It is the year 2030. Imagine a healthcare system that provides high-quality medical services in specialised hospitals, which are working in close cooperation with a network of primary care facilities located at a moderate distance from people’s homes. Universal digital services are widely available and accepted by all age groups, providing 24/7 guidance and easy access to preventive care, self-monitoring, and personal health data.
Remote services have replaced much of the need for visiting doctors’ and nurses’ offices, saving patients travel time. Even expert clinicians located hundreds of kilometres away can be reached this way. Travel to healthcare facilities has fallen by over 20% compared with 2020, and some hospitals have reduced the amount of office and ward space they use
While there are fewer hospitals in 2030 than there were in 2020, they are modern, and built to be energy-efficient. All hospitals have their own fossil-free energy production – providing heating in the winter and cooling in the summer, covering most of their needs. During peak consumption, electricity, heating, and cooling supply relies on local power plants that offer 100% carbon-free energy for the area. Many hospitals claim to be carbonneutral in terms of their own energy usage.
Semi-automated supply management
Hospital supply management, meanwhile, is semi-automated and data-driven, guiding the purchasing and storage of materials and items, and in the process decreasing waste. Waste management systems support separation of used products – immediately after use – into different streams of high-quality reusable waste materials. In addition to paper, cardboard, glass, and metal, several different plastics are collected as raw material for new products, including some that return to be used in the hospitals.
The amount of paper waste has also decreased considerably. Transport robots take care of logistics and communicate with healthcare facility staff to guide and maintain high-quality waste management streams. Hospital wastewater is managed in such a way that no significant amounts of harmful pharmaceuticals enter natural water sources and soil. Most of the wastewater heat is recovered via efficient heat pumps at wastewater treatment plants.
Current conditions
Since 2015, the national Climate Change Act has set a goal of reducing Finland’s greenhouse gas emissions by at least 80% by 2050 from 1990 levels. The Act also lays down provisions for a climate policy planning system and on monitoring its achievements, both in climate change mitigation and adaptation.
Under Prime Minister Sanna Marin’s 2019 Government Programme, Finland will be carbon-neutral by 2035, and the world’s first fossil-free welfare society.1 This requires both faster reductions in emissions across all sectors, and strengthening of national carbon sinks.
The Finnish parliament supports the goal of strengthening the EU’s climate policy to achieve climate neutrality in the EU, the binding target of Net Zero greenhouse gas emissions by 2050, and the target for greenhouse gas emission reductions by 2030.
Prime Minister Marin’s proposal for the use of €2.9 bn in funding from the EU’s Recovery and Resilience Facility accounts for 50% of spending on the green transition, with the remaining funds divided between digitalisation, and research and development investment. This ‘Sustainable Growth Programme’ was accepted by the Finnish government in May 2021.2
COVID’s impact felt
In the Finnish healthcare sector, however, the government’s plans for climate change mitigation action are missing. COVID-19 has placed all levels of Finnish society under stress, with much of the focus having been on controlling the pandemic and its impacts.
At the same time, the government has been preparing much-awaited social and healthcare reform, a gigantic effort entailing considerable challenges that resulted in the resignation of the former government in 2019. These two issues have left little room to focus on sustainability issues in the healthcare sector, at a national, or even a local, level.
Social and healthcare reform proposals
The Finnish parliament accepted the government’s proposals for social and healthcare reform in June 2021, and 21 wellbeing services regions and rescue services planned to begin providing all public social and healthcare from January 2023. As a result, healthcare decision-makers and administrative personnel will be extremely busy in preparing the reorganisation and transfer of responsibilities and functions from municipalities to the new wellbeing areas.
Rising interest in climate change mitigation Is there indeed any room to properly consider climate change mitigation and adaptation in the healthcare sector?
Well, it seems that climate change mitigation in public healthcare is in fact being led by other sectors of society. In recent months in Finland, in accordance with the Government Programme, sectoral lowcarbon roadmaps have been prepared for 13 different sectors of society, including energy, the chemical and food industry, construction, logistics, transport, and commerce – but not for the healthcare sector.3
Fortunately, we have observed an increasing demand for more sustainable solutions among healthcare personnel. The amount of waste created by the pandemic has increased interest in better waste management, safe ways to re-use singleuse items, and a transition from single-use to reusable items. In January 2021, the Finnish Medical Association declared a climate emergency, and pleaded with decision-makers to limit global warming, and to establish carbon neutrality by 2030.4
Interest in the circular economy
Interest in the circular economy is growing – especially among young people, businesses, and in the academic world, and solutions are being investigated for new methods of waste processing to new materials. As contaminated hospital plastics are not welcome in mechanical processing of plastic waste, thermolysis and chemical processing are being developed instead.
Healthcare systems should be able to identify which types of waste can be separated and provided for reprocessing. Additional work must be undertaken both internally and externally to develop new separated waste streams, e.g. for different plastics; recognition of the product, collection with quality control, storage, and finding a recipient. With motivated staff, we expect to be able to accomplish this.
In Finland, municipalities are responsible for the funding of public healthcare. Since 2008, one in four have increased their climate actions, and sustainability programmes are gradually proliferating in public healthcare. Many hospitals and health centres are now being constructed using new technology that increases their energy efficiency, and geothermal and solar energy solutions have recently been introduced.
There is growing interest in the use of more sustainable construction materials such as wood, which is already used in multi-storey residential buildings, schools, and other public properties, supported by national funding.5 However, large hospitals are not, as yet, seen as suitable buildings for wooden construction. In this regard, ‘greener technologies’ within the concrete industry would be welcome, since cement production is one of the most carbonpolluting industries.6
Fossil-free energy
Healthcare providers can already buy fossil-free energy – because water, wind, and nuclear power are universally available, and many energy companies plan to end the use of coal, gas, and peat, by 2035. Some public hospitals have already claimed they will be carbon-neutral by 2030.7
In 2020, the Hospital District of Southwest Finland introduced a new five-year Sustainability Programme, which includes a number of steps for better waste management, energy efficiency, and staff, in specialised public healthcare. We intend to implement these principles in all our present and future hospital construction projects, such as the Lighthouse Hospital that opened in Turku in February 2022, replacing an outdated 1960s building.
Healthcare technology is widely used in Finnish hospitals, health centres, and in people’s homes, providing communication and alert systems, or supporting use of pharmaceuticals and self-monitoring.
With widening use of 5G technology, we can expect better quality in data transfer from ambulances to consultants, or in diagnostic image analysis. Remote communication between homes and hospitals will become more efficient. Companies and the academic world are already working together to develop artificial intelligence (AI), and some experiments have already been undertaken in implementing AI in patient care. We expect AI to effectively assist in monitoring people’s health, as well as in decision-making and contributing more to efficient use of human resources where actual personal contact is required. Due to current demographic trends in Finland, we cannot realistically expect the number of personnel employed in healthcare to increase at the same pace as patient numbers.
A strategy for adaptation
Finland was one of the first countries to publish a National Strategy for Adaptation to Climate Change, in 2005. The first action plan was published in 2008, and recently a healthcare-specific action plan for adaptation has been prepared.8 In Nordic countries, climate change means warmer winters that increase the incidence of vector-borne diseases spread by mites. Winters will be darker, which may cause stress and depression. Buildings, meanwhile, must be able to withstand increasing humidity, storms, and heatwaves, while snow and rainwater must be controlled to prevent flooding or any other disruption to hospital functions. It should not be too much of a challenge to factor in climate change adaptation through regulation of hospital planning and construction
Recommended steps
Despite ambitious climate goals set by Finnish government, there is no national roadmap for decarbonisation in Finnish healthcare. A global organisation, Health Care Without Harm, published a roadmap for healthcare decarbonisation from both a global perspective, and that of 68 individual countries, including Finland.9
The roadmap’s proposals are well argued, and should be considered both at a local and a national level in each country. Although the data for carbon footprint calculations are from 2014, and much work has been done since, it seems that plenty of work still lies ahead, particularly in terms of the items and materials used in healthcare.
According to another calculation by the British NHS, 62% of healthcare’s greenhouse gas emissions are generated by medicines, equipment, and other items procured for care, while just 10% originate from energy usage from buildings, and a further 10% from patient and staff transport.10 This suggests that the road to Net Zero carbon should be focused on material usage and production.
A common Nordic information source
Nordic healthcare systems share a common source of information on sustainable practices in healthcare. The Nordic Center for Sustainable Healthcare has proven to be a valuable forum for sharing information and great examples of sustainable solutions in healthcare facilities.11
Sharing the same Nordic climate, we can also learn from each other in hospital construction, technology, and maintenance. At present, several Finnish hospital districts are aiming for enhanced co-operation to share best practices in sustainable procurement, construction, energy solutions, and waste management, and initiate research activities with local universities. Funding healthcare’s green transition should come from the European Union’s Recovery and Resilience Facility
Conclusions
Generally speaking, healthcare sustainability has not been a high priority in Finland, yet we can identify several actions that could support climate change mitigation in Finnish society. The government’s commitments, the growing interest and sense of urgency among the population, all the technical solutions available, and the R&D process, support the Finnish healthcare system in finding a path for carbon neutrality. However, it is too early to say when.
I would like to thank Juha Rantasalo MSc, Technical director of the Hospital District of Southwest Finland, for his valuable contribution when I was putting together this article.
This article, titled ‘Climate change mitigation and adaptation in Finland’, was originally published in the IFHE Digest 2022. HEJ thanks the IFHE, the author, and the Digest’s editor, for allowing its reproduction here in slightly edited form.
Leena Setälä
Leena Setälä, MD, PhD, is a specialist in plastic surgery, and an executive Master of Business Administration. She has worked in hospitals for over 30 years as a consultant, and since 2005 in a variety of administrative roles. She is currently Sustainability director at the Hospital District of Southwest Finland. Since 2019, she has been responsible for the design and implementation of the Sustainability Programme in this Hospital District, including its environmental, economic, and social sustainability elements. She also works with other hospitals, municipalities, universities, and national institutes, to increase sustainability awareness. In addition, she is as a director of Development at Health Campus Turku.
References
1 Finland Ministry of the Environment. Finland’s national climate change policy. https://ym.fi/en/finland-s-nationalclimate-change-policy
2 Finland Ministry of Finance. Sustainable Growth Programme for Finland – boosting reforms and investments, 2021. https:// vm.fi/en/sustainable-growth-programmefor-finland
3 Finland Ministry of Economic Affairs and Employment. Summary of sector-specific low-carbon roadmaps, 2021. https:// julkaisut.valtioneuvosto.fi/bitstream/ handle/10024/162851/TEM_2021_9.pdf
4 Finnish Medical Association et al. Medical associations declare a climate emergency, 2021. https://lsv.fi/parasol/ wp-content/uploads/2021/01/ClimateEmergency_070121.pdf
5 Finland Ministry of the Environment. Wood Building Programme 2016-2023. https://ym.fi/en/wood-building
6 Timperley J. Q&A: Why cement emissions matter for climate change. Carbon Brief. 13 September 2018. https://carbonbrief. org/qa-why-cement-emissions-matterfor-climate-change
7 HUS (Helsinki University Hospital. Environmental responsibility. https:// tinyurl.com/2y8twdua
8 Finland Ministry of Social Affairs and Health. Healthcare and social welfare must systematically prepare for climate change, 25 May 2021. https://tinyurl. com/45kwxs98
9 Health Care Without Harm. Global Road Map for Health Care Decarbonization, 2021. https://healthcareclimateaction. org/roadmap
10 NHS England. Delivering a ‘Net Zero’ National Health Service, 2020. https:// tinyurl.com/35s5htet 11 Nordic Center for Sustainable Healthcare. https://nordicshc.org