Pollution and environmental degradation intensify environmental health risks and create harmful living conditions. Pollution of the water, soil, and the air is a threat to human health and wellbeing and exacerbates poverty and inequality. Additionally, natural and man-made disasters can quickly overwhelm and/or interrupt the healthcare system. Public health can be affected by disruptions of physical, biological, and ecological systems, including disturbances originating here and elsewhere. The health effects of these disruptions include increased respiratory and cardiovascular disease, injuries and premature deaths related to extreme weather events, changes in the prevalence and geographical distribution of food- and water-borne illnesses and other infectious diseases, and threats to mental health.

• Women and girls tend to be affected disproportionately by emergencies. Indeed, gender inequalities tend to be exacerbated, leading to increased dependence and exclusion. This can directly impact their capacity to access external assistance and restrict and/or influence individual coping mechanisms.
• An inclusive healthcare system can facilitate access of persons with disabilities to health facilities and distribution sites, contribute to overcoming the barriers they may face, and ensure that their specific vulnerabilities and needs have been taken into account. Well-planned health interventions can act positively on the safety and well-being of populations and contribute to addressing some of the risks directly linked with health conditions in emergencies.

Air pollution
Soil pollution
Water pollution
Deforestation
Desertification
Eutrophication
Climate Change
Loss of biodiversity and ecosystems
Natural resource depletion
Soil erosion

•  Construction waste
•  Unsustainable natural resource depletion for the supply of construction materials

•  Laboratory and hospital waste
•  Solid waste burning or disposal causes air, water, and soil pollution
•  Burning fossil fuels for energy generation
•  Water resource depletion
•  Greywater and black water pollution
• Environmental determinants of health
• Environmental hazards
• Hazardous substances/chemicals

Environmental impacts can occur from all health service activities, including construction waste, laboratory and hospital waste; construction materials; solid waste management causing air, water, and soil pollution; burning fossil fuels for energy generation, minimising water waste and effluent polluting soil and water; environmental determinants of health; environmental hazards such as floods, droughts, crop pests, and disease; landslides and desertification. Health services produce waste including solid waste, organic, and medical waste which can all pollute and create disease vectors. Health facilities use hazardous substances/chemicals for cleaning, medicinal use, and anaesthetics which can seriously pollute the environment if released in an uncontrolled manner.

• Reduce construction waste
• Sustainably source construction materials
• Implement sustainable solid waste
• Assess and mitigate sources of air, water, soil pollution
• Sustainable utilities avoiding fossil fuels, minimising water waste and effluent polluting soil and water
• Assess and plan to mitigate environmental determinants of health
• Assess and address environmental hazards
• Sustainable solid, organic, and medical waste handling and disposal
• Assess and address disease vectors
• Controlled storage and handling of hazardous chemicals.

• Most examples of change management towards environmental sustainability, are bottom-up, local, and driven by providers. While bottom-up change is crucial, it needs to be complemented by a governance-driven top-down change in order to have a significant effect throughout whole health systems.
• Assess and mitigate environmental impacts of health facility refurbishment, maintenance, operation, and construction activities including solid waste, construction materials, pollution of air, water, soil, and use of utilities including fossil fuels. Assess and plan to mitigate environmental determinants of health. Assess and address environmental hazards such as landslides, malaria, flooding, and disease spread. Assess and address solid, organic, and medical waste handling and disposal. Assess and address disease vectors including facilities cleaning and storage and handling of hazardous chemicals.

• Examples of planned change for environmental sustainability in health systems exist in a few countries: the NHS Sustainable Development Unit is using a “Route Map” to develop a sustainable health system by identifying areas that require progress and describing roles of different stakeholders. The Route Map is structured across a vision, or ultimate goal, and covers three periods: “Getting started”, “Transformation phase” and “Transformation occurs”.
• Integrating health systems sustainability into national environmental programming.
• Organizing national stakeholder consultations to agree on a national joint vision and objectives.

# of locations / communities / facilities that have been included in an overall environmentally sustainable healthcare service provision plan.

• Prevention of environmental damage
• Mitigation of environmental damage
• Environmental enhancement

Significant time for consultation and assessment of existing health services capacities, efficiency, environmental impacts, and opportunities for environmental impact prevention, mitigation, and possible enhancements.