By considering sustainability at the care pathway level rather than individual products, industry leaders may identify innovations that accelerate the decarbonisation of healthcare, says Nathan Wilkinson of TTP’s sustainability team.

At COP26, fifty countries committed to creating climate resilient, low carbon, sustainable health systems. Fourteen countries have gone further and committed to net zero emissions across their healthcare systems [1]. 

Under the umbrella of Race to Zero, healthcare institutions representing over 14,000 hospitals and health centres in 22 countries want to make swifter progress towards net zero healthcare [2]. 

These numbers will only climb higher, and they don’t yet include some healthcare giants like, for instance, Kaiser Permanente who achieved carbon neutral status in 2020, in part through emissions offsetting [3].

For medical device developers, pharma, and digital health innovators, the signs are clear. All these industries need to get a head start by exploring sustainability opportunities within their development pipelines and pursuing those that deliver the greatest possible reduction in environmental impact, whilst still improving the quality of care.

This isn’t as tall an order as it sounds. Identifying opportunities is only a matter of asking the right questions. 

In this post, I take a step back to show how sustainability targets are usually set and met within business. Then I outline how we can make faster progress within healthcare by broadening the scope of Life Cycle Analysis to consider impacts at the level of the care pathway rather than individual product. Often, this will allow us to identify opportunities to achieve emissions reductions that are orders of magnitude greater than the material footprint of any single product.

For individual organisations, reducing their own carbon footprint to net zero is the bare minimum in the long term. But what should inspire and encourage further action is the impact organisations can have by reducing their “carbon brain-print”: the total emissions and impact associated with their influence on the world. By thinking beyond the material footprint of your product or service and collaborating with others, it is often possible to achieve a net-negative impact.

Stepping back: How are sustainability targets set and met for medical products?

Most companies with a sustainability policy are approaching the problem by following the same blueprint. 

First, they calculate their own emissions across the classifications of scopes 1, 2 and 3 to assess the magnitude of the challenge they face; then, they set reduction targets. A net zero goal means net zero emissions across the three scopes. 

In the case of medical device manufacturers and pharma, the impact of the products they sell sits almost entirely within their scope 3 emissions and can form a significant proportion of their total emissions.

Within the scope 3 definitions, the only option for these companies is to reduce the impact of devices. This may be through improved material choices, opting for greener (and more expensive) alternatives; reducing part count or assembly complexity; reducing emissions from use; or exploring circularity of devices after initial use. 

Although these actions are commendable, sustainability targets to reduce scope 3 emissions at the device or product level can inherently limit what can be achieved. Often, there are opportunities to reduce emissions outside of scope 3 that are orders of magnitude greater than the device’s material footprint – potentially allowing for a net-negative impact when a novel or improved device is used in place of incumbent devices and techniques.

Identifying these opportunities is a matter of thinking about direct and indirect emissions impacts of medical devices.

Scope 1, 2, and 3 emissions of the UK’s National Health Service (Taken from Delivering a net zero NHS [4])

Direct and indirect impacts

A medical device generates both direct and indirect carbon dioxide emissions. 

Direct contributions constitute the environmental footprint of the device itself, the material that went into it, its transport, its energy consumption in use, and how it is treated at the end of life. 

Indirect contributions go much wider and include emissions across the care pathway that the device forms a part of, including anything from patient transport to a clinic following at-home diagnostic testing to the impact of a hospital intervention if a patient incorrectly uses a device. 

Direct impacts are accounted for in both the scope 3 emissions of the users and producers. Indirect impacts are only accounted for by the end buyer of a product, often a healthcare provider, even though they are locked in at the very early stages of device development and there is almost no opportunity for the buyers to mitigate them. It is the suppliers that see these indirect impacts as outside of their scope 3 emissions but has the greatest power to reduce them. 

The figure below shows this relationship and the overlap in emissions accounting between suppliers and a healthcare provider in a healthcare system. By understanding and mapping these interconnections, opportunities for maximum impact can be pinpointed and used to guide the sustainability strategy of both parties.

By following this new blueprint, the healthcare industry can transition from reactive and unnecessarily defensive policies to more progressive and impactful approaches to sustainability.

The relationship in emissions accounting between suppliers and a healthcare system

An example: autoinjectors for at-home drug delivery

Take the example of an autoinjector, a device that allows patients to self-administer medications through subcutaneous injection. These devices allow patients to receive treatment in their own home, without the presence of a healthcare professional. 

When we look just at the device itself, we see a single-use product made from a wide variety of engineering plastics and metals. Once used, autoinjectors become contaminated making disposal by incineration the only practical solution.

From this narrow viewpoint, the environmental impact of autoinjectors seems hard to tackle, but this is where indirect impacts must be considered. By mitigating the emissions of patient travel to receive an injection in a clinical environment, autoinjector use can generate a net-negative impact 11x the devices material footprint. 

Therefore, the low-hanging fruit for sustainability interventions would be to increase access to at-home drug delivery, rather than focusing entirely on reducing the material footprint of autoinjectors themselves. For autoinjector developers, this might be achieved through improving usability and adherence or developing lower-cost products. For pharma companies, exploring subcutaneous reformulation for IV drugs would be a win-win both for patient comfort and environmental impact.

What next?

This is just one example. 

In our whitepaper “Ready for Net Negative? Minimising Healthcare’s Contribution to Climate Change through Innovation”, we provide detailed case studies of how environmental sustainability and efficiency improvements in healthcare generally pull in the same direction and discuss methodologies for holistic environmental impact assessment.

Industry leaders can exploit the connection between environmental sustainability and healthcare innovation to offer net-negative products and services.


Experts from across TTP’s Healthcare technology teams contributed to this white paper. Freddie Scott and Adam Bostanci posed the question “How can we improve the quality of healthcare while achieving the greatest possible net reduction in associated carbon emissions?”, and Freddie Scott answered it for medical devices. Rita Stella explored an area with huge potential to benefit patients and reduce climate impact: minimally invasive surgery. Karthik Chellappan, Clennell Collingwood, Nathan Wilkinson, and Simon Lyons focused on what the approach would mean for pharma and digital health.

Nathan Wilkinson