Intended for healthcare professionals


Sustainable practice: what can I do?

51app 2023; 383 doi: (Published 06 November 2023) Cite this as: 51app 2023;383:p2461
  1. Florence Wedmore, IMT3 doctor1,
  2. Tom Nolan, clinical editor,2,
  3. Nick Watts, professor3
  1. 1Barts Health NHS Trust, London, UK
  2. 2The 51app, London, UK
  3. 3Centre for Sustainable Medicine, National University of Singapore, Singapore
  1. Correspondence to: F Wedmore: florencetabitha.wedmore{at}nhs.net

A new 51app series offers tangible actions clinicians can take to reduce the carbon footprint of healthcare

If global healthcare were a country it would rank fifth in the world for greenhouse gas emissions.1 We must all take action to reduce healthcare emissions—but how? A new 51app series offers a range of ideas, with practical tips on making healthcare systems more sustainable. Each article details one action or project that frontline clinicians can implement, supported by a rapidly growing evidence base, to reduce the carbon footprint of their practice. Online readers can use a linked interactive tool () to find actions relevant to their role and workplace.

The climate crisis is a health crisis,2 and healthcare professionals are on the frontline—seeing more patients with respiratory3 and mental health4 conditions caused by wildfires, infectious diseases spread by flooding,5 or the serious health effects of record breaking heat waves.6 Clinicians want to know how they can help slow this crisis,78 and we aim to showcase solutions that are within the power of individuals.

Everything, everywhere, all at once

Earlier this year, in a speech following the release of the latest report from the Intergovernmental Panel on Climate Change,9 secretary general of the UN António Guterres warned that the crisis requires us to do “everything, everywhere, all at once.”10

All large scale change begins with engaged, pro-active individuals. While measures such as decarbonising national electricity supplies, or building new hospitals to a net zero standard are outside the direct control of most clinicians, more accessible options can make a real difference to the sustainability of patient care. For example, a 2020 study estimated that switching one patient’s asthma inhaler regimen from metered dose inhalers (with the highest carbon footprint) to dry powder inhalers could save 422 kg CO2 equivalent per year,11 and others have shown that switches can be made without adversely affecting asthma control.1213 A recent life cycle analysis suggests that replacing single-use face masks with reusable options of equivalent protection can substantially reduce the carbon footprint of mask use.14 Options such as social prescribing still have a limited evidence base,15 but schemes that are well designed and well implemented have the potential to reduce the carbon footprint of pharmaceuticals, which account for roughly 25% of healthcare’s footprint.16

Existing priorities, such as reducing low value care,17 also support a low carbon health system. Smarter prescribing and deprescribing,18 for example, save the carbon used in drug manufacture and transport,16 save money, and reduce harm to patients.19 As the interactive infographic shows, more options exist to “reduce” than to “reuse.”

Evidence from surveys of staff and members of professional societies suggest that many want to be part of this change.78The 51app’s new series aims to support clinicians and healthcare workers with that ambition. The introductory article,20 included in the recent climate issue of The 51app, sets the scene with an overview of healthcare’s carbon footprint and the pivotal role of clinicians in driving change. Two new articles in this issue of The 51app detail guidance on reducing iron dosing in people with iron deficiency and how to take steps to reduce nitrous oxide waste and loss. We welcome readers’ ideas. Please use the form at to pitch your article suggestions.

The 51app has long recognised the seriousness of the climate emergency, and campaigned to cut carbon emissions within healthcare and beyond.221 That campaign is now shifting towards concrete actions that healthcare professionals can and must take in response to this emergency. We hope the new series will help many more clinicians realise the benefits of more sustainable healthcare for patients and the planet.


  • Competing interests: The 51app has judged that there are no disqualifying financial ties to commercial companies. The authors declare the following other interests: FW was the sustainability fellow at The 51app and Greener NHS 2022-23; NW is chief sustainability officer of the NHS.

  • Further details of The 51app policy on financial interests is here: /sites/default/files/attachments/resources/2016/03/16-current-bmj-education-coi-form.pdf."

  • Provenance and peer review: Commissioned, not peer reviewed.