This article explores the healthcare sector’s impact upon the environment, and the link between human and climate health. It also spotlights how The Bahamas is working to create a more sustainable and resilient health system.

Around the world, health systems are responsible for nearly five percent of global carbon emissions.1 This is because healthcare is a massive global industry, with 24/7 facilities that consume significant amounts of energy, as well as generating a material level of medical, pharmaceutical, and hazardous waste which if not disposed of correctly can lead to environmental pollution. Hospitals also consume significant amounts of water putting a strain on local water resources. Transportation and supply chains are also relatively larger in the healthcare sector. Climate and human health are interlinked. Poorer air quality can cause or worsen respiratory disease. A hotter planet has been linked to higher rates of infectious disease, heat-induced illness, malnutrition from food insecurity, and more.

There is a strong rationale for healthcare to engage with the 'E' in ESG, even before considering that organizations will soon be mandated to account for their environmental impact under new regulations coming into effect in the European Union and elsewhere. Yet, there remains potential for many health systems to further their efforts in reducing climate impact.

Research on 18 healthcare systems around the world by the Partnership for Health System Sustainability and Resilience revealed most jurisdictions in their sample did not have mechanisms for routinely capturing emissions and other environmental impacts.2 KPMG research has also found that healthcare performed worse than many other sectors when it came to reporting on carbon targets.3

reporting of carbon targets

The healthcare sector’s underwhelming response to addressing its climate impacts is not surprising, given the multitude of other challenges faced by over-stretched and under-staffed health systems in the wake of the COVID-19 pandemic. But for some, pushing climate change to the bottom of the agenda is not an option, because they are already dealing with its consequences.

Spotlight on The Bahamas: Making climate change a healthcare priority

In September 2019, Hurricane Dorian devastated Abaco and Grand Bahama in the Northern Bahamas. A number of medical facilities including the Rand Memorial Hospital on Grand Bahama and the Marsh Harbour Community Clinic on the Abaco were negatively impacted.

At Rand Memorial Hospital more than 90 percent of equipment was damaged or destroyed, severe flooding and “blackwater intrusion” rendered most of the hospital inoperable for nearly 12 months. International Relief organization, Samaritans Purse, responded by setting up a nearby field hospital staffed with a disaster assistance response team. The Marsh Harbour clinic sheltered patients, staff and community members during the storm but afterwards had to contend with a surge of many injured patients and displaced residents looking for shelter. Medical services were re-organized and provided by local team members along with international relief nurses and physicians who were rostered to provide emergency support.

After the storm (and in the years since) SBP, formerly the St. Bernard Project and its partner organization, Water Mission responded by providing five reverse osmosis systems, including one at Rand Memorial Hospital.4 These systems have been installed above flood levels and can intake from multiple sources such as ground wells and the local utility system. Using a specialized water purification process, these systems filter saltwater before it is treated and ensure in the aftermath of strong storms, that water is fit for human consumption.

Hurricane Dorian galvanized Bahamian health leaders to make change to reduce carbon footprints and improve resiliency of healthcare infrastructure and service delivery. In 2021, the Bahamian government committed to building five new family health clinics across the island chain that use at least 20 percent less energy, water and embodied energy in materials.5 In the future when building any new hospitals, construction plans will factor in the latest climate resilience science and technologies.

The Bahamas has been proactive in its approach to addressing climate change in healthcare, as evidenced by the completion of its first Health and Climate Country Profile. This World Health Organization document summarizes climate hazards and health risks countries face and tracks national progress in addressing threats and gains from mitigation opportunities. Health representatives were also invited to join the Prime Minister’s COP27 delegation in Sharm El Sheik, Egypt. In 2022, the Bahamian government further committed to financially supporting its first Climate Change and Health Project Team who completed its first iteration of the Health National Adaptation Plan along with a Health Readiness Assessment for the Green Climate Fund. The documents produced along with a health concept note are the blueprints for the next steps in developing and strengthening a climate resilient health system. Most importantly, the government piloted its first community Climate Change and Health Ambassadors training that brought together healthcare providers, youth and community members.

I believe, health is in the hands of the people, and we must empower and train healthcare providers, youth and community leaders to become Climate Change and Health Ambassadors, advocates and agents of climate change action.

Dr. Calae Philippe
Project Coordinator, Focal Point for a Climate Resilient Health System,
Ministry of Health and Wellness for the Government of The Bahamas

Beyond the physical infrastructure of health systems, Bahamian leaders are also anticipating how disease burden will grow and change on a hotter planet. More frequent or stronger El Nino events are expected to increase the incidence of dengue fever in the Caribbean. Rising temperatures will lead to increased illness due to heat stress. Mental health is also top of mind: in the aftermath of Hurricane Dorian, many survivors suffered from depression, anxiety or post-traumatic stress disorder.

The Bahamas also provides a case study in how multiple elements of ESG can be addressed with the same initiative. Health leaders aim to increase the provision of telemedicine to populations on remote islands. The primary aim of these plans is to create more equitable access to healthcare. But because people in remote island communities currently have to fly to capital city Nassau or the United States, when they require specialist treatment, increased use of telemedicine would also cut the health system’s carbon footprint.

Island nations, including The Bahamas, are particularly vulnerable to the effects of climate change. They are leading the way when it comes to building resilience and addressing the ways in which their own health systems damage the planet, even though their own emissions are a drop in the ocean.

Getting started in addressing climate change

Momentum is growing. Fifty countries and territories have made commitments in creating climate resilient, low carbon, sustainable health systems, including 14 that have set a target of reaching net zero emissions by 2050.6 The next steps will be implementation of these pledges.

Health organizations who are interested in addressing, and reducing, their environmental impact should ask themselves:

  • Does our organization understand its climate risk? It is important to measure, quantify and assess risks and opportunities across supply chains under a wide range of scenarios so that leadership teams understand how climate change will affect their organizations.
  • Has our organization mapped out a path to decarbonization? This requires organizations to measure emissions and set reduction targets. Strategies to decarbonize include switching to renewable energy sources, boosting the energy efficiency of buildings and procedures, considering the reuse of some materials and introducing carbon footprint considerations when selecting suppliers.
  • Is our organization regulation-ready? Legislation such as the European Union’s Corporate Sustainability Reporting Directive, and similar regulations elsewhere will require organizations to report on the environmental impact of their activities. 
Country and territorial commitments

Navigating a journey of setting decarbonization targets and transition plans to decarbonize business operations and supply chains can be challenging tasks. At KPMG, we assist healthcare organizations with their decarbonization efforts through a suite of specialized services and innovative technologies to help them achieve their environmental goals.

Key takeaways and action points

  • There's a growing recognition of the interconnectedness of climate change and human health. The Bahamas provides an example of how countries and jurisdictions can work towards integrating the 'E' in ESG into healthcare. 
  • Healthcare organizations can start to address this issue by taking small steps such as undertaking assessments of organizational climate risk and working from there to engage stakeholders in developing and implementing action plans.

Throughout this website, “we”, “KPMG”, “us” and “our” refers to the global organization or to one or more of the member firms of KPMG International Limited (“KPMG International”), each of which is a separate legal entity.

Lenzen et al. (2020). The environmental footprint of health care: a global assessment. The Lancet Planetary Health, Volume 4, Issue 7, Pages 271-279.

Partnership for Healthcare System Sustainability and Resilience. (2023). Key findings from country reports: Building sustainable and resilient health systems.

KPMG International. (2022). Big shifts, small steps. Survey of Sustainability Reporting 2022.

Young, J. (2021 July 8). Stronger after the storm: Safe water for the Bahamas.

Government of The Bahamas (2021). Contribution to the 2021/2022 Budget Debate by Hon. Renward R. Wells, M.P., Minister of Health, House of Assembly.

World Health Organization. (9 November 2021). Countries commit to develop climate-smart health care at COP26 UN climate conference. News release.