Climate Change and Healthcare

Greenhouse gas accounting in the healthcare sector

Presented by: Tom Penny (Environmental Resources Management) Laura Draucker (World Resources Institute)

26th April 2013 Boston

Contents

1. Climate Change and Healthcare

2. Initiatives, Standards and Support

3. Measuring and Reducing

4. Q&A

Contents: Climate Change and Healthcare

1. A Brief Introduction to Climate Change

2. The Healthcare Picture

3. Future Trends

Climate system, processes and interactions are complex

Introduction to Climate Change

IPCC

Global Greenhouse Gas Emissions

Total GHGs Gt CO2e / year (2005)

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WRI, 2009

Question

“is  the  healthcare  sector  a  major  source  of  global  greenhouse  gas  emissions?”

a) less than 2% b) 2 to 10% c) greater than 10%

Healthcare Greenhouse Gas Emissions

Healthcare roughly 3-5% of global GHG emissions United States healthcare roughly 8-12% of country GHG emissions

ERM estimate

Total global health expenditure US$ 6.5 Trillion

WHO Global Health Expenditure Atlas, 2012

Current population roughly 7.1 Billion United Nations

Why is Healthcare a GHG Issue? Population likely to increase (31%) to 9 billion

by 2050 United Nations

Increased demand on healthcare

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Future Trends: Increase in Spend Spend on healthcare per capita

Average: $948 USD High: $7,960 (United States), $4519 (Canada), $3440 (UK) Low: $44 (India), $56 (Indonesia), $191 (China) WHO Global Health Expenditure Atlas, 2012 (in $USD)

Potential global health expenditure US$ 57 Trillion

If all of current population had the equivalent healthcare spend as US

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Where is the Challenge?

Crucial for industry to measure what is currently being done and target areas for significant reductions

Real reductions need to be realized to meet

future challenges (for example) new care pathway models telemedicine unused medicines remanufacture of medical devices

Contents: Initiatives, Standards and Support

1. Introduction to GHG Protocol

2. Standards

3. Support available

Flashback  to  1998…

The Greenhouse Gas Protocol is a partnership between the World Resources Institute and the World Business Council for Sustainable Development. GHG Protocol is built on the expertise of WRI and WBCSD, combined with

the  insight  and  experience  of  hundreds  of  the  world’s  leading  organizations.

A global partnership

The Greenhouse Gas Protocol, led by WRI and WBCSD, provides the foundation for comprehensive measurement and management strategies to reduce

emissions and drive more efficient, resilient, and profitable businesses and organizations.

Mission

http://www.youtube.com/watch?v=_urMCfkPdus

Corporate Standard Corporate Value Chain (Scope 3) Standard

Project Protocol Product Standard

GHG Protocol Standards

The Corporate Standard • Helps companies prepare a true and

fair inventory of their GHG emissions • Aids the development of effective

reduction strategies • Supports credible and consistent

reporting • Available in seven languages • First to introduce the concepts of scope

1, 2, and 3

Over 85% of respondents to a 2010 Carbon Disclosure Project survey of 2487 companies either directly used GHG Protocol or used it through their participation in a climate change program that used GHG Protocol.

Related Corporate Standard sector publications

Office-based organizations

US public sector Agricultural sector Scope 2 accounting

Under development

The Scope 3 Standard

• To be used in conjunction with the Corporate Standard

• Includes requirements and user-friendly guidance for quantifying and reporting Scope 3 emissions

• Includes upstream and downstream emissions organized into 15 different scope 3 categories

Why is considering full value chain

(scope 3) emissions important?

Note: Chart represents average breakdown of emissions by category from scope 3 road testers

Scope 1 & 2, 21%

1. Purchased goods and

services, 34%

2. Capital goods, 1%

3. Fuel- and energy-related activities, 4%

4. Upstream transportation

and distribution, 4%

5. Waste generated in

operations, 1%

6. Business travel, 7%

7. Employee commuting, 2%

8. Upstream leased assets, 1%

9. Downstream transportation

and distribution, 2%

11. Use of sold products, 16%

12. End-of-life treatment of sold

products, 3%

13. Downstream leased assets, 1%

15. Investments, 3%

Scope 1 & 2 emissions Scope 3 emissions categories

The Product Life Cycle Standard

• Entities perform product level assessment to meet demands from: – Customers wanting measurement and disclosure of product-level GHG

information – Investors demanding more transparency – Consumers seeking greater clarity and environmental accountability

Drivers for Product Level Assessments (Carbon Footprints)

Full suite of GHG measurement standards

• Since their launch in October 2011, several in- person trainings have been offered on the Scope 3 and Product Standards

• To reach wider audiences, we are currently: – Offering quarterly webinar training

• May 7 – 9 , Scope 3 Standard • June 4 -6 , Product Standard • Visit our website for more information and to register:

www.ghgprotocol.org

– Developing e-learning online trainings for both standards

GHG Protocol Capacity Building

• Tools and guidance available on our website: – List of third party databases for secondary data sources – Uncertainty calculator and guidance – Supplier engagement guidance – Reporting template

• Product Standard sector guidance built on the GHG Protocol: – Information and Communication Technology ( ICT) (under

development) – ENCORD Guidance for Construction Companies – Concrete PCR – Pharmaceutical products and medical devices

• Tools and guidance are developed based on stakeholder

needs

GHG Protocol Tools and Guidance

Contents: Measuring and Reducing

1. Impacts within the healthcare sector

2. Healthcare carbon footprinting guidance

3. Benefits, case studies and initiatives

Question

“Are  direct (eg hospital energy, etc) or indirect operations (eg manufacture of consumables, etc) more significant for healthcare GHG emissions?”

a) Direct operations <50% b) Direct operations >=50%

Healthcare Impacts: Direct & Supply Chain

X ~35% Direct

State of Green Business 2013, GreenBiz

Healthcare Impacts: UK NHS Footprint

UK NHS Footprint 2010

Why was the Guidance Developed NHS undertook an organizational carbon footprint in 2010 – pharmaceuticals 1/3rd

Summits held by NHS Sustainable Development Unit (SDU) – promote low carbon healthcare

2011 summit identified need for guidance to aid in the carbon footprinting within the sector

Steering Group put together to develop guidance

Who Developed the Guidance Association of British Healthcare Industries Association of British Pharmaceutical Industries AstraZeneca Baxter Healthcare British Generic Manufacturers Association Environmental Resources Management GlaxoSmithKline Hull and East Yorkshire NHS Trust Johnson & Johnson Medicines and Healthcare products Regulatory Agency National Institute for Health and Clinical Excellence NHS Commercial Medicines Unit NHS Sustainable Development Unit Novo Nordisk Pfizer SustainPharma UK Department of Health United Nations Development Programme (UNDP) Europe and Central Asia Western Health Australia World Resources Institute

Healthcare Carbon Footprint Guidance

Aimed to support consistent quantification of the carbon footprint of pharmaceutical products and medical devices

NHS SDU GHG Protocol

What can the Guidance be Used For

Internal product appraisals • eg hotspot analysis or eco-design initiatives

Performance tracking • eg products GHG emissions over time

Reporting • eg product GHG emissions

NOT FOR: Comparative claims • eg favourable environmental performance of one product over another

Who Should Use the Guidance

The guidance aims to provide Clarity on life cycle stage and process inclusions/ justified exclusions Guidance on challenging aspects of the inventory calculation process Requirements/recommendations on primary & secondary data

needs, sources and data quality appraisal Requirements/recommendations with regard to reporting

Guidance is intended for Producers within the sector or value chain Healthcare services / regulators /policy makers Procurement teams

Structure of the Guidance Section 1: Introduction Section 2: Core Principles Section 3: R&D, Clinical Trials & Marketing Section 4: Pharmaceutical Products Section 5: Medical Devices Section 6: Distribution & Delivery Section 7: Use Phase Section 8: End-of-Life Section 9: Reporting & Assurance Section 10: Care Pathways

Section 4: Pharmaceutical Products

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Guidance  ‘modules’  provided  for  production  processes  or  stages  with  similar accounting challenges and data needs. These can be combined to develop a profile for the production of the final, packaged product

Active Pharmaceutical Ingredients ■ Synthetic organic chemicals

■ Cell cultures

■ Egg-based cultivation

■ Conjugate vaccines

■ Plant-based extraction

■ Human & animal-derived

Delivery Mechanisms ■ Solid dose forms

■ Liquid dose forms

■ Creams & ointments

■ Patches

■ Gases

■ Administering devices

■ Packaging

Section 5: Medical Devices

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Guidance  provided  for  similar  product  ‘groups’ with similar accounting challenges and data needs.

Medical Device Categories ■ Passive, Single Use Devices with Multiple Components/Materials

■ Passive, Single Use Devices with Few Components/ Materials

■ Passive, Multiple Use Devices

■ Implantable Devices

■ Energy Consuming Devices

Johnson & Johnson

Example Process Diagram

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Example Processes to Include/Exclude

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Include these non-attributable processes: •Chemicals used for cleaning •Sterilisation •Refrigerant leakage associated with product manufacturing

Include these attributable processes: • Material and chemical inputs • Material and chemical transport • Energy/fuel generation and

consumption • Waste disposal • Solvent manufacture, use and

disposal • Catalyst manufacture, use and

disposal • Solvent recovery and incineration • Process emissions from synthesis

Exclude these attributable and non-attributable processes: • Packaging of material & chemical inputs • Disposal of input packaging (eg IBCs, drums, pallets, etc) • Production and disposal of consumables (eg gloves and protective clothing,

filters, cartridges, etc)

Drivers and Benefits Help to identify supply chain risks, threats & opportunities

Understand product life cycle & whole value chain

Help improve operating efficiency

Drive product innovation

Align with customers and industry

Identify cost reduction and efficiency savings

Prioritize sustainability activities and future product strategies

NHS SDU Sustainable Development

Unit set up in 2008 Working across the health

sector in England

To develop organisations, people, tools, policy and research which will enable organisations to promote sustainable development, to mitigate and to adapt to climate change.

NHS SDU

Carbon Reduction Strategy implemented (2009 – 2014)

New plan currently under public consultation

Respond to questionnaire online www.sdu.nhs.uk/sds Open between 29th January

2013 – 31st May 2013

2009 - 2014 2014 - 2020

UNDP UNDP mission is to partner with people at all levels of society to

help build nations that can withstand crisis, and drive and sustain the kind of growth that improves the quality of life for everyone

UNDP operates in over 177 countries and procures approx $2.9 billion per year (80% from developing countries)

Sustainable Development is a central agenda as of 2015

Development of a carbon footprint and marginal abatement cost analysis for Global Fund HIV and Tuberculosis (TB) grants

Contributed to GHG guidance document Sustainable specifications for critical products Training for sustainable procurement for various segments of the workforce

depending on their role. Guidance for country offices

Pfizer Pregabalin case study Drug for the treatment of neuropathic pain Launched in the US - September 2005 Sales $3.69 billion (2011) $ 4.16 billion (2012)

Change in process Process 1 (2005-2006)

Classical chemistry, carbon based solvents. Used to launch the product

Process 2 (2006-2010) Enzymatic chemistry, all chemical processes use water as solvent

Process 3 (2010-present) Enzymatic process, all chemical processes use water as solvent. One key by-product

which was incinerated in process 2 is now recovered and converted to high quality product, albeit with a relatively high energy process

Pfizer

Solvent, reagent and energy reduction gives a saving of 3 million tonnes of CO2 emissions. Or equivalent to 500,000 US cars off the road for a year.

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GlaxoSmithKline Annual sales £27.4bn

Pharmaceuticals (68%), Consumer Healthcare (19%), Vaccines (13%)

Sustainability and carbon footprinting core part of business

2020 2015 GSK Environmental Strategy

10% reduction in value chain

Carbon Footprint

25% reduction in value chain

Carbon Footprint

20% reduction in water use

within our own Operations

20% reduction in our water impact

across the whole Value Chain

• 25% Reduction in Operational waste to landfill

• 25% Reduction in hazardous and non-hazardous waste

• Zero Operational waste to landfill

• 50% Reduction in hazardous & non-hazardous waste

GlaxoSmithKline Taking action: recycling inhalers

Q: How do you currently dispose of your/your child’s  asthma  inhaler  device  when  you  have  finished using it?

Put it in the domestic waste bin at home

63%

23% Put it in the recycling bin at home

11% Take to a pharmacy that offers a recycling service

Other  mentions  ≤  10%

Key information

Around 40% of GSK’s  carbon  footprint comes from propellants

released from inhalers.

Scheme recycles any inhaler not just GSK

New ways of managing manufacturing waste

Pharma distribution supplier: no extra trips needed, used to

handling medicines, good tracking processes and willingness to

partner

Pharmacist: Patient interactions, medicines review, device use

Many being returned full or partially full

Worked with supplier to use recycled aluminium (9ktCO2e

saved)

Feb 2013: 115,006 inhalers collected in the UK resulting in 807 tonnes CO2e savings

What are the next steps?

Final  Thoughts…

Questions?

Laura Draucker, PhD Senior Associate, Sustainability Manager World Resources Institute +1 202 729 7828 ldraucker@wri.org

Tom Penny Senior Consultant, Product Sustainability Services Environmental Resources Management +44 203 206 5386 tom.penny@erm.com

Thank You

Laura Draucker, PhD Senior Associate, Sustainability Manager World Resources Institute +1 202 729 7828 ldraucker@wri.org

Tom Penny Senior Consultant, Product Sustainability Services Environmental Resources Management +44 203 206 5386 tom.penny@erm.com