ustainable healthcare provides high-quality care in the present without compromising the health of future generations and our planet. The healthcare sector must play a critical role in delivering sustainable healthcare and achieving this balance for the following reasons: healthcare is itself a significant contributor to greenhouse gas emissions; we must address the risk that climate change presents to the operations of healthcare as an industry; and we must consider the impact of climate change on population health, which in itself places further demand on already stretched healthcare systems. Mitigating climate change through making healthcare more sustainable is imperative. It offers numerous co-benefits: Not only is it good for patients and their health, but it is also a business derisking activity.

Globally, the healthcare sector accounts for more than 4% of carbon dioxide equivalent (CO₂e) emissions annually. These emissions are categorized into three scopes:

• Scope 1: direct emissions from owned assets
• Scope 2: indirect emissions from consumed energy
• Scope 3: emissions across the supply chain, including upstream and downstream activities.

The need for sustainable healthcare is recognized globally, and the appetite for change is accelerating. The Alliance for Transformative Action on Climate and Health (ATACH) is a global initiative, established after the 2021 UN Climate Change Conference in Glasgow (COP26), focused on addressing climate change and human health. There are more than 90 member countries, and the World Health Organization acts as Secretariat. Nearly half of those member countries have made commitments towards achieving net zero emissions, including the UK, Sweden, Norway, Denmark, and Switzerland. Initiatives such as the European Green Deal, launched by the European Commission in December 2019, aimed to set the EU on the path to a green transition with the ultimate goal of reaching climate neutrality by 2050. Commitments and regulatory changes such as these, combined with increasing demands from customers, employees, investors, and regulators, has made environmental sustainability a critical component of healthcare design and delivery.

Ninety percent of the pharmaceutical industry’s emissions fall under Scope 3, with 66% attributed to upstream activities such as the purchase of goods and services, transportation, and distribution, demonstrating the complexity and broad reach of the industry’s activity.

The pharmaceutical industry is reliant at every step of their value chain on the biosphere, which is affected by climate change. Biodiversity is relied upon for research and development of new medicines. Excipients (the nonactive substances in drugs) such as cornstarch, sourced from corn, are impacted by agricultural practices such as the use of pesticides and fertilizers. Active pharmaceutical ingredients (APIs), the biologically active ingredients in drugs, are found in waters including drinking water, soil, manure, and the food chain, primarily from untreated household wastewater and effluent from wastewater treatment plants. They have been shown to impact animals and insects. It could therefore be considered a matter of self-preservation for the industry to mitigate climate change.

Increasing regulatory and stakeholder pressure to adopt sustainable practices has begun to transform the way pharmaceutical companies operate. Global sustainability initiatives are setting new standards, and companies must adapt to retain market access, and to remain compliant and competitive. Industry must consider the total cost of the value chain, including environmental and societal impacts, rather than just the cost per unit of medication.

• Regulatory Initiatives: Initiatives like the European Green Deal and the efforts of the European Federation of Pharmaceutical Industries and Associations (EFPIA) are setting new benchmarks for environmental sustainability. Last year, the European Commission published a strategy to address pharmaceuticals in the environment. In their 2022 survey, EFPIA member companies reported a reduction of approximately 1.5 million tons of CO₂e emissions over a 3-year period.
• Stakeholder Demands: Customers, employees, investors, and regulators are increasingly demanding environmental sustainability; for example, BlackRock, a major investor, has put sustainability at the center of its investment strategies. The demand for environmental sustainability is not just about compliance but also about the long-term viability and social license to operate for pharmaceutical companies.
• Industry Performance: While the industry has made progress, there is still a long way to go. Two-thirds of the top 20 pharmaceutical companies are either fully certified with net-zero ambitions and science-based targets or are on the pathway to certification, as per My Green Lab’s annual review. However, performance in reducing Scope 3 emissions remains nuanced, with some companies making significant progress while others lag.

The dialogue was started at DIA Europe 2023, the organization’s annual flagship conference in Europe, and continued extensively in various fora throughout 2024, where the opportunities and challenges faced by the healthcare sector were explored through a range of events and debates. The following broad themes arose from this dialogue:

• Transparency and Reporting: Pharmaceutical companies must adopt consistent frameworks to assess and report their climate and environmental impact, such as the Greenhouse Gas Protocol (GHP). This consistency is crucial for understanding the current emission footprint and for informing stakeholders about sustainability ambitions and progress. Initiatives are already underway to standardize reporting through collaborations such as the Sustainable Markets Initiative with BSI, NHS England and others.
• Goal Setting and Decision-Making: Companies must embed sustainability goals into management objectives and incentives. Integrating sustainability considerations into R&D decision-making and program design is vital. This ensures a continuous and integrated approach to sustainability, aligning every decision in healthcare with environmental impact alongside cost and health outcomes.
• Optimization of Clinical Trials: Clinical trials are a significant source of emissions within the pharmaceutical industry, generating approximately 100 million tons of CO₂e annually. The main drivers of these emissions include clinical facilities, travel associated with trials, drug product logistics, and the selection of clinical research organizations (CROs). To reduce emissions, companies can optimize trial design, site selection, and logistics. This includes reducing travel associated with trials, improving drug product logistics, and selecting CROs with better environmental track records.
• Collaboration and Partnerships: Sustainable partnerships are essential for tackling the environmental impact across the entire value chain, much of which lies outside the direct control of individual pharmaceutical companies. Such collaborations are addressing issues from discovery and development, through to manufacturing and supply, and into end-of-life management of products and services (such as SHC, PSCI, SMI, CiPPPA, and others).
• Regulatory Support: Medicines regulators play a critical role in enabling innovation that meets climate and environmental goals. Integrating environmental concerns into the benefit-risk assessment rather than treating them as standalone issues is essential. This approach ensures that environmental sustainability is embedded into regulation, guiding the development and approval processes of pharmaceutical products in a way that balances patient needs with environmental considerations.

The journey towards environmental sustainability in drug development will need to balance competing priorities. One of the recognized barriers to implementing sustainability within the healthcare sector is the fear that its implementation may impact negatively on access, availability, and affordability, not to mention corporate profits. A broad ecosystem of expert partners is working to address this, including patient associations and Health Technology Assessment partners, through a variety of strategies and solutions such as:

• Total Cost of the Value Chain: The discussion needs to move beyond the cost per unit of medication to the total cost of the value chain, including environmental and social impacts.
• Innovation and Sustainability: Environmental impact assessment and innovation both need to be incentivized. This can be achieved by embedding environmental concerns into the benefit-risk assessment and by creating market incentives that reward sustainable practices.

Given the need for sustainable healthcare, the following actions should be considered as a starting point:

• Ensure holistic decision-making: Ensure that every decision in healthcare considers environmental impact alongside cost and health outcomes.
• Advocate for regulatory frameworks: Advocate for and support regulatory frameworks that embed environmental sustainability into the development and approval processes of pharmaceutical products.
• Collaborate across the ecosystem: Collaborate with partners from the broader healthcare ecosystem to identify and mitigate the environmental impact of drug development.
• Build relationships towards a higher purpose: Engage the healthcare stakeholders in co-development of the tools and methods to embed innovation faster for a sustainable future.
• Continue the conversation: Attend DIA Europe 2025 in Basel, which will provide a platform to discuss these critical issues and advance the agenda for sustainable healthcare.

By taking these steps, we can advance towards a more sustainable, carbon-neutral, circular model of healthcare, whilst addressing the threat to health that climate change is posing and optimizing patient health. This approach ensures that we balance the needs of patients today with the health of our planet for future generations, ultimately saving lives while protecting the environment. The journey towards sustainable healthcare will be examined through a series of articles, linked to upcoming conference sessions, with the next planned article focusing on clinical trials. The journey towards sustainable healthcare is undeniably complex, but through collaboration and innovation, we can achieve a healthier future for all.

DIA and its many partners look forward to engaging in and contributing to discussions about sustainability and sustainable healthcare with the broader healthcare community through upcoming sessions at DIA Europe 2025. In subsequent Global Forum articles, we aim to share learning from and enlarge the geographical scope of these important and multifaceted discussions, and to drive action and the new leadership approaches needed to navigate this increasingly complex world.