Hospital Sírio-Libanês decarbonization program (HSLPD) focused on mitigating greenhouse gas (GHG) emissions as part of their 2019 commitment to become a carbon-neutral organization. The program included actions to measure GHG emissions, manage consumption that impacted carbon emissions, and compensate for what could not be reduced.

• City: São Paulo
• State/province/region: São Paulo
• Country: Brazil
• Type of institution: Nonprofit health institution 
• Number of full-time staff: 9,000
• Number of beds: 600
• Patient population served annually 
  • 100,000 patients served annually (total of inpatient and outpatient) 

Geographic area served: Brazil and Latin America

Decreasing carbon use in health care requires technologies that enhance energy efficiency, renewable energy sources, and introduction of CO₂ capture and storage. Considering the health impacts of climate change, the need for a reduction in GHG emissions was clear. Actions needed to be guided by a strategy with an institutional goal that would motivate other hospitals.

The hospital aimed to prepare a strategy for decarbonization indicating goals, deadlines, and actions to mitigate the GHG emissions and influence other health institutions towards low-carbon actions. Climate change mitigation technical studies were analyzed to define the basis of HSLPD, which used the design methodology developed by Health Care Without Harm and produced by ARUP specifically for this project. It stems from a long-term projection phase based on integrated models used in established studies.

Measuring GHG emissions was the first step toward understanding available opportunities. Next, areas for potential reductions were identified and some immediate action was implemented. The goal was to reduce emissions by 15% compared to previous years. It was compatible with the Race to Zero initiative, which included a goal of 50% emissions reduction by 2030 and 100% by 2050. The commitment and goal were based on the science-based target initiative.

HSLPD designed and structured actions based on the long-term forecast of science-based target initiative methodology configurations and GHG emission guidelines for the overall health care industry. Actions began with the environmental sustainability office centralizing data compilation for the emissions inventory, in partnership with maintenance staff, who are responsible for reporting scopes 1 and 2. Environmental sustainability staff contributed the scope, coverage, analysis, methodology, and structured approach that provided a body of evidence, including the following: 

• Assessment of HSL reports of GHG emissions since 2011, analysis of the base year (2017), and challenges for actions and decarbonization goals (Scopes 1, 2, and 3).
• Meetings were held with the departments involved by presenting our emission levels since 2017 and our reduction goals. 
• We built awareness among various departments through processes and actions intrinsically connected to the decarbonization of our deliverables.
• We incorporated climate actions that may be adopted by health care.

Our main challenge with tracking was to identify a system that would measure emissions in healthy eating, reduction of pharmaceutical footprint, and enhance effectiveness.

Hospital Sírio Libanês, similarly to other health care facilities, depends on other industries that provide energy, chemicals, construction materials, packages, infrastructure, transportation, and food, among others. Broad decarbonization of society would be crucial for zero emissions goals while protecting the health of people and the planet. Health care professionals and organizations may play a leadership role as advocates of decarbonization, which reduces the incidence of diseases. We started our path toward decarbonization in 2019 and have assessed the potential impact through seven actions for emission reduction. In 2021, we purchased renewable energy, avoiding the emission of 5,820 tCO₂, by recycling HFC R-134A gas in 2019 and 2022 we achieved a reduction of 3,500 tCO₂e. Despite the significant technological challenges to achieve net-zero emissions in hospital activities (scopes 1 and 2), we are on the right track to fulfill the commitment of zero carbon by 2050.

There was a lack of technical material and market options to replace some equipment and gases. We seek to understand more about the emissions in the supply chain. Climate neutrality of health care organizations is a challenge as the industry depends on carbon-intensive economic activities, whereas other industries have the opportunity to achieve co-benefits by adopting different techniques to remove carbon from the atmosphere.

Some actions are under study and others are underway, such as:

• Removal or exchange of combustion vehicles in the organization-owned fleet or fleet service provider for electric vehicles.
• Use closed anesthetic systems and intravenous anesthesia, remove desflurane, and minimize the use of nitrous oxide.
• Expansion of efficient lighting (LED bulbs).
• Understand and reduce the GHG emissions in the supply chain.