1. Climate Change and Healthcare
Greenhouse gas accounting in the healthcare
sector
Presented by:
Tom Penny (Environmental Resources Management)
Laura Draucker (World Resources Institute)
26th April 2013
Boston

2. Contents
1. Climate Change and Healthcare
2. Initiatives, Standards and Support
3. Measuring and Reducing
4. Q&A

3. Contents: Climate Change and
Healthcare
1. A Brief Introduction to Climate Change
2. The Healthcare Picture
3. Future Trends

4.  Climate system, processes and interactions are complex
Introduction to Climate Change
IPCC

5. Global Greenhouse Gas Emissions
Total GHGs
Gt CO2e / year
(2005)
44
WRI, 2009

6. Question
“is the healthcare sector a major source of
global greenhouse gas emissions?”
a) less than 2%
b) 2 to 10%
c) greater than 10%

7. Healthcare Greenhouse Gas Emissions
 Healthcare roughly 3-5% of global GHG emissions
 United States healthcare roughly 8-12% of country GHG emissions
ERM estimate
 Total global health expenditure US$ 6.5 Trillion
WHO Global Health Expenditure Atlas, 2012
 Current population roughly 7.1 Billion
United Nations

8. Why is Healthcare a GHG Issue?
 Population likely to increase (31%) to 9 billion
by 2050
United Nations
 Increased demand on healthcare
6.5
7.0
7.5
8.0
8.5
9.0
9.5
10.0
2010 2020 2030 2040 2050 2060 2070
Globalpopulation(billion) X
BBC

9. Future Trends: Increase in Spend
 Spend on healthcare per capita
 Average: $948 USD
 High: $7,960 (United States), $4519 (Canada), $3440 (UK)
 Low: $44 (India), $56 (Indonesia), $191 (China)
WHO Global Health Expenditure Atlas, 2012 (in $USD)
 Potential global health
expenditure
US$ 57 Trillion
If all of current population had the
equivalent healthcare spend as US
0
10,000
20,000
30,000
40,000
50,000
60,000Totalspend($USDBillion)
Global Healthcare Spend
(if country spend was the average)

10. Where is the Challenge?
 Crucial for industry to measure what is currently
being done and target areas for significant
reductions
 Real reductions need to be realized to meet
future challenges (for example)
 new care pathway models
 telemedicine
 unused medicines
 remanufacture of medical devices

11. Contents: Initiatives, Standards and
Support
1. Introduction to GHG Protocol
2. Standards
3. Support available

12. Flashback to 1998…

13. The Greenhouse Gas Protocol is a partnership between the World Resources
Institute and the World Business Council for Sustainable Development.
GHG Protocol is built on the expertise of WRI and WBCSD, combined with
the insight and experience of hundreds of the world’s leading organizations.
A global partnership

14. The Greenhouse Gas Protocol, led by WRI and WBCSD, provides the foundation
for comprehensive measurement and management strategies to reduce
emissions and drive more efficient, resilient, and profitable businesses and
organizations.
Mission

15. http://www.youtube.com/watch?v=_urMCfkPdus

16. Corporate Standard
Corporate Value Chain
(Scope 3) Standard
Project Protocol Product Standard
GHG Protocol Standards

17. The Corporate Standard
• Helps companies prepare a true and
fair inventory of their GHG emissions
• Aids the development of effective
reduction strategies
• Supports credible and consistent
reporting
• Available in seven languages
• First to introduce the concepts of scope
1, 2, and 3
Over 85% of respondents to a 2010 Carbon Disclosure Project survey of
2487 companies either directly used GHG Protocol or used it through their
participation in a climate change program that used GHG Protocol.

19. Related Corporate Standard sector
publications
Office-based
organizations
US public sector Agricultural sector Scope 2 accounting
Under development

20. The Scope 3 Standard
• To be used in conjunction
with the Corporate
Standard
• Includes requirements and
user-friendly guidance for
quantifying and reporting
Scope 3 emissions
• Includes upstream and
downstream emissions
organized into 15 different
scope 3 categories

21. Why is considering
full value chain
(scope 3) emissions
important?
Note: Chart represents average breakdown of emissions by category from scope 3 road testers
Scope 1 & 2, 21%
1. Purchased
goods and
services, 34%
2. Capital
goods, 1%
3. Fuel- and
energy-related
activities, 4%
4. Upstream
transportation
and distribution,
4%
5. Waste
generated in
operations, 1%
6. Business
travel, 7%
7. Employee
commuting, 2%
8. Upstream
leased assets, 1%
9. Downstream
transportation
and distribution,
2%
11. Use of sold
products, 16%
12. End-of-life
treatment of sold
products, 3%
13. Downstream
leased assets, 1%
15. Investments,
3%
Scope 1 & 2
emissions
Scope 3
emissions
categories

22. The Product Life Cycle Standard

23. • Entities perform product level assessment to meet demands
from:
– Customers wanting measurement and disclosure of product-level GHG
information
– Investors demanding more transparency
– Consumers seeking greater clarity and environmental accountability
Drivers for Product Level Assessments
(Carbon Footprints)

24. Full suite of GHG measurement
standards

25. • Since their launch in October 2011, several in- person trainings
have been offered on the Scope 3 and Product Standards
• To reach wider audiences, we are currently:
– Offering quarterly webinar training
• May 7 – 9 , Scope 3 Standard
• June 4 -6 , Product Standard
• Visit our website for more information and to register:
www.ghgprotocol.org
– Developing e-learning online trainings for both standards
GHG Protocol Capacity Building

26. • Tools and guidance available on our website:
– List of third party databases for secondary data sources
– Uncertainty calculator and guidance
– Supplier engagement guidance
– Reporting template
• Product Standard sector guidance built on the GHG
Protocol:
– Information and Communication Technology ( ICT) (under
development)
– ENCORD Guidance for Construction Companies
– Concrete PCR
– Pharmaceutical products and medical devices
• Tools and guidance are developed based on stakeholder
needs
GHG Protocol Tools and Guidance

27. Contents: Measuring and Reducing
1. Impacts within the healthcare sector
2. Healthcare carbon footprinting guidance
3. Benefits, case studies and initiatives

28. Question
“Are direct (eg hospital energy, etc) or indirect
operations (eg manufacture of consumables,
etc) more significant for healthcare GHG
emissions?”
a) Direct operations <50%
b) Direct operations >=50%

29. Healthcare Impacts: Direct & Supply Chain
X ~35% Direct
State of Green Business 2013, GreenBiz

30. Healthcare Impacts: UK NHS Footprint
UK NHS Footprint 2010

31. Why was the Guidance Developed
NHS undertook an organizational carbon
footprint in 2010 – pharmaceuticals 1/3rd
Summits held by NHS Sustainable Development
Unit (SDU) – promote low carbon healthcare
2011 summit identified need for guidance to aid
in the carbon footprinting within the sector
Steering Group put together to develop
guidance

32. Who Developed the Guidance
 Association of British Healthcare Industries
 Association of British Pharmaceutical Industries
 AstraZeneca
 Baxter Healthcare
 British Generic Manufacturers Association
 Environmental Resources Management
 GlaxoSmithKline
 Hull and East Yorkshire NHS Trust
 Johnson & Johnson
 Medicines and Healthcare products Regulatory Agency
 National Institute for Health and Clinical Excellence
 NHS Commercial Medicines Unit
 NHS Sustainable Development Unit
 Novo Nordisk
 Pfizer
 SustainPharma
 UK Department of Health
 United Nations Development Programme (UNDP) Europe and Central Asia
 Western Health Australia
 World Resources Institute

33. Healthcare Carbon Footprint Guidance
 Aimed to support
consistent quantification
of the carbon footprint of
pharmaceutical products
and medical devices
NHS SDU GHG Protocol

34. What can the Guidance be Used For
Internal product appraisals
• eg hotspot analysis or eco-design initiatives
Performance tracking
• eg products GHG emissions over time
Reporting
• eg product GHG emissions
NOT FOR: Comparative claims
• eg favourable environmental performance of one product over another

35. Who Should Use the Guidance
The guidance aims to provide
 Clarity on life cycle stage and process inclusions/ justified exclusions
 Guidance on challenging aspects of the inventory calculation process
 Requirements/recommendations on primary & secondary data
needs, sources and data quality appraisal
 Requirements/recommendations with regard to reporting
Guidance is intended for
 Producers within the sector or value chain
 Healthcare services / regulators /policy makers
 Procurement teams

36. Structure of the Guidance
 Section 1: Introduction
 Section 2: Core Principles
 Section 3: R&D, Clinical Trials & Marketing
 Section 4: Pharmaceutical Products
 Section 5: Medical Devices
 Section 6: Distribution & Delivery
 Section 7: Use Phase
 Section 8: End-of-Life
 Section 9: Reporting & Assurance
 Section 10: Care Pathways

37. Section 4: Pharmaceutical Products
37
 Guidance ‘modules’ provided for production processes or stages with
similar accounting challenges and data needs. These can be combined to
develop a profile for the production of the final, packaged product
Active Pharmaceutical Ingredients
■ Synthetic organic chemicals
■ Cell cultures
■ Egg-based cultivation
■ Conjugate vaccines
■ Plant-based extraction
■ Human & animal-derived
Delivery Mechanisms
■ Solid dose forms
■ Liquid dose forms
■ Creams & ointments
■ Patches
■ Gases
■ Administering devices
■ Packaging

38. Section 5: Medical Devices
38
 Guidance provided for similar product ‘groups’ with similar accounting
challenges and data needs.
Medical Device Categories
■ Passive, Single Use Devices with Multiple Components/Materials
■ Passive, Single Use Devices with Few Components/ Materials
■ Passive, Multiple Use Devices
■ Implantable Devices
■ Energy Consuming Devices
Johnson & Johnson

39. Example Process Diagram
39

40. Example Processes to Include/Exclude
40
Include these non-attributable
processes:
•Chemicals used for cleaning
•Sterilisation
•Refrigerant leakage associated with
product manufacturing
Include these attributable processes:
• Material and chemical inputs
• Material and chemical transport
• Energy/fuel generation and
consumption
• Waste disposal
• Solvent manufacture, use and
disposal
• Catalyst manufacture, use and
disposal
• Solvent recovery and incineration
• Process emissions from synthesis
Exclude these attributable and non-attributable processes:
• Packaging of material & chemical inputs
• Disposal of input packaging (eg IBCs, drums, pallets, etc)
• Production and disposal of consumables (eg gloves and protective clothing,
filters, cartridges, etc)

41. Drivers and Benefits
Help to identify supply chain risks, threats & opportunities
Understand product life cycle & whole value chain
Help improve operating efficiency
Drive product innovation
Align with customers and industry
Identify cost reduction and efficiency savings
Prioritize sustainability activities and future product strategies

42. NHS SDU
 Sustainable Development
Unit set up in 2008
 Working across the health
sector in England
 To develop organisations,
people, tools, policy and
research which will
enable organisations to
promote sustainable
development, to mitigate
and to adapt to climate
change.

43. NHS SDU
 Carbon Reduction Strategy
implemented (2009 – 2014)
 New plan currently under
public consultation
 Respond to questionnaire
online
 www.sdu.nhs.uk/sds
 Open between 29th January
2013 – 31st May 2013
2009 - 2014 2014 - 2020

44. UNDP
 UNDP mission is to partner with people at all levels of society to
help build nations that can withstand crisis, and drive and sustain
the kind of growth that improves the quality of life for everyone
 UNDP operates in over 177 countries and procures approx $2.9
billion per year (80% from developing countries)
 Sustainable Development is a central agenda as of 2015
 Development of a carbon footprint and marginal abatement cost analysis for
Global Fund HIV and Tuberculosis (TB) grants
 Contributed to GHG guidance document
 Sustainable specifications for critical products
 Training for sustainable procurement for various segments of the workforce
depending on their role.
 Guidance for country offices

45. Pfizer
Pregabalin case study
 Drug for the treatment of neuropathic pain
 Launched in the US - September 2005
 Sales $3.69 billion (2011) $ 4.16 billion (2012)
Change in process
 Process 1 (2005-2006)
 Classical chemistry, carbon based solvents. Used to launch the product
 Process 2 (2006-2010)
 Enzymatic chemistry, all chemical processes use water as solvent
 Process 3 (2010-present)
 Enzymatic process, all chemical processes use water as solvent. One key by-product
which was incinerated in process 2 is now recovered and converted to high quality
product, albeit with a relatively high energy process

46. Pfizer
Solvent, reagent and energy reduction gives a saving of 3 million tonnes of CO2
emissions. Or equivalent to 500,000 US cars off the road for a year.
0
100
200
300
400
500
600
700
800
900
1000
LifeCycleEmissions(kg/kgAPI)
Total Carbon Dioxide
Emissions
Waste Disposal &
Recovery
In-process Energy
Raw Material
Manufacturing

47. GlaxoSmithKline
Annual sales £27.4bn
 Pharmaceuticals (68%), Consumer Healthcare (19%), Vaccines (13%)
Sustainability and carbon footprinting core part of business
20202015GSK Environmental Strategy
10% reduction in value chain
Carbon Footprint
25% reduction in value chain
Carbon Footprint
20% reduction in water use
within our own Operations
20% reduction in our water impact
across the whole Value Chain
• 25% Reduction in Operational
waste to landfill
• 25% Reduction in hazardous
and non-hazardous waste
• Zero Operational waste to landfill
• 50% Reduction in hazardous &
non-hazardous waste

48. GlaxoSmithKline
Taking action: recycling inhalers
Q: How do you currently dispose of your/your
child’s asthma inhaler device when you have
finished using it?
Put it in the
domestic
waste bin at
home
63%
23%
Put it in the recycling
bin at home
11%
Take to a pharmacy
that offers a
recycling service
Other mentions ≤ 10%
Key information
 Around 40% of GSK’s carbon footprint comes from propellants
released from inhalers.
 Scheme recycles any inhaler not just GSK
 New ways of managing manufacturing waste
 Pharma distribution supplier: no extra trips needed, used to
handling medicines, good tracking processes and willingness to
partner
 Pharmacist: Patient interactions, medicines review, device use
 Many being returned full or partially full
 Worked with supplier to use recycled aluminium (9ktCO2e
saved)
Feb 2013: 115,006 inhalers collected in the UK resulting in
807 tonnes CO2e savings

49. What are the next
steps?
Final Thoughts…

50. Questions?
Laura Draucker, PhD
 Senior Associate, Sustainability Manager
 World Resources Institute
 +1 202 729 7828
 ldraucker@wri.org
Tom Penny
 Senior Consultant, Product Sustainability Services
 Environmental Resources Management
 +44 203 206 5386
 tom.penny@erm.com

51. Thank You
Laura Draucker, PhD
 Senior Associate, Sustainability Manager
 World Resources Institute
 +1 202 729 7828
 ldraucker@wri.org
Tom Penny
 Senior Consultant, Product Sustainability Services
 Environmental Resources Management
 +44 203 206 5386
 tom.penny@erm.com