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How can we close the knowledge-to-action gap to accelerate climate change action & protect public health?

This is one of the main questions the CATALYSE project is seeking to answer. To advance this objective, the UNESCO Chair in Life Cycle and Climate Change (ESCI-UPF) and ISGLOBAL, in collaboration with health entities and other diverse stakeholders, have carried out an extensive study on climate change mitigation in the Catalan health system.

The publication of the report – Climate Change Mitigation in the Catalan Health System – marks a key milestone in advancing climate mitigation within healthcare systems. This report presents the first comprehensive subnational carbon footprint assessment of Catalonia’s healthcare sector and evaluates long-term mitigation scenarios up to 2050. By generating robust quantitative evidence and evidence-based recommendations, the study provides a strategic foundation for integrating climate action into healthcare planning and delivery.

Healthcare systems play a vital role in protecting population health, yet they are also significant contributors to greenhouse gas (GHG) emissions. As climate change itself becomes a major health risk – through heatwaves, air pollution, emerging diseases, and extreme weather – the responsibility of the healthcare sector to reduce its own environmental footprint has become critical. The challenge is further intensified by aging populations and rising healthcare demand, which threaten to increase emissions unless decisive action is taken.

This report provides a system-wide, life-cycle-based accounting of healthcare emissions in Catalonia. Unlike previous studies in Spain, which have often focused on individual hospitals and excluded major Scope 3 categories, this assessment includes emissions from pharmaceuticals (~18%), purchased goods and services such as medical consumables (~24%), equipment (~7%), food services (~7%), and transport from staff commuting (~4.6%) and patient travel (~16%). The findings clearly demonstrate that these categories represent the largest share of healthcare emissions and that their omission has led to significant underestimations of the sector’s true climate impact.

Despite these challenges, many healthcare institutions in Catalonia have shown strong leadership through bottom-up sustainability initiatives. Their experience informed an extensive stakeholder co-creation process, through which a broad portfolio of mitigation strategies was identified and assessed. Seventy percent of the proposed measures were deemed feasible, although half were considered “feasible with social limitations,” underscoring the importance of professional training, behavioural change, and awareness-raising among healthcare staff, suppliers, and patients.

These mitigation actions were translated into two long-term scenarios. The FRONTRUNNERS scenario reflects the diffusion of best practices from leading institutions, while the DESIRABLE scenario represents full system-wide implementation, supported by strong policy action and cross-sectoral decarbonisation. By 2050, total emission reductions range from 14% under the FRONTRUNNERS scenario to 61% under the DESIRABLE scenario, considering also the external decarbonisation of the energy and transport sectors. The modelling clearly shows that frontrunners alone cannot deliver the necessary emission cuts, and full participation of all healthcare centres is essential.

The mitigation measures with the highest reduction potential include the electrification of transport and promotion of active mobility for staff and patients, the expansion of telemedicine, securing a 100% renewable energy supply, and the systematic integration of green public procurement to decarbonise healthcare supply chains. Other mitigation actions, while individually more moderate, remain fundamental to achieving cumulative system-wide impact and should not be underestimated.

A key insight of the report is that internal healthcare mitigation alone is insufficient. Without parallel decarbonisation of interconnected sectors – energy, transport, food systems, and biomedical supply chains – the overall mitigation potential would be reduced by half. In the FRONT scenario, internal reductions alone would not even compensate for emission growth driven by population ageing. This highlights the critical importance of policy coherence and cross-sectoral climate action in line with the European Green Deal.

Even under the most ambitious scenario, achieving absolute net-zero emissions in healthcare remains extremely challenging. Rising service demand, demographic change, and increasing climate-related health pressures continue to offset mitigation gains. For this reason, the report calls for more courageous and ambitious action, extending beyond incremental efficiency improvements toward structural transformation.

In response, the Report introduces the vision of a “smart net-zero healthcare” system for Catalonia. This transition requires a combination of bottom-up innovation from healthcare centres and top-down policy support, including strategic direction, regulatory frameworks, financing mechanisms, and innovation ecosystems. Importantly, while the scenarios focus on climate impacts measured through global warming potential, the report also emphasises the need to address broader environmental trade-offs – such as eutrophication, energy demand, and resource depletion – through detailed life cycle assessments to support robust and responsible decision-making.

The evidence generated through this work has laid the foundation for the development of tailored mitigation guidelines for the Catalan healthcare system. These guidelines assign responsibilities for each mitigation action to relevant stakeholder groups and provide targeted recommendations for policymakers, healthcare managers, professionals, and patients. They are conceived as a living framework to be continuously refined through stakeholder dialogue and emerging scientific evidence.

Ultimately, while population growth, aging, and climate-related health risks place growing pressure on healthcare systems, the sector also faces a unique opportunity to become a driver of societal transformation. Through its own decarbonisation efforts, by raising awareness of climate–health links, and by promoting healthier and more sustainable lifestyles, the healthcare sector can contribute not only to emission reductions but also to long-term public health resilience.

The launch of Climate Change Mitigation in the Catalan Health System report thus represents more than a technical report – it marks a strategic step toward embedding climate mitigation at the heart of healthcare systems in Catalonia and beyond.

Access the full report here: https://www.esci.upf.edu/ca/catedra-unesco-de-cicle-de-vida-i-canvi-climatic/projecte-catalyse-horizon

Authors:

Marta Santamaría | Ph.D. Student at UNESCO Chair in Life Cycle and Climate Change ESCI-UPF

Dr. Ilija Sazdovski | Researcher at UNESCO Chair in Life Cycle and Climate Change ESCI-UPF