Hospital Planning and Design: Sustainability and Green Hospitals

1. Sustainable Development and Climate Change

Sustainable development and the climate change movement have been gaining momentum globally for decades. With a growing population and limited resources, it’s critical to consider how we will sustain future generations. Despite 71% of the Earth's surface being covered by water, only 0.03% is fresh and accessible for human consumption. According to the United Nations World Water Development Report 2023, nearly 2 billion people (26% of the global population) lack access to safe drinking water, signaling an urgent crisis.

Sustainable Development

The concept of sustainable development, as defined in the 1987 Brundtland Report published by the World Commission on Environment and Development (WCED), is “development that meets the needs of the present without compromising the ability of future generations to meet their own needs.” This idea gained further prominence during the 1992 Earth Summit in Rio de Janeiro, where the UN Framework Convention on Climate Change (UNFCCC) was established to combat human-induced climate change. The Conference of the Parties (COP) is UNFCCC’s supreme decision-making body, which meets annually for the UN Climate Change Conference to assess progress in dealing with climate change.

Climate Change

Climate change refers to long-term shifts in temperature and weather patterns, which, since the 1800s, have been largely driven by human activities—burning fossil fuels, deforestation, and changes in land use. These actions release greenhouse gases (GHGs) into the atmosphere, trapping heat and causing global warming. The effects of climate change include extreme weather events (more frequent and severe droughts, intense heatwaves, heavier rainfalls), rising sea levels, food and water insecurity, and biodiversity loss.

Greenhouse Gases and Carbon Footprint

From the seven GHGs accepted by UNFCCC through the Kyoto Protocol, the primary gases causing climate change include carbon dioxide and methane. Other GHGs include nitrous oxide, hydrofluorocarbons, perfluorocarbons, sulphur hexafluoride, and nitrogen trifluoride. The "carbon footprint" refers to the total GHG emissions produced by an individual, product, activity, or organisation expressed in CO2 Equivalent (CO2e). One tonne CO2e is a standardised measure used to quantify the impact of GHG emissions on global warming. It represents the amount of warming caused by emitting 1 tonne of CO2, or an equivalent amount of another GHG, adjusted for its global warming potential (GWP), typically over 100 years. For example, methane has a GWP of 28, meaning 1 tonne of methane is equivalent to 28 tonnes of carbon dioxide.

Paris Agreement

The Paris Agreement, adopted in 2015 at COP21, set a global framework for reducing GHG emissions and limiting the rise in global average surface temperature to well below 2°C above pre-industrial (1850-1900) levels, with efforts to limit it to 1.5°C. To meet these goals, emissions must peak by 2025 and decline by 43% by 2030.

Net-Zero and Carbon Neutrality

The Intergovernmental Panel on Climate Change (IPCC) reports that achieving net-zero emissions by 2050 is essential to limit global warming to 1.5°C. net-zero means balancing the amount of GHGs emitted and removed from the atmosphere. Achieving net-zero requires reducing emissions (over 90%) and offsetting the residual emission, through the process of Carbon Neutrality, by buying Carbon Credits?(from activities such as reforestation, carbon capture, etc.).

Nationally Determined Contributions (NDCs)

Under the Paris Agreement, countries set their own emission targets through NDCs. India’s commitments at COP26 include:

• Increasing non-fossil fuel energy capacity to 500 GW by 2030.
• Meeting 50% of energy needs from renewable sources by 2030.
• Reducing carbon emissions by 1 billion tonnes by 2030.
• Reducing carbon intensity of economy by 45% by 2030 compared to 2005 levels.
• Achieving net-zero emissions by 2070.

2. ESG, Sustainability Standards, and BRSR Framework

Environmental, Social, and Governance (ESG)

The concept of ESG emerged in 2005 at the ‘Who Cares Wins’ conference on responsible investing, following the UN’s Global Compact introduced in 1999. ESG principles guide businesses to adopt socially responsible practices across environmental, social, and governance dimensions. In the context of healthcare, adopting ESG principles ensures hospitals operate in a way that minimises environmental impact, enhances social well-being, and fosters strong governance practices.

United Nations’ 17 Sustainable Development Goals (SDGs)

Adopted in 2015, the UN SDGs outline a global framework to address economic, social, and environmental challenges by 2030. Goal 13 on Climate Action directly addresses global warming and its impacts, emphasising the need for governance, policy action, and climate resilience.

National Guideline for Responsible Business Conduct (NGRBC)

In India, the National Voluntary Guidelines (NVGs) were introduced in 2011, and later updated to NGRBC in 2019. NGRBC includes nine principles covering social, environmental, and economic responsibilities for businesses, aligned with global sustainability efforts such as the UN SDGs and the Paris Agreement. Hospital organisations are encouraged to adopt these principles to reduce their environmental footprint and contribute to the well-being of their communities.

Sustainability Standards

Sustainability standards provide organisations with frameworks to measure, disclose, and monitor their environmental and social impact. Examples of global standards include:

• TCFD (Task Force on Climate-related Financial Disclosures)
• GRI (Global Reporting Initiative)
• SASB (Sustainability Accounting Standards Board)

These standards help businesses assess climate risks, such as extreme weather impacts, and develop strategies to reduce GHG emissions, waste, and water usage. At the same time, they allow investors, regulators, and customers to understand the environmental, social, and governance impacts of an organisation’s operations, which is especially critical in hospitals where patient welfare and environmental sustainability are both paramount.

BRSR Framework

To align with global sustainability standards, the Securities and Exchange Board of India (SEBI) introduced the Business Responsibility and Sustainability Reporting (BRSR) framework. Effective from FY 2022-23, this framework mandates top 1000 listed companies by market capitalisation to disclose their ESG performance in a quantitative and standardised format as part of their Annual Reports. Principles 2 and 6, covering sustainability and environmental indicators, focus on energy efficiency, water efficiency, GHG emissions, waste management, renewable energy, and business continuity. Hospitals are increasingly required to adopt such frameworks to ensure that they practice responsible business and achieve sustainable development.

3. Green Hospitals: Mitigating Climate Change and Adapting to Its Impacts

Green hospitals serve as a dual solution to climate change. They help mitigate climate change by reducing GHG emissions and adapt to its impacts by incorporating climate-resilient features.

Mitigation Strategies

Green hospitals reduce environmental impacts through:

• Energy-efficient systems: Use of energy-efficient lighting, MEP system, insulation materials, high reflective materials, building management systems, heat recovery during air-conditioning, and motion sensors for lighting.
• Solar panels and renewable energy: Reducing reliance on fossil fuels by integrating solar panels and other renewable energy sources.
• Water-saving systems: Rainwater harvesting, low-flow fixtures, and greywater reuse.
• Sustainable materials: Use of eco-friendly, locally sourced materials and recyclable construction products.
• Waste management: Composting and segregating waste to reduce landfill impact.

Adaptation Strategies

Green hospitals also incorporate features to withstand extreme weather events and adapt to climate change:

• Building orientation: Maximising daylight (with structural glazing on east and north sides) and reducing heat gain or cooling loss, using external overhangs to block direct sunlight in summer.
• Climate-resilient landscaping: Incorporating native plants that require less water, thus reducing overall water demand.
• Flood-resistant designs: Elevating buildings or using materials that resist water damage to protect against flooding.
• Improved indoor air quality: Using materials with low VOCs and properly designing HVAC system to ensure healthier environment for patients and staff.

Green Hospital Certifications in India

India has established two primary green hospital certification systems:

• LEED (Leadership in Energy and Environmental Design) by IGBC (Indian Green Building Council).
• GRIHA (Green Rating for Integrated Habitat Assessment) by TERI (The Energy and Resources Institute).

These certifications ensure that hospitals meet stringent sustainability criteria, promoting environmental stewardship and energy efficiency. Hospitals and healthcare facilities are increasingly seeking these certifications to improve operational efficiency and reduce carbon footprint.

Conclusion

As the world surpasses critical temperature thresholds, with February 2023–January 2024 being the first 12-month period exceeding 1.5°C of global warming, the need for sustainable development has never been more urgent. Green hospitals, along with effective sustainability frameworks, offer a crucial pathway for mitigating climate change and adapting to its impacts. For the healthcare sector, embracing these practices not only reduces environmental impact but also enhances patient care and operational efficiency, ensuring that healthcare systems remain resilient in the face of a changing climate.

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