REDUCING HEALTHCARE'S CLIMATE FOOTPRINT - OPPORTUNITIES FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS
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2 REDUCING HEALTHCARE’S CLIMATE FOOTPRINT: OPPORTUNITIES FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS REDUCING HEALTHCARE’S CLIMATE FOOTPRINT: OPPORTUNITIES FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS 3 ACKNOWLEDGEMENTS CONTENTS Author: Ana-Christina Gaeta Hernández (Climate & Resources Policy Officer, INTRODUCTION: CLIMATE CHANGE, HEALTH, AND THE HEALTHCARE SECTOR 4 HCWH Europe) BACKGROUND 6 Climate policy chapter author: Josh Roberts (Lawyer, ClientEarth) HOW CLIMATE CHANGE IMPACTS HEALTH IN EUROPE 7 Editor: Mary Taylor CLIMATE CHANGE AND HEALTHCARE 9 HEALTHCARE’S CLIMATE IMPACTS 11 Thank you to all the hospitals, health systems and their representatives who collaborated with us by providing the information and images showcased in the EXPECTATIONS FOR THE HEALTHCARE SECTOR 12 case studies of this report: Didier Bourdon (Assistance Publique - Hôpitaux de CASE STUDIES: EUROPEAN HOSPITALS TACKLING CLIMATE CHANGE 14 Paris, France), Simon Briggs (Sustainable Development Unit, UK), Will Clark (Sus- sex Community NHS Foundation Trust, UK), Annegret Dickhoff (Bund für Umwelt FRANCE: Assistance Publique - Hôpitaux De Paris 16 und Naturschutz Deutschland e.V., Germany), Christian Dreißigacker (Klinikum FRANCE: Centre Hospitalier De Niort 18 Neukölln, Germany), Kristina de Geer (Region Skåne, Sweden), Bernard Jourdain GERMANY: BUND “Energy Saving Hospital” Label 20 (Centre Hospitalier de Niort, France), Chris Large (Operation TLC, UK), Ahmed GERMANY: BUND KLIK Project 22 Idhammad (Centre Hospitalier Universitaire Mohammed VI, Morocco), and Mela- nie Waitz (Klinikum Neukölln, Germany). GERMANY: Klinikum Neukölln 24 MOROCCO: Centre Hospitalier Universitaire Mohammed VI Marrakech 26 Special thanks to Grazia Cioci (Deputy Director, HCWH Europe), Anja Leetz (Ex- ecutive Director, HCWH Europe), and Taha Bousmaha (Volunteer, HCWH Europe), SWEDEN: Region Skåne 30 as well as Björn Fagerberg, Kristina de Geer, Hanns Moshammer, and Polyxeni UNITED KINGDOM: Operation TLC (Barts Health NHS Trust) 34 Nicolopoulou Stamati. UNITED KINGDOM: Sussex Community NHS Foundation Trust 36 Published: December 2016 UNITED KINGDOM: Sustainable Development Unit (SDU) 38 CLIMATE POLICY 42 Design: PrinzDesign, Marc Prinz, Maren Maiwald INTRODUCTION 43 Cover image: Heilig-Geist-Krankenhaus, Bingen, Germany, received the BUND OVERVIEW OF THE PARIS AGREEMENT – ESSENTIAL ELEMENTS 43 “Energy Saving Hospital” label in 2010 THE EU’S 2030 CLIMATE AND ENERGY FRAMEWORK 48 Photo credits: Николай Григорьев/fotolia (P.6), Gina Sanders/fotolia (P.10), AN ENERGY UNION ON – OR OFF – TRACK? 48 Manuel Hoffmann (P.14), Assistance Publique Hôpitaux de Paris (P.17), Centre POLICY RECOMMENDATIONS MOVING FORWARD 50 Hospitalier de Niort (P.18), BUND (P.16), BUND-Anja Tech (P.20), BUND – Clinic Muehlacker (P.23), Vivantes Hospital Network (P.25), Health Care Without Harm RECOMMENDATIONS FOR THE HEALTHCARE SECTOR 52 Europe (P.27/29), Region Skåne (P.31/32), Global Action Plan (GAP) (P.35), Care Without Carbon/Sussex Community NHS Foundation Trust (P.37), Sustainable Development Unit (P.39/41), Ewais/fotolia (P.52)
4 REDUCING HEALTHCARE’S CLIMATE FOOTPRINT: OPPORTUNITIES FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS REDUCING HEALTHCARE’S CLIMATE FOOTPRINT: OPPORTUNITIES FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS 5 INTRODUCTION air conditioning, and electric and electronic equip- CLIMATE CHANGE, HEALTH, ment. Health systems are also major consumers of AND THE HEALTHCARE SECTOR medical goods and equipment, which are often pro- Climate change is linked to an increase in the fre- duced in carbon-intensive processes in the devel- quency and intensity of extreme weather events. oping world under unsafe, toxic, and unregulated This means more heat waves, changing rainfall pat- conditions. It is within the role of health systems as terns, rising sea levels, wildfires, drought, and in- health stewards to make responsible decisions that tense cold spells. The exacerbation of these events guarantee both human and environmental health can have a direct or indirect effect on human health throughout their entire supply chain. Sustainable METHODOLOGY by disrupting ecosystems, agriculture, food and alternatives to health sector-related products and The case studies presented in this report began with a questionnaire. The information entered into water quality and availability, air quality, and dam- activities - that contribute to the mitigation of cli- the survey by respondents was used to develop the case studies presented in this report. The sur- aging infrastructure.1 In turn, the disturbance of mate change, save money, and ultimately protect vey process was then followed up by telephone interviews with the environmental representatives these systems can directly affect human health by human health - already exist. It is merely a matter of the participating hospitals and organisations. causing heat-related illnesses, infectious diseases, of structural transition and policy implementation. cardiovascular diseases, injuries, and respiratory The hospitals showcased in this report were hand picked by Health Care Without Harm (HCWH) Climate change has been declared the greatest Europe for their impressive efforts in reducing their institution’s climate footprint. These case diseases. Climate change is already contributing to threat to global health of the 21st century; yet re- studies provide examples of current best practices, yet the scope of European hospitals’ the global burden of disease and premature deaths. sponding to this threat is also the greatest public efforts to address climate change is not limited to these examples. Climate change induced events place great burden health opportunity.4 This report sets out to identify on health systems to cope with the consequences the threats that climate change poses to Europe- The report also takes a look at some useful tools and systems developed by the NHS of such events. These range from a hospital’s abil- an public health, and the opportunities for action Sustainable Development Unit in England, a behaviour change programme in UK, and ity to support a flood of patients after an extreme against climate change within the healthcare sec- a German NGO. Their projects encourage analysis and provide ways forward in tack- weather event, to the potential damage to infra- tor. The report showcases a number of initiatives, ling the environmental footprint of healthcare facilities. The diversity of programmes structure, or the ability to control infectious diseas- including eight case studies of hospitals in Europe and strategies presented in this report demonstrate that reducing an institution’s es. The burden of responsibility that lies with health and one in Morocco, that are already working to- impact on climate change requires collective input from many different sources systems in the face of climate change is enormous. wards reducing the climate footprint of healthcare with different areas of expertise, and a recognition that responsibilities need For this reason, strengthening public health ser- facilities. We hope this report can be used as a to be shared. vices must be a central component of all nations’ guide and inspire other health systems to adopt climate change adaptation measures and policies. green practices, and to become leaders in the fight against climate change. According to the World Health Organization (WHO), health systems comprise “all the organizations, institutions and resources that are devoted to pro- ducing actions principally aimed at improving, main- taining or restoring health.”2 As the organisations that exist to be the protectors of health, the health sector has the moral responsibility and social ob- ligation to be a leader in the fight against climate change. This must be done by eliminating health systems’ own toxic emissions, and minimising their contribution to harming human health and the en- vironment. Healthcare infrastructures have a large climate footprint. The approximately 15,000 hospitals across the European Union3 (EU) have a high de- mand for heating and electricity and require a large amount of energy for transport, lighting, ventilation,
6 REDUCING HEALTHCARE’S CLIMATE FOOTPRINT: OPPORTUNITIES FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS REDUCING HEALTHCARE’S CLIMATE FOOTPRINT: OPPORTUNITIES FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS 7 have significant impacts. Over 80% of Europeans HOW CLIMATE CHANGE are exposed to particulate matter (PM) concentra- IMPACTS HEALTH IN EUROPE tions exceeding the WHO recommended levels, al- ready reducing the life expectancy of each citizen Vulnerable Europe by an average of nearly nine months.12 The impacts of climate change in Europe vary be- In 2012, 403,000 premature deaths in the 28 tween regions. Europe can expect to see an in- Member States of the EU originated from long-term crease of certain weather events in the years to exposure to air pollution;13 this is equivalent to 8% come.5,6 of all deaths that year.14 Air pollution is the largest contributor to the burden of disease from the envi- BACKGROUND àà Southern and central Europe: Increased heat ronment and the number one environmental cause waves, forest fires, and droughts; of premature death in the EU. Heart disease and àà Mediterranean region: Expected intensifica- strokes are the most common causes of premature tion of heat waves, droughts, and wildfires; deaths due to air pollution, and are responsible for àà Northern Europe and The Arctic: Higher tem- 80% of these deaths, followed by lung diseases, peratures will cause melting of ice caps, more such as cancer.15 Air pollution also has consider- intense precipitation events, and increased able economic impacts: increasing medical costs, winter flooding; and reducing productivity through lost working àà Urban centres: Expected intensification of days. All of these figures are due to increase as heat waves, worsening of air pollution, rising temperatures keep rising and air pollution is aggra- sea levels, and flooding. vated. Heat waves Cold spells The heat wave of 2003 claimed approximately Extreme cold spells will continue to be a public 70,0007 lives in 12 countries of western and cen- health challenge, although winter mortality is de- tral Europe. In 2010, another heat wave caused creasing across Europe due to better social, eco- an estimated 55,000 deaths in Russia alone.8 The nomic, and housing conditions. Nevertheless, inad- elderly are most at risk of death from heat stroke equate indoor temperatures are a key contributor and cardiovascular, respiratory, and metabolic to rates of cardiovascular and respiratory diseases. disorders that are caused by high temperatures. Low-income households will continue to be the Without the implementation of adaptation meas- most vulnerable to deaths and diseases related to ures, heat-related mortality is expected to increase cold temperatures due to poor housing conditions across Europe, particularly in the South/Mediter- and inability to pay for heating. In the winter of ranean regions. The European Environment Agency 2011, much of Europe was engulfed by a hostile (EEA) predicts that by 2050, heat waves will cause cold front, and poorer populations, particularly the 120,000 deaths per year in the EU alone, and this homeless, were the ones to suffer the consequenc- will create an economic burden on public health of es. More than 300 deaths were reported across €150 billion.9 Europe, and in Ukraine alone the death toll exceed- ed 130, of which the majority were homeless peo- ple.16 Air pollution Rising temperatures aggravate the effects of air pollutants. Recent research by the European Res- Flooding piratory Society predicts that an increase in tem- Increased glacial melting and sea level rise lead- perature of 1°C will produce a 1-3% increase in ing to winter flooding, as well as river and coastal mortality within the general population, but this will flooding, are all expected to increase due to cli- result in a 6.5% increase among people with res- mate change, threatening more than 1.6 million piratory illnesses.10 Given that asthma affects 30 people across Europe. Health effects from flooding million people in Europe,11 rising temperatures will range from drowning, injuries, heart attacks, infec-
8 REDUCING HEALTHCARE’S CLIMATE FOOTPRINT: OPPORTUNITIES FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS REDUCING HEALTHCARE’S CLIMATE FOOTPRINT: OPPORTUNITIES FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS 9 tions, water-borne diseases, vector-borne diseas- across Europe. For example, Spain is already seeing CLIMATE CHANGE AND Capacity es, respiratory infections, and psychological prob- a decrease in agricultural productivity, and experts lems, as well as health consequences caused by from the region fear that many of the agro-regions HEALTHCARE The vulnerability of health professionals to climate change events is particularly important due to the the disruption of services, damaged infrastructure, will simply dry up and become fruitless deserts. crucial role that they play in a hospital’s disaster and loss of food production. Flooding can lead to In 2015, Spanish mandarin and clementine farm- Financial burden response systems. Measures must be taken to contamination of drinking, recreational, and irriga- ers suffered a 25% decrease in productivity, and in The environmental and health impacts of climate minimise the risk to health workers, in order to tion water, and to the disruption of water supply 2011, maize production across Europe dropped by change place great financial burden on health sys- maintain high productivity for both human health and sanitation systems, as is already happening on 13% due to heat-stress. Galicia, in north-western tems, and can also place substantial economic and economic efficiency. a significant scale across much of the developing Spain has experienced adverse impacts to its hy- world. Flooding may also lead to the vast displace- drological system due to persistent droughts since strain on local, national, and global economies. The increased frequency and intensity of climate ment of people.17 2014.19 The health sector is a highly carbon-intensive sec- change-induced events can lead to some social, tor that uses a lot of energy for all of its functions health, and emergency organisations and systems Droughts can also have indirect effects on human Drought and activities. These basic activities can have an being unfit to cope with the consequences of such health; they can cause dams to dry up and become impact on the budget of hospitals and health min- events. Having stable access to energy, clean wa- Prolonged rainfall shortage and high temperature inefficient, which may lead to energy shortages istries when their demand increases in times of ter, food, and all other medical resources is indis- anomalies often lead to severe drought. This phe- that could affect health systems. These systems climate-related stress. An over-extended health pensable. nomenon is not foreign to Europe. Countries includ- must be prepared to cope with the adverse effects of periods of severe drought. system can have an overwhelming financial burden ing Belgium, The Czech Republic, France, Germany, As well as the burden that climate change places on a nation’s economy. The WHO estimates there Hungary, Italy, Luxembourg, The Netherlands, and on health systems - which threatens their ability to will be an increase of $2 to $4 billion USD in annual Spain have all been affected by droughts. Droughts serve their communities - other unexpected conse- health sector costs by 2030 as a direct result of the are expected to increase in duration and severity quences, such as a surge in mass migration, must adverse effects of climate change on human health across the Mediterranean. In 2015, (one of the hot- also be considered as a real and pressing factor (excluding indirect costs from impacts on agricul- test years in recorded history), Europe was hit by that will increase the financial burden on health ture, sanitation, etc.).20 the worst droughts since 2003.18 systems, while impacting their ability to respond to During extreme weather events, hospitals and the health impacts of climate change. Droughts also contribute to the increased risk of health institutions may become physically dam- large wild fires, which in turn increase deforesta- aged, resulting in significant re-construction costs. tion. In the face of climate change, those regions Health professionals are also at risk from the every- not currently vulnerable to fires may soon find day threats of climate change, such as aggravated themselves affected. air pollution and the spread of climate change-re- Severe droughts can result in food and water short- lated diseases in hospital settings. This reality may ages, malnutrition, and water and food-borne dis- result in more staff having to take sick leave, thus eases. Some of these effects are already being felt reducing productivity and causing economic loss.21
10 REDUCING HEALTHCARE’S CLIMATE FOOTPRINT: OPPORTUNITIES FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS REDUCING HEALTHCARE’S CLIMATE FOOTPRINT: OPPORTUNITIES FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS 11 Migration burden they suffer from a communicable disease. Although HEALTHCARE’S CLIMATE Sustainable procurement practices (by which au- the provision of healthcare for all is a human right thorities, including hospitals and health systems, Climatic variability has long had an impact on that requires nations to provide care to all citizens, IMPACTS address green and social/ethical considerations global migration. Throughout history people have legal status is the main barrier to a migrant’s ac- It is now widely recognised that the excessive burn- in all purchasing practices throughout their sup- abandoned their homes in times of deteriorating cess to health services. ing of fossil fuels across all sectors is a major con- ply chain)25 are becoming more commonplace in environmental conditions. Whether from sudden tributor to the accelerated rate of global warming European hospitals, and expectations for health natural disasters, such as floods and landslides, or In light of the worsening adverse effects of climate we are experiencing today, and the health sector is systems to be held accountable for the GHG emis- disasters that cause more gradual environmental change being felt all across the globe, climate in- a major emitter of greenhouse gasses. For exam- sions of all activities throughout their value chains degradation (such as droughts and sea level rise), duced migration is bound to continue and poten- ple, in 2012, the total carbon footprint of England’s are growing. climate change undoubtedly contributes to the tially accelerate. For the sake of public health, it public healthcare sector was 32 million tonnes of mass displacement of people. is urgent that all citizens, including undocument- Pharmaceuticals carbon dioxide equivalents (MtCO2e) (CO2 equiva- ed migrants, receive necessary medical attention. Migrants are highly vulnerable to both communica- lent refers to a combination of harmful greenhouse Hospitals are by far the largest contributors of CO2e Health systems must enhance their ability to de- ble and non-communicable diseases during their gases, not just carbon dioxide), accounting for 38% emissions within the health sector. The second liver “migrant-sensitive” care by guaranteeing the journey and adaptation to a new location. They of public sector emissions in England.23 This serves largest polluter, providing goods for the health sec- ability to support a greater capacity of patients, by often experience socioeconomic inequalities and to illustrate how the healthcare sector is contrib- tor, is the pharmaceutical industry. For example, including cultural and interpretation services, and related stress that can lead to poor daily habits, uting an enormous amount of harmful emissions, in the case of the National Health Service (NHS) by pushing to remove the social, legal, and eco- such as unhealthy diet and physical inactivity, use which in turn undermines the health of the same in England, the entire life cycle of pharmaceuticals nomic barriers that lead migrants to refrain from of tobacco, and harmful consumption of alcohol. population the sector is meant to heal. The scope accounts for 22% of the their total CO2 emissions. seeking medical care.22 Many migrants avoid seeking medical attention and size of health systems varies across all regions The CO2-intensive activities of the pharmaceutical due to fear of police arrest, language barriers, ina- of Europe. Nevertheless, regardless of their size, industry include water use, energy consumption in bility to pay for treatment or, ultimately, fear of de- health systems and all of their activities and servic- buildings, manufacturing processes, and disposal portation. Avoiding medical attention not only puts es have an important influence on their communi- of waste. migrant`s health and potentially lives at risk, it can ties and their surrounding environments. also become a great threat to their communities if While the majority of pharmaceutical pollution takes In the following section, we describe some of the place outside the hospital setting, expectations for health sector’s most intensive greenhouse gas health systems to take responsibility for the full (GHG) producing activities. carbon footprint of their value chains is growing. There is also growing pressure for the pharmaceu- Procurement tical industry to adopt more sustainable strategies to reduce their carbon emissions and to clean up The EU healthcare sector, which provides care their production sites. Due to resource scarcities, across the 28 Member States, is a major public the strengthening of environmental regulations, purchaser of goods and services. In the process of and concerns about reputation, companies are be- treating patients, the healthcare sector consumes ing driven to explore solutions. The health sector significant amounts of energy, water, building ma- can also contribute by ensuring sound prescription terials, food, pharmaceuticals, and medical de- and drug management practices to minimise waste vices, and produces vast amounts of waste. The are in place. processes, supply chains, and end uses involved in this consumption create health risks and can have serious environmental impacts. Energy and buildings The majority of the healthcare sector’s CO2e emis- A major contributor of GHG emissions within health sions come from the procurement of goods and systems is the high-energy consumption of build- services.24 While hospitals might be working to ings and medical procedures. Hospitals need to cure diseases at home, the carbon-intensive pro- have an uninterrupted power supply for heating, duction of medical products and pharmaceuticals cooling, lighting, ventilation, medical treatments is often simultaneously polluting the air, water, and and devices, cleaning, and much more. Health sys- soil of developing nations across the globe, while tems also rely heavily on the use of secondary gen- also contributing to the health impacts of climate eration capacity for emergency uses. change.
12 REDUCING HEALTHCARE’S CLIMATE FOOTPRINT: OPPORTUNITIES FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS REDUCING HEALTHCARE’S CLIMATE FOOTPRINT: OPPORTUNITIES FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS 13 A Health and Environment Alliance (HEAL) 88 million tonnes of food each year.28 ment to reduce health risks linked to climate vices. The healthcare sector must strengthen early expert assessment found the health impacts change (please see the Climate Policy chapter for warning and disaster response systems and build Apart from providing care to patients, health sys- caused by coal power plants in the EU cost more information about the Paris Agreement). This climate resilient infrastructure. Health systems tems are also significant providers of food services. between €15.5 to €42.8 billion per year in conference set a health action agenda for the im- must also be prepared to support a greater influx of Hospitals offer their staff and patients at least three total health costs, and cause approximately plementation of the Paris Agreement, and included patients. It is vital that health professionals receive meals a day, and in some EU nations the average 18,200 premature deaths each year.26 With specific recommendations for the healthcare sec- the necessary training to act as a protective force number of meals per day is even higher. Therefore, astounding numbers such as these, health systems tor, arguing that health systems can “lead by ex- in emergency situations. the food that hospitals choose to procure and the have the moral obligation to make a full transition ample, advancing models of low-carbon health care way it is produced, processed, and transported can from the use of dirty energy to clean, renewable that improve access to health care services, reduce have a profound effect on the environment. Also, occupational and environmental health risks and Leadership energy sources that can help protect public health taking into account the health benefits of providing Health systems must play a strong leadership role from climate change. Health systems can also re- save energy costs.”30 Similarly, the 2015 Lancet healthy, organic, and sustainable food, health sys- in advocating for health, in order to encourage and duce their carbon footprint by reducing energy con- Commission on Health and Climate argued that by tems have the opportunity to both reduce carbon engage the support of different sectors and mem- sumption through a series of efficiency measures. moving toward low-carbon health systems, health- emissions from food and improve human health. bers of the government, industry, and civil society Combined, greater efficiency and the transition to care can mitigate its own climate impact, become renewable energy can also help to improve outdoor more resilient to the impacts of climate change, in the implementation of effective adaptation and air quality, which directly benefits human health by Waste and lead by example.31 mitigation policies. This influence can take many reducing harmful chemicals emitted from fossil fuel forms. For example, health systems and profes- Health facilities create significant amounts of dai- combustion and electricity generation. sionals, in their role as health stewards, can pro- ly waste of all types of materials, ranging from Mitigation vide evidence-based information for the establish- recyclable materials such as paper, plastics, and As the sector that exists to promote and maintain ment of norms and standards for the transition Transportation metals, to compost materials, electronics, chemi- human health and well-being, the health sector has from fossil fuels to clean, renewable energy, and cals, pharmaceuticals, and other waste considered the challenge, opportunity, and moral obligation the green and ethical procurement of goods and The burning of gasoline and diesel fuels used to hazardous. Many of these materials must undergo to lead by example and act on climate change by services that can be legally enforced, locally, na- power motor vehicles produces large amounts of special treatment and disposal methods, in order reducing its own carbon footprint. The health sec- tionally, and internationally. CO2 and also releases traces of methane (CH4) and to reduce harmful impacts on humans and the en- tor not only provides healthcare, it is also a major nitrous oxide (N2O), which are even more potent vironment. Health professionals have expertise, resources, employer, landowner, purchaser of goods, and a and harmful greenhouse gasses. Hospitals and oth- and knowledge; they are often sought out for a Waste that is classified as hazardous is a minor provider of energy-consuming services, such as 24- er health facilities rely on transportation systems reliable opinion regarding the health effects of cli- part of healthcare waste. Globally, materials that hour hospital care and transportation. Across all of to transport patients, families, staff, supplies, and mate change. Therefore, their participation in ad- are classified as similar to domestic waste make their activities, health systems have the opportuni- waste. Therefore, the careful evaluation and rede- vocacy activities adds immense value to the fight up between 75% to 90% of hospital waste.29 While ty to adopt and engage in sustainable practices that sign of hospital transportation systems and the for adaptive and preventive action at both policy some of these materials get recycled, much of the are beneficial to the environment, reduce health transition to less polluting vehicle fleets can have and community level. From providing public edu- waste is disposed by landfilling or incineration. risks, and save money. To honour its commitment significant climate change mitigation benefits.27 cation inside health clinics, to participating in ed- to the Hippocratic Oath – First, do no harm – the Incineration of healthcare waste produces main- ucational programmes on topics such as personal health sector should take on the responsibility of Food ly gaseous emissions, including steam, carbon moving away from fossil fuels, so that its practic- hygiene and nutritional advice, to publicising the dioxide, nitrogen oxides, a range of volatile sub- health risks of climate change for political leverage, Emissions from food consumption take place at es and services, the products it consumes, and the stances (e.g. metals, halogenic acids, products of health professionals have great capacity to spread all stages of the food supply chain: agriculture, buildings it operates, do not harm human health incomplete combustion) and particulate matter, knowledge and awareness across communities, manufacturing, transportation, consumption, and and the environment. plus solid residues in the form of ashes.30 All of and to influence the political momentum of climate disposal. It is estimated that agriculture in Europe change policies. these harmful gases contribute to air pollution, accounts for around 15% of GHG emissions from all increasing the burden of disease. Resilience EU food production. In agriculture, GHG emissions It is under these three pillars – mitigation, resil- Healthcare infrastructure and services need to result from the cultivation of certain crops, from ience, and leadership – that we have developed become increasingly resilient to all possible cli- livestock excretion, and from the use of petrole- EXPECTATIONS FOR THE mate-related conditions, such as extremes of heat, case studies from European hospitals (including um-based resources such as fertilisers, pesticides, one from Morocco) that are addressing climate herbicides, and fuel used for farm operations, pro- HEALTHCARE SECTOR cold, droughts, and storms. There are many differ- change. While there is still much work to be done ent measures that must be implemented in order cesses, and transportation. Food waste is a major to significantly reduce the health sector’s climate In July 2016, participants attending the World to become more resilient. Vaccination programmes avoidable contributor to GHG emissions; when impacts, many lessons can be learned from the Health Organization (WHO)’s Second Global Con- and the monitoring of sanitation, waste, and wa- food is wasted, all of the resources used in it’s pro- following case studies, which provide a wide and ference on Health and Climate proposed key ac- ter are necessary to build resilience to infectious duction and supply are also wasted. According to diverse set of strategies to reduce healthcare’s tions for the implementation of the Paris Agree- diseases and strengthen environmental health ser- the European Commission, the EU wastes around climate footprint.
14 OPPORTUNITIES REDUCING HEALTHCARE’S FOR HEALTHCARE CLIMATETOFOOTPRINT: REDUCE CLIMATE OPPORTUNITIES CHANGE FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS REDUCING HEALTHCARE’S CLIMATE FOOTPRINT: OPPORTUNITIES FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS 15 CASE STUDIES: WHAT EUROPEAN FRANCE: PAGE 16 Assistance Publique - Hôpitaux de Paris FRANCE: PAGE 18 Centre Hospitalier de Niort HOSPITALS ARE DOING TO TACKLE CLIMATE CHANGE GERMANY: PAGE 20 GERMANY: PAGE 22 GERMANY: PAGE 24 Bund Label KLIK Project Klinikum Neukölln MOROCCO: PAGE 26 SWEDEN: PAGE 30 Centre Hospitalier Universitaire Region Skåne Mohammed VI of Marrakesh Klinikum Neukölln, Berlin UK: PAGE 34 UK: PAGE 36 UK: PAGE 38 Operation TLC Sussex Community NHS Sustainable Development Unit Foundation Trust
16 REDUCING HEALTHCARE’S CLIMATE FOOTPRINT: OPPORTUNITIES FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS REDUCING HEALTHCARE’S CLIMATE FOOTPRINT: OPPORTUNITIES FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS 17 At the event, hospitals and other public services, ing plan in each hospital of the APHP network. The ASSISTANCE PUBLIQUE - such as the city postal service, present their pro- aim is to promote environmentally-friendly means HÔPITAUX DE PARIS grammes of active mobility to inspire sustainable of transportation, and to replace each vehicle with travel across the city. The second annual confer- an electric or hybrid option. APHP also encourages ence took place on 23rd September 2016 in Paris. employees to reduce the use of personal vehicles ABOUT At the European level, APHP participates in the Eu- through the use of Velib (a network of shared bi- cycles)33 and Autolib (an electric car-sharing pro- Assistance Publique - Hôpitaux de Paris (APHP) is ropean research project STREAMER,32 which aims gramme),34 and has also put in place a carpooling the largest hospital group in Europe, delivering to curb energy consumption and GHG emissions of system for all its employees. medical care, research, and education across the new and renovated health facilities by 50% with- region of Paris at its 39 hospitals. APHP has more in 10 years. Using building information modelling than 22,000 beds, including 350 in intensive care technologies, the project sets out to develop inno- Building facilities. On a yearly basis, APHP medical teams vative designs for sustainable buildings. Current- As part of its efforts to reduce its carbon emis- offer advanced treatments in all medical disci- ly, the pilot project is developing models for the sions in its hospitals, APHP has also partnered plines to 7 million patients – including 5 million Georges Pompidou Hospital in Paris. with the French Environment and Energy Manage- medical consultations and 1.5 million hospital- ment Agency (Agence de l’Environnement et de la APHP is playing a key leadership role in promoting isations (roughly 10% of all hospitalisations in Maîtrise de l’Énergie, ADEME). It is working to im- environmental policies within the Parisian health France). With 95,000 health professionals, includ- plement the High Quality Environmental standard sector. In light of the increasing awareness of the ing doctors, researchers, paramedics, adminis- (a standard for green buildings in France), and re- impact of climate change on human health, APHP trative staff and workers, the APHP is the largest duce its energy consumption by 20% by 2019, com- acknowledges its responsibility to develop initi- employer in the Paris region. pared to its 2013 levels. ADEME provides financial atives that reduce GHG emissions across all of its activities (including those emanating from its assistance for projects, work review services, and supply chain) in order to protect the health of its recommendations for specialised consulting organ- patients. Through increasing its efforts to address isations. climate change, APHP creates momentum through - FRANCE - its relationship with the French Federation of Hos- pitals to influence national policies that will pave Institut E3M: Institute of Endocrinology, Metabolic Diseases, and Internal Medicine, Paris, France the way for a more sustainable healthcare sector LEADERSHIP in France. Given the size of their network, APHP understands the influence it can have in swaying public health To this end, APHP is developing more sustaina- and climate change policies across the Paris region ble policies for many of its polluting activities. In and is constantly working towards the implementa- waste management, it is working towards more tion of them. From setting up research projects on systematic sorting of 18 different kinds of waste, energy management with the City of Paris, to de- and seeking to reduce packaging. APHP has also veloping new techniques on renewable energy con- established a working group composed of medical sumption, APHP seeks to create awareness about professionals to raise awareness and find ways to sustainable development and climate change is- minimise carbon emissions from the procurement sues among health professionals and concerned of pharmaceuticals. APHP expects to implement government stakeholders. sustainable development policies across its many activities, and to develop solid programmes and In partnership with the Centre Hospitalier Universi- strategies for the reduction of GHG emissions in taire de Bordeaux and Centre Hospitalier Universi- years to come. taire de Rennes, APHP initiated the Mobility Day of University Hospitals in France, aimed at gathering professionals working on sustainable development Transportation in the healthcare sector to exchange and promote APHP seeks to facilitate the use of alternative innovative sustainable mobility practices. This has means of transport for its employees in order to op- become an important day for strengthening the timise intra-hospital travel and to reduce its carbon health sector’s collaboration with the City of Paris. footprint. It has put in place a travel and commut-
18 REDUCING HEALTHCARE’S CLIMATE FOOTPRINT: OPPORTUNITIES FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS REDUCING HEALTHCARE’S CLIMATE FOOTPRINT: OPPORTUNITIES FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS 19 parallel to working to meet this target, the hospi- CENTRE HOSPITALIER DE tal seeks to solve parking problems that the staff Positive energy buildings NIORT encounter. In March 2013, the hospital launched A significant contribution to the sustainable development programme at the Centre Hospitalier de Niort was the de- its travel and parking plan, aimed at reducing un- cision to commission a positive energy building. Positive energy buildings generate their own energy for consumption necessary travel and solo car journeys. It has also but also create surplus energy that can be used for other purposes (such as running electric vehicles or providing ABOUT sought to promote environmentally-friendly means power to the grid). Construction of such a building began in February 2014, and was completed in October 2015. of transportation, such as carpooling, and by grad- Centre Hospitalier de Niort is the largest public ually replacing hospital vehicles with electric or hy- Located 30km from Niort, in the city of Parthenay, this building was built to reduce the amount of patients travelling health facility in the Deux-Sèvres region in West- brid options. to Niort for consultations. The building is a day hospital and houses consultation offices, care facilities, and activity ern France.35 The hospital is made up of one gen- rooms for patients. eral hospital and a psychiatric unit, has 1,295 beds, and employs more than 3,300 health pro- Waste management With the first positive energy building in the Poitou-Charentes region, the hospital succeeds in producing an amount fessionals. Overall, the hospital produces about 1,325 tonnes of renewable energy greater than the energy consumption of the building. In 2013, the planned hospital building won of waste per year (see Table 1). The hospital sep- an award in a project launched by the region and Agence de l’Environnement et de la Maîtrise de l’Energie, ADEME, arates oils, paper, cardboard, green waste, toxic in the National Research and Experimentation Programme on Energy in Buildings. waste from laboratories, common industrial waste, MITIGATION scrap metal, computer waste, batteries, neon The hospital emits 44,165 tonnes of CO2e per year How is this achieved? bulbs, wood, and rubber. The current waste poli- from its collective activities. In order to reduce car- cies encourage the sorting of waste in order to min- Environmental concerns were considered during the project design in order to incorporate them into the construc- bon emissions, the hospital has implemented pol- imise the quantities of materials going to landfill or tion of the building. The hospital was built to maximise natural light and to reduce primary energy consumption. The icies in line with the United Nation’s Agenda 21, incineration, and instead re-use or recycle them as facade is covered by wood certified for solar protection. Safe linoleum materials were used, as well as paints without which is a non-binding, comprehensive plan for much as possible. any volatile organic compounds. A new boiler installed in September 2014 is fuelled with wooden pellets and gener- sustainable development. ates 3.1 MW of power. There is double-flux ventilation throughout the entire building, which helps heat and cool the To encourage recycling, Centre Hospitalier de Niort building more quickly. Centre Hospitalier de Niort was the first public has developed an awareness campaign for person- health institution in the region of Poitou-Cha- In 2015, the hospital also installed 228 m2 of photovoltaic panels on its rooftop, producing 39,500 kWh annually - FRANCE - nel in order to educate them about sorting waste. rentes to launch such a sustainable development Educating the workforce is challenging, but is the and offsetting the building’s energy consumption. These panels produce surplus electricity that is then sold to the approach in 2010. To this end, three committees most important element to achieve effective imple- general electricity grid. The total energy consumption of the building is 53,046 kWh, across a surface area of 1,596 were established: a steering committee to devel- mentation of waste management separation sys- m2 (33 kWh/m2). op a sustainable development strategy and action tems. The hospital has started auditing their var- plans, a partnership committee, and a technical ious departments, and has established treatment committee to monitor the carbon footprint. More- systems with external waste collectors for specific over, every employee was invited to participate in materials, such as cardboard and plastic for recy- working groups to develop strategies for imple- cling. There are over 30 sorting streams to promote TABLE 2: CO2 EMISSIONS OF GENERAL HOSPITAL mentation of the sustainable development policies the recycling of more waste and to help find ways FOR SELECTED YEARS for the hospital. of processing specific materials. Vegetable waste Year Fuel Emissions tCO2 % Reduction The hospital set a goal to reduce CO2 emissions by is treated in industrial composting units that belong 15% by 2020. In 2014, Centre Hospitalier de Niort to the city of Niort. 2010 Gas 5,475 replaced its gas heater with a new system fuelled by wood. This change helped Niort to exceed its tar- 2014 Gas/wood 4,204 -23% TABLE 1: ANNUAL WASTE PRODUCTION get, having reduced emissions by 25% compared to 2015 Wood 577 -89% 2010 levels (see Table 2). As a result, the target was Type of waste Amount (in tonnes) reviewed in 2010 and 2014, and it will be reviewed again in 2018. Healthcare waste 229 Household waste 750 Transportation Paper & cardboard 120 Implementing effective travel policies is a key ob- jective for Niort Hospital. A 20% reduction target Vegetable waste 99 in emissions from transportation has been set. In The positive energy building at Centre Hospitalier de Niort, Parthenay
20 REDUCING HEALTHCARE’S CLIMATE FOOTPRINT: OPPORTUNITIES FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS REDUCING HEALTHCARE’S CLIMATE FOOTPRINT: OPPORTUNITIES FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS 21 BUND FÜR UMWELT UND Today, 45 German hospitals have received the The “Energy Saving Hospital” Label - Case studies BUND label. Overall, 65,000 tonnes of CO2 emis- NATURSCHUTZ DEUTSCHLAND sions per year have been saved. This translates EVANGELISCHE ELISABETH KLINIK in Berlin is one of six hospitals that belong to the hospital group Paul Gerhardt Diakonie. It is a small hospital with 150 beds, and receives 21,400 patients each year. Based – THE BUND “ENERGY SAVING into the reduction of 22,000 MWh electricity per year, and 140,000 MWh of heat per year. Through on 2014 data, this hospital consumes about 5,600 MWh energy, and emits around 1,800 tonnes of CO2 each HOSPITAL” LABEL year. the implementation of BUND label criteria, a single hospital could save at least €100,000. One hospital Through the implementation of energy efficiency policies for electricity, heat, and water consumption, Elis- LEADERSHIP in Berlin saved up to €2.1 million per year in energy abeth Klinik has achieved a significant reduction in energy use. In 2016, the hospital paid €250,000 less in The “Energy Saving Hospital” label36 was estab- costs by implementing BUND’s energy saving solu- energy costs than in 2010. lished in 2001 by BUND (Bund für Umwelt und tions. More than €20 million per year has been Naturschutz Berlin e.V., also known as Friends of saved by all 45 hospitals bearing the BUND label. Reduced CO2 emissions: the Earth Berlin), a German NGO active in environ- Participating hospitals can also take advantage of • 2000 to 2004: mental policy. It is awarded to German hospitals a growing network where they can exchange views CO2 reduction of approximately 30% (c. 615 tonnes per year) that have achieved outstanding results and en- and experience, and learn from other success sto- gagement in the fields of energy saving and climate ries to further improve their hospital’s energy effi- • 2004 to 2009: protection. ciency. CO2 reduction of approximately 8.2% (c. 141 tonnes per year) • 2009 to 2015: CO2 reduction of approximately 7.3% (c. 142 tonnes per year) While the hospital made significant reductions in the first award period between 2000-2004, it becomes much more of a challenge to achieve further CO2 reductions in the second and third award periods on top of savings already achieved. The label is initially granted for five years to hospi- - GERMANY - tals that: LWL LIPPSTADT is a hospital of the Regional authority of Westphalia Lippe. The hospital has 862 beds and a. implement an energy management plan (in- cares for 2,370 psychiatric patients per year. Based on data from 2015, the hospital consumes 23,470 MWh cluding designating an energy officer, providing for energy and emits 5,140 tonnes of CO2 each year. collection and validation of data and costs, regular inspection of facilities and equipment, and imple- Through the implementation of energy efficiency policies for electricity, heat, and water consumption, menting a list of recommendations) and: Lippstadt hospital has made significant reductions in their energy use. b. demonstrate compliance with at least two of Reduced CO2 emissions: the following criteria: • 2000 to 2005: àà Reduction of CO2 emissions by more than CO2 reduction of approximately 40% (c. 7,400 tonnes per year) 25% in the last five years, or • 2005 to 2010: àà Continuous reduction of energy consump- CO2 reduction of approximately 10.9% (c. 872 tonnes per year) tion compared to the specifications of the VDI-guideline 3807,37 • 2010 to 2015: or CO2 reduction of approximately 14.6% (c. 929 tonnes per year) àà Long term optimisation of energy consump- tion in new buildings. Between 2010 and 2015, it has saved a total of €170,000 though energy saving strategies. After the initial five years, the label can only be ex- tended after an external audit identifies continuous improvements and compliance with the criteria, and the adoption of a further minimum target of Top image: 2013 BUND Label ceremony for Franziskus Clinic, 5% reduction in energy consumption over the fol- Berlin & Havelhöhe Clinic, Berlin lowing five years. Bottom image: Clinic Mühlacker, Germany
22 REDUCING HEALTHCARE’S CLIMATE FOOTPRINT: OPPORTUNITIES FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS REDUCING HEALTHCARE’S CLIMATE FOOTPRINT: OPPORTUNITIES FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS 23 Of the 51 hospitals that participated in the KLIK BUND’S KLIK PROJECT - project, 34 were public, 14 were charities, and 3 “DEVELOPING CLIMATE three were private hospitals. MANAGERS IN HOSPITALS” The success of the energy saving solutions of the KLIK project was very much determined by the commitment of the climate managers, and suc- LEADERSHIP cessful implementation was reliant on strong lead- Following on from the success of the label project, ership. For this reason, climate managers needed BUND also led a project to help hospitals to devel- to fulfil some important criteria, such as being an- op climate strategies. The initiative is called KLIK38 chored in internal hospital structures. This could (Klimamanager für Kliniken) and exists to devel- be an administrative role, or a technical or quality op and train employees in hospitals to be climate management position, but the leader required an managers. Funded by the National Climate Protec- affinity for climate protection issues, and also the tion Initiative (Nationale Klimaschutzinitiative), the authority to make decisions, changing some rules KLIK project began in 2014, and ran until the end or procedures if necessary. of 2016. The focus of the project was to increase energy efficiency in hospitals through low and no- Of the hospital participants in the KLIK project, 21 cost measures. climate managers were technical leaders, 19 were technical qualified employees, three were adminis- Germany has 3,183 hospitals, which collective- tration managers, and three held other positions. ly consume 12.5 million MWh of heating and 3.9 million MWh of electricity, accounting for a to- Within three years, all participating hospitals re- tal spending of approximately €1.7 billion each duced their CO2 emissions by approximately year. Numerous opportunities exist to save en- 34,500 tonnes collectively. At the same time, en- ergy costs decreased by €9 million. Measures were - GERMANY - ergy – and costs – given the diversity of energy use in healthcare settings. While saving money carried out in a number of areas such as: ventila- is an obvious incentive, hospitals also have the tion, cooling, heating, lighting, and consumer be- opportunity to be leaders in energy efficiency haviour. The greatest reduction of CO2 emissions in the public sector. This is what KLIK set out to were achieved in ventilation – approximately 3,000 do: mobilise climate managers across the Ger- tonnes per year. man health sector to guide their institutions to- An online guidebook with tips and results is availa- wards more efficient and energy saving systems. ble on the KLIK website (in German).39 From 2017, other (German) hospitals will be able to join the The specific goals of the KLIK project were to: network40 which will continue to host seminars and àà maximise the energy saving potential of workshops. hospitals; àà train and qualify 50 climate managers in the German health sector; àà establish an internal network of climate lead- ers in every participating hospital; àà publish an online guidebook for hospitals; àà create a database with examples of best practice; and àà reduce CO2 emissions by approximately 30,000 tonnes, mostly through non- and low-investment measures. This meant reduc- ing energy costs by approximately 6% to 10% per clinic. Solar panels on the exterior of Clinic Mühlacker, Germany
24 REDUCING HEALTHCARE’S CLIMATE FOOTPRINT: OPPORTUNITIES FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS REDUCING HEALTHCARE’S CLIMATE FOOTPRINT: OPPORTUNITIES FOR EUROPEAN HOSPITALS & HEALTH SYSTEMS 25 VIVANTES KLINIKUM Low investment measures Neukölln carries out daily checks and maintenance of approximately 2% to 3% per year. of equipment consuming electrical energy. For ex- NEUKÖLLN Klinikum Neukölln has implemented a variety of dif- ample, it is critical to check that fans are running at Since 2003, Klinikum Neukölln has prevented over ferent low investment measures to improve energy 100,000 tonnes of CO2e emissions, saved 400,000 full load, and to make sure that ventilation systems efficiency, many of which are simple measures to MWh of energy, and approximately €23 million in are clean in order to reduce power consumption. guide behaviour change towards more conscious energy costs. In 2014, Neukölln consumed 60% less ABOUT energy use. For example, by attaching thermostat- energy than in their baseline year of 2003. Klinikum Neukölln is one of the nine hospitals that ic valves to radiators, the hospital is able to better High investment measures make up the Vivantes hospital network. Located monitor and control the temperature levels of the Higher investments can contribute to much great- in central Berlin, it is an acute hospital with mul- building. These valves have locking devices which RESILIENCE er energy savings. In 2010, the Klinikum Neukölln tiple specialist centres, covering traumatology, allow radiators to be set to a specific level, which modernised its refrigeration equipment, replacing Klinikum Neukölln has implemented particular in- lung cancer and thorax conditions, gastroenter- is very important when an increase in temperature the old steam-heated absorption refrigeration sys- frastructure projects to support healthcare in the ology, and neurology, amongst others. The clinic of 1°C means a 15% increase in heating costs. At has 1,288 hospital beds, and cares for 125,000 first, hospital staff were unhappy with lower tem- patients each year. With a large workforce of peratures in the buildings and this resulted in valves 400 doctors and 750 nurses, Neukölln also has being disassembled. However, through capacity the largest emergency department in Berlin, with building and awareness raising, the new system 77,000 cases per year. In order to provide for this was soon accepted by all. wide scope of specialised and emergency care, the The hospital also replaced all permanent lighting hospital has a high energy demand. Klinikum Neu- with more efficient fluorescent tubes. Klinikum kölln has taken it upon itself to become a leader in Neukölln has approximately 10,000 lights through- energy efficiency. out its buildings, creating great opportunity for easy energy saving. The costs of this measure were paid off in only eight months. - GERMANY - Another strategy was to optimise lighting by au- tomatically cutting off lights after three minutes in areas with low transit, such as staircases, and Aerial view of Klinikum Neukölln Solar panels at Klinikum Neukölln throughout the hospital during sleeping hours. MITIGATION Along with signs on light switches to educate pa- tem with three new screw compressors powered case of emergency situations. The main parts of the Energy efficiency tients and staff to turn off unnecessary lights, these by electricity. This replacement required an invest- hospital are equipped with autonomous electricity, ideas have proven to be valuable methods of con- ment of approximately €4 to €5 million, but this water, and heating supply systems. The emergen- In 2003, energy saving goals were set in accord- cy generators are able to supply the hospital with serving energy. new system has helped Neukölln reduce the costs ance with the BUND label for “Energy Saving Hospi- electricity for up to five days. The boilers for central of gas supply by €400,000 per year, and reduce an- tals” (see pages 20-21). In the past, energy conser- Another energy-saving approach came from heating are normally fuelled by city gas, but in emer- nual power consumption by approximately 2 million vation was primarily achieved by the replacement merely adjusting the air conditioning units during gency situations, they can be fuelled by oil reserves kWh. of energy-inefficient facilities and devices. Today, low-transit hours, and shutting them down in the kept at the hospital. Klinikum Neukölln is also attempting to improve operating suites at night. Neukölln uses residual The whole Vivantes network has switched to green energy conservation through construction projects. heat from sludge and blowdown water from boil- electricity. At Klinikum Neukölln, a photovoltaic sys- To cope with extreme heat events, the hospital The hospital is currently working on a reconstruc- ers for heating, while also making the most of re- tem was installed on the roof. The system achieves built its air conditioning unit with a higher capacity tion strategy where a key objective is the integra- sidual heat by using recovery systems in midsum- an output of 50.54 kilowatts peak (kWp). It produc- than is typical. This system has sufficient reserves tion of energy-efficient technologies in a long-term mer to power air conditioning. es 45.5 MWh of electricity and saves 30 tonnes of to cool the hospital buildings, including medical strategy to reduce GHG emissions. CO2 per year. Excess electricity generated is fed functional areas and intensive care units, in periods In order to save energy through reduced water con- of extreme heat. The technical system is manufac- into the public electricity network to be used for the In 2003, when Klinikum Neukölln began its ener- sumption, the clinic installed 200 waterless urinals tured for outdoor temperatures up to 40oC. energy demand of Berlin. Through all of these poli- gy saving efforts, the hospital consumed 103,092 for staff and visitors (not for patients). Additionally, cies and improvements, Klinikum Neukölln has be- MWh of energy, and produced 31,227 t CO2 emis- the replacement of older water circulation pumps Taking into account possible situations of water come “the energy saving hospital” of the Vivantes sions. In 2015, after 12 years of implementing en- with highly efficient pumps has been a significant scarcity or contamination, Klinikum Neukölln has network. Considering the development of energy ergy efficiency solutions, the hospital consumed contributor to the clinic’s increased water and en- its own water tower and deep well to provide a safe markets and the value of energy resources, there 52,057 MWh of energy and produced 17,927 t CO2 ergy efficiency. supply of water. has been a saving in the hospital’s energy demand - a 43% reduction in emissions. Maintenance is crucial to maximise efficiency, and
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