Sustainable healthcare

ZonMw has signed the Sustainable Healthcare Green Deal 3.0. All signatories have agreed to make a joint effort to further reduce the environmental pressure caused by the healthcare sector. In 2022 we investigated what research and knowledge development will be needed to support sustainable healthcare.

Sustainable healthcare: a collective ambition

ZonMw is contributing to the Sustainable Healthcare Green Deal, which aims to reduce the environmental pressure caused by healthcare, thus also reducing the healthcare sector’s negative effects on health. We signed the deal at the very start of the initiative, in 2018. In 2022 we recommitted to the targets, by signing the Sustainable Healthcare Green Deal 3.0.

The Sustainable Healthcare Green Deal 3.0 contains 5 agreed actions

All the parties that have signed the Green Deal have agreed to do the following five things:

  • Promote the health of patients, clients and healthcare workers
  • Encourage awareness-raising and knowledge development
  • Reduce carbon emissions
  • Reduce use of resources and achieve maximum circularity in healthcare
  • Reduce the environmental burden caused by pharmaceuticals

Policy goals for sustainable healthcare

The government has expressed an ambition to make healthcare more sustainable in several policy documents and agreements. The previous government already undertook, in the Climate Act (Klimaatwet), to reduce carbon emissions to net zero by 2050, and healthcare institutions will also have to comply with this target. The government has set out three specific goals:

  • Regular assessment of the healthcare sector’s ecological footprint
  • Support to help the healthcare sector provide sustainable care
  • Development of a low-carbon healthcare supply chain

The healthcare sector causes environmental pollution

Why is it important that healthcare be made more sustainable? Calculations at macro, meso and micro level show that the healthcare sector as a whole causes environmental pollution. It is responsible for at least 7% of Dutch carbon emissions, for example, as much as steel manufacturer Tata Steel and the Eemshaven coal-fired power station together.

Did you know that one patient spending one day in intensive care is equivalent to felling 200 m² of forest, driving a car 2000 km and/or consuming over 15,000 litres of water?  The average hospital can easily produce 430,000 kg of waste a year.

Exploratory study: plea for knowledge development

We regard seeking solutions to social issues as one of our core tasks. We fulfil this task by highlighting the need for knowledge, programming research and ensuring it has impact. Since 2019, for example, we have been contributing knowledge in the fight against COVID. We have been sharing and connecting knowledge about a healthy living environment since 2020. And in May 2022 we published our exploratory study of knowledge gaps and needs as regards sustainable healthcare.

Exploratory study of sustainable healthcare

In 2022 we performed an exploratory study to ascertain what research and knowledge development is necessary to support sustainable healthcare, and what role ZonMw programmes can play in this. The study was commissioned by the ZonMw Management Team (MT) in collaboration with the Ministry of Health, Welfare and Sport’s Sustainable Healthcare programme team. The report on the study called for knowledge to be developed in innovative partnerships.

A number of countries are already doing a lot to reduce the climate footprint of their healthcare sectors. Our study showed that we could for example learn from Germany, the UK and Scandinavian countries. We also called for the drafting of an international research agenda. Lack of funding is often cited as a major obstacle to making healthcare more sustainable. At the same time, however, we found that there are often more funding opportunities than is thought.

We are now working on the follow-up to the study, which includes incorporating environmental impact as a factor into ZonMw programmes, where possible and useful.

> Read the report of the exploratory study on sustainable healthcare (in Dutch)

A more sustainable healthcare system

More sustainable healthcare also means that our healthcare system itself has to become more sustainable. The Netherlands Institute for Health Services Research (Nivel) sets out several possibilities in its 2022-2024 research agenda. The drivers of the Code Red initiative have called for more efforts to ensure that people do not become ill (‘health in all policies’). When people do fall ill, treatments should not harm the environment, nature and the climate (‘climate in all health policies’). The saying ‘the most sustainable healthcare is undelivered healthcare’ is now increasingly being heard in a number of healthcare sectors.

Part of Healthy living environment

All activities that can encourage more sustainable healthcare are part of our broader ‘Healthy living environment’ theme. A healthy living environment promotes people’s physical, mental and social wellbeing. It encompasses a wide range of issues, from climate change and infectious disease to nutrition and sustainable healthcare. ZonMw is working with the National Institute of Public Health and the Environment (RIVM) on a new Healthy Green Living Environment programme, commissioned by the Ministry of Health, Welfare and Sport, and the Ministry of Agriculture, Nature and Food Quality. This will of course tie in with our exploratory study of sustainable healthcare.

Examples at ZonMw and elsewhere

Our ‘Prospective actions for making the emergency, surgical and intensive care process more sustainable' project from the Climate and Health research programme is a good example of our efforts in support of sustainable healthcare. Other examples at ZonMw and elsewhere include:

  • Researchers at Maastricht University have looked at changes hospitals made during the COVID pandemic and their impact on the sustainable deployment of healthcare staff.
  • Urologist Bertil Blok of the ErasmusMc has developed a reusable catheter with a grant from the ZonMw Good Use of Medical Devices programme. In 2020 his invention was voted best idea or initiative for sustainable healthcare.
  • The Healthcare Institute of the Netherlands has explicitly incorporated environmental impact into its assessment framework as a criterion for all quality standards and monitoring instruments.
  • Our partner BWM is researching the impact on health of pharmaceutical residues in water.
  • The National Green Operating Theatre Network is attempting to reduce the carbon footprint of operating theatres.
  • The RIVM is collecting examples of how measures combining nature, architecture and diet can encourage sustainable healthcare.


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