermore, the cost of the health and environmental damage from current food systems exceed the value they contribute to global gross domestic product.3
Is there government support for the implementation of green hospitals?
Important reports like the Wuppertal report on climate-neutral hospitals indicate that hospitals do not currently have the financial means to make the necessary investments on their own. However, it would seem sensible for not only hospitals but also the state to make investments to maintain sustainability. It would make sense to have a hospital-climate fund, worth several billion euros, which would contain the necessary investment funds. These funds would not only cover investments, but also provide start-up financing for sustainability managers and the establishment of staff transport schemes.4 There are currently a few funding opportunities available through the Federal Ministry for Economic Affairs. But there are also city-specific funding opportunities, as well as those which are Germany-wide.
However, even where funding exists, preparing funding applications for healthcare facilities is often a problem. Often there is a lack of expertise for writing a successful and implementable application. Therefore, within the framework of KliMeG, we want to offer new opportunities to support the preparation of applications, in order to bring interested parties and supporters together.
What recommendations can you give to the members of the DGP?
We have founded a climate change and health taskforce in the DGP (the German Respiratory Society), that might be recognised as a working group within a directorate after a few years. I would be really happy if more members of the DGP, and also the YoungDGP, joined this network. As doctors, we should take responsibility not just for individual patients, but for the whole system that interacts with our planet. I think this effort fits well with our professional society.
We have also published an AWMF (the Association of the Scientific Medical Societies in Germany) guideline on ‘Climate-conscious prescription of inhaled medication’ on behalf of the DGP and the DEGAM (German Society for General and Family Medicine). The aim is to increase the rate of dry powder inhalers used in relation to pressurised metered dose inhalers from the current 50% to at least 80%. Through this, we could save 10 million tonnes of CO2e over the next ten years. At the same time, the awareness of climate-sensitive behaviour would increase for patients and doctors. In the global south, however, these measures are still a problem because of the current limited availability of powder inhalers. Therefore, in the spirit of a just world, we should strive to ensure the availability of powder inhalers in the global south too.
References and acknowledgements
1. Romanello M, Napoli MD, Green C. et al. The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health-centered response in a world facing irreversible harms. The Lancet 2023; S0140673623018597. DOI: 10.1016/S0140-6736(23)01859-7.
2. Health care climate footprint report. Health Care Without Harm, 2019. https://www.noharm-uscanada.org/ClimateFootprintReport (Accessed 04.12.2023)
3. Food System Economics Comission. The Hidden Costs of Food. https://www.foodsystemeconomics.org/hidden-food-costs/ (Accessed 18.03.2024)
4. Deutsche Krankenhaus Gesellschaft (DKG). Deutsche Krankenhausgesellschaft fordert Sondervermögen zur Klinik-Transformation. https://www.dkgev.de/dkg/presse/details/deutsche-krankenhausgesellschaft-fordert-sondervermoegen-zur-klinik-transformation/ (Accessed 16.01.2024)
The interview was conducted by Dr Malek Chaabouni. The questions were prepared by Dr Chaabouni and Dr Christoph Fisser. The article was written by them both and added to by Dr Christian Grah.
The original article is available in German here: https://www.thieme-connect.de/products/ejournals/abstract/10.1055/a-2319-4418 Copyright © Georg Thieme Verlag KG.
Grünes Krankenhaus: innovatives Konzept für eine klimaneutrale Zukunft des Gesundheitssystems. Pneumologie 78(07): 443-444, 2024. doi: 10.1055/a-2319-4418.
Translated and reproduced with permission. Thank you!
Image used with permission from Havelhöhe Hospital. Thank you!