Sustainable healthcare

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

More information on the Green Deal Sustainable Healthcare.

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 3 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

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.

In 2022, we conducted an exploration of the research and knowledge development needed to support sustainable healthcare, and the role that ZonMw programming can play in this. This exploration was commissioned by the ZonMw Management Team and carried out in collaboration with the Sustainable Healthcare programme team of the Ministry of Health, Welfare and Sport (VWS). The exploration advocates knowledge development within innovative collaborative partnerships.

• View the 2022 exploration on sustainable healthcare (in Dutch).

To gain more insight into knowledge gaps in sustainable healthcare, health, and prevention, ZonMw carried out an analysis. This analysis is based on an internal inventory by ZonMw, ongoing GDDZ projects funded in 2023 by the Ministry of VWS, and the project plans of the GDDZ working group for 2024–2026.

• View ZonMw’s internal inventory (in Dutch)
• View the analysis of knowledge gaps in sustainable healthcare, wellbeing, and prevention (in Dutch)

ZonMw will address sustainability through the following 2 approaches:

1. Stimulating knowledge development, use, and infrastructure in the field of sustainability
2. Encouraging sustainability in ZonMw-funded projects through grant conditions

• View the vision document on sustainable healthcare, prevention, and wellbeing (in Dutch)

Following the ZonMw vision document on Sustainable Healthcare, Prevention and Wellbeing, Margot Stone investigated—within the context of her master’s programme at Vrije Universiteit—what ZonMw can learn from European (research) funders in order to successfully develop and implement specific sustainability-related grant conditions. Her study resulted in 5 recommendations for ZonMw:

• Develop a harmonised measurement framework with clear responsibilities for research organisations and their researchers
• Make use of ZonMw’s unique role in health, prevention, and wellbeing by developing an accessible database of sustainable (research) methods for medical and health-related research
• Increase collaboration and harmonisation between (international) funding organisations in the field of sustainability (EViR, Science Europe, HIROs)
• Ensure communication with and training for committee members, reviewers, and ZonMw colleagues
• Involve the research community in the development of grant conditions

The study also identifies several factors that hinder the implementation of sustainability-related grant conditions:

• The importance researchers attach to scientific quality, and concerns that additional criteria may undermine this
• A lack of clear and applicable assessment criteria
• Researchers’ need for freedom to choose their own methods
• Concerns that geopolitical developments may reduce attention to sustainability
• Insufficient availability of staff to work on grant proposal development

Facilitating factors include:

• A highly motivated research community willing to engage with sustainability
• Growing awareness that sustainability can contribute to project quality

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.

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.

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.