Race to Zero is a global campaign launched by the United Nations Framework Convention on Climate Change (UNFCCC) that mobilizes a coalition of leading net-zero initiatives in different sectors, and an increasing number of health care organizations have signed on.

The Race to Zero campaign is organized under the “5 Ps” criteria:

1. Pledge: Organizations commit to achieving net-zero emissions by 2050, setting interim targets in line with global efforts to limit warming to 1.5ºC, including a 50% GHG reduction by 2030 for high-emitting countries.
2. Plan: Organizations develop a plan describing how they will meet the Race to Zero pledge (including their interim targets) and an action plan to achieve it.
3. Proceed: Organizations carry out mitigation actions as soon as possible and implement the plan to meet their pledge.
4. Publish: Organizations must publicly report on progress annually, disclosing emissions and describing actions implemented, challenges encountered, and strategies to continue advancing toward net zero.
5. Persuade: Organizations collaborate and partner with others across sectors to achieve the highest possible impact.

As Race to Zero’s health sector partner, Health Care Without Harm is sharing and collating learnings on GHG emissions reduction, resilience building, and adaptation efforts across the health care sector, accessible through Health Care Without Harm’s Global Green and Healthy Hospitals (GGHH) network.

Working with global partners, Health Care Without Harm developed this guidance to build on Race to Zero’s “5 Ps” criteria and lead health care organizations on the path to net zero. This includes:

• Category 1 – Pledge: Gather support and resource allocation from leadership and an expressed commitment to climate action
• Category 2 – Plan: Baseline and estimate emissions, risk, and vulnerability
• Category 3 – Plan: Develop a Carbon Management Plan (CMP) or Climate Action Plan (CAP) to improve facility- and community-based adaptation and resilience
• Category 4 – Proceed and Publish: Prioritize and implement high-impact interventions to reduce emissions and build resilience and adaptive capacity. Monitor, track and report progress related to these interventions.

Category 1 – Pledge: Gather support and resource allocation from leadership and an expressed commitment to climate action

Systemic, transformative climate action will require advocacy, relationship building, coalition support, and the creation of larger networks to propel wider societal and environmental change. Remember to remain persistent and patient in gathering buy-in, as building consensus and achieving your goals may take time. The following steps will lead to meaningful progress in achieving climate action goals.

1 - Identify key decision-makers: Consider the local context of your organization and determine who the decision-makers and influencers are in your organization and the community. Work to understand their priorities and concerns. Identify the individuals who can influence behavior change as well as the allocation of resources and support for climate action. This step may include a survey of the policy landscape to identify influential political allies.

2 - Develop a compelling business case for climate action, resilience, and net-zero emissions: This case should include health, environmental, reputational, and financial benefits, including a financial account of the cost of inaction. This will give you a comprehensive return on investment (ROI) assessment of investing in sustainable, climate-smart health care. Include and present these in a way that speaks to leadership’s existing priorities. Leverage existing commitments to net zero made by governments/agencies where the organization is located.

3 - Engage stakeholders: Engage stakeholders across the organization, including employees, patients, health care professionals, and suppliers, to build support for climate action. Provide training and education to senior leaders and staff on the importance of climate action, instilling a sense of urgency and emphasizing the role of health care in addressing climate change.

Use case studies and examples to demonstrate the benefits of sustainability initiatives, and promote a culture of sustainability within the organization. In some settings, including sustainability in accreditation mechanisms will encourage leadership to take action.

4 - Leverage external expertise: If you do not have internal knowledge or skills on the topic, consider enlisting external expertise, such as consultants or allied organizations, to provide additional information and support for your business case. Consider engaging with forward-thinking suppliers to identify or commit to innovative, low-carbon, toxic-free alternatives. Local higher education organizations may be exploring new technologies and solutions you could partner on or offer health professional intern capacity to leverage for mutual benefit.

5 - Craft a financial strategy: Consider grants or loans available through public health, government, or philanthropic entities. Experiment with creative budgetary approaches to free up funds for upfront expenses. If funding is unavailable, start where you are and focus on education, behavior change, and no-cost interventions that may generate cost savings that you can invest in future years. The business case should include considerations around public health and disease prevention. It is important to acknowledge that climate strategies ensure the sustainability of direct patient care in times when it is needed most.

6 - Set and publicly share a commitment to action: Develop a high-level goal for your organization, such as achieving carbon neutrality or reducing emissions by a certain percentage over a specific timeframe. The goal should be specific, measurable, achievable, relevant, time-bound, and should consider inclusion and equity (SMARTIE). Review existing frameworks, and work to align with sector-specific goals such as the Health Care Climate Challenge, national goals such as a commitment set by your government as part of the COP26 Health Programme, or international goals such as Race to Zero.

Category 2 – Plan: Baseline and estimate emissions, risk, and vulnerability

Baselining and estimating emissions, risk, and vulnerability are crucial to developing effective climate action strategies. Full emissions accounting across all three scopes is a significant undertaking that will take considerable time. Start with the data you have or can easily obtain, knowing you will add data from other sources in the future. It is important to review and update these strategies as new information becomes available.

1 - Baseline emissions: To effectively manage emissions, it is important to first understand the current emissions profile of your organization. You will need to determine time boundaries for the collection of your data. Enlist technical support to assist with establishing your baseline. Local higher education organizations may have student support to offer, or you may enroll a consultant organization to assist. This involves calculating the climate footprint and developing a baseline for each source, such as energy use, transportation, food purchasing, and waste. The data can then be used to establish a baseline emissions level, which serves as a benchmark for measuring progress in reducing emissions.

2 - Forecast future emissions: Once baseline emissions are established, it is important to estimate future emissions, which can involve projecting future business growth and changes in operations, as well as adopting new technologies or changes in regulations. These projections can help identify potential areas of risk and opportunities for emissions reduction and help you define how you may monitor and evaluate your efforts.

3 - Identify risks and vulnerabilities: Scenario analysis can be used to assess the potential impacts of different climate-related impacts on an organization. This can involve modeling the potential impacts of different physical risks like temperature increases or policy scenarios on key performance indicators such as revenue, profits, or patient admissions. Assess the climate risks and vulnerabilities of health care operations and communities served. Use established methodologies such as the Climate Vulnerability Index or the Public Health Adaptation Pathways to identify potential impacts and develop strategies to build resilience and adaptive capacity. Explore if these assessments have taken place at the national or sub-national level so you can reference them.

4 - Quantify risks: Once climate-related risks are identified, it is important to quantify the potential impacts considering financial, operational, and community health factors. This can involve estimating the potential costs of impacts such as property damage, supply chain disruptions, exacerbation of health disparities, or litigation. By quantifying risks, organizations can prioritize investments in risk mitigation and ensure these investments are aligned with overall business and health impact objectives. You may choose to focus on an assessment of the organization’s highest-value assets to contribute to the business case.

5 - Data quality assurance: Make note of assumptions made and data references when collecting and entering data. This will create a record for those who take up this work next to ensure data integrity is maintained. Carbon accounting is an emerging field with deficits in understanding how to fully measure all aspects of an organization’s climate impact. Avoid being stalled by data precision, as you may improve the depth and specificity of your data as you move forward. As the field continues to improve the way emissions are measured, targets may change. It is essential to remain flexible to allow for continual learning and necessary modifications.

6 - Share to motivate: Share the data and summary of findings with the board, leadership, and your colleagues, especially those who helped you gather the data. By seeing the product of their efforts, you may enlist their support in the next steps to reduce emissions. Share findings with external stakeholders, as they are essential to the continued success of your efforts.

Category 3 – Plan: Develop a Carbon Management Plan or Climate Action Plan to improve facility- and community-based adaptation and resilience

Developing a Carbon Management Plan (CMP) or Climate Action Plan (CAP) can help health care organizations reduce their GHG emissions, improve their resilience to climate change impacts, and demonstrate their commitment to sustainable and resilient health care delivery. A Carbon Management Plan refers to a plan focused solely on mitigation efforts, while a Climate Action Plan is holistic and considers the crucial intersection of mitigation, resilience, and adaptation efforts.

Key components of a plan include:

• Emissions baseline
• Emissions reduction targets
• Summary of risks and vulnerabilities through stakeholder input
• Actions and interventions to reduce and avoid emissions
• Financing arrangements and governance of the plan
• Progress reporting and regular review of the plan

Equally important to a comprehensive plan is the process used to develop it. Consider the following action steps when developing your plan:

1 - Engage stakeholders: Engage stakeholders across the organization, including staff, patients, and suppliers, as well as local government or agencies, to build support for the plan and ensure its success. Creating a governance structure is essential, such as a climate action committee – with membership from various departments – tasked with development and implementation of the plan. This approach is similar to a green team, which has proven essential to the effective implementation of organizational sustainability strategies. Use a participatory approach and strategic communications to ensure buy-in and ownership of the plan and promote a culture of sustainability within the organization and community.

2 - Establish reduction targets: Using the baseline emissions footprint identified in Category 2, establish specific, achievable reduction targets that align with the facility's overarching climate goals and respond to identified risks and vulnerabilities. These will serve as a key frame of reference at which all of the action items you identify are aimed. Avoid working on all areas at the same time or in the first year. This is an emerging area of knowledge, so expect to learn and adjust targets as you move through the implementation plan.

3 - Identify and prioritize interventions: You may prioritize opportunities that have financial benefits or those that allow you to gather early wins that can further motivate your team and leadership to continue with more challenging interventions. Consider stakeholder input from staff and community members that will be impacted by the interventions. To avoid unintended impacts, initiatives should consider the impact on emissions reduction alongside the impact on health disparities. Interventions should also consider the just transition of industries involved and aim to contribute to facility and community resilience and adaptive capacity. Refer to Category 4 for more guidance.

4 - Develop an implementation plan: Develop a detailed approach that outlines the specific implementation actions needed to achieve the identified targets. This should include timelines, budget estimates, key performance indicators to track progress, key stakeholders to involve and inform along the way, and a communications strategy to maintain stakeholder engagement.

5 - Monitor and report progress: Establish a system for monitoring and reporting progress on the plan. Include both quantitative and qualitative indicators to measure success. This can help identify areas for improvement and ensure the plan achieves its intended outcomes. To make knowledge more accessible and equitable, make resources and reporting multilingual and easily digestible to support stakeholders from different backgrounds. Beyond indicator reporting, it is essential to tell the story in a way that keeps internal and external stakeholders engaged.

Category 4 – Proceed and Publish: Prioritize and implement high-impact interventions to reduce emissions and build resilience and adaptive capacity

There are a vast number of possible interventions to decrease GHG emissions and build resilience and adaptive capacity. Identifying and implementing high-impact interventions first can assist in gathering buy-in for harder-to-implement interventions. Here are some critical steps to consider:

1 - Assess feasibility: Evaluate the feasibility of each intervention, considering factors such as cost, technical requirements, potential impact on operations, and the regulatory conditions influencing your organization or region. This can involve conducting a cost-benefit analysis and engaging with stakeholders to understand their perspectives and concerns.

2 - Identify quick-win opportunities: Start with projects and initiatives that require low financial investment, limited effort, or achieve other priorities through the same effort. Staff behavior change and efficiency improvements can often generate results in mitigating emissions while saving money or bringing other co-benefits like addressing health disparities or motivating staff for future initiatives. These savings can demonstrate the benefits of this work to leadership and create a climate fund to finance future emissions mitigation work.

3 - Outline components of your intervention implementation: Lay out timelines, budget estimates, staff capacity, and key performance indicators to track progress. This may involve engaging with suppliers, contractors, and other stakeholders to ensure they understand the objectives of the interventions and can provide the necessary support. It is critical to gather buy-in and alignment around the approach. Consider simple actions staff or community members can take to get involved that will foster a sense of ownership and contribute to success.

4 - Engage suppliers: If applicable, ask your suppliers, contractors, or other entities involved in your services to provide tracking of their emissions so you can ensure tracking along the entire value chain and identify more sustainable and lower-emitting procurement options. Supplier engagement is also critical to ensuring uninterrupted access to the goods and services hospitals need to care for their community during extreme weather events and other emergencies. Consider how you may codify these requests in contracts with these entities or in the selection of suppliers and partners based on their willingness to contribute.

5 - Secure funding if needed: No-cost and low-cost interventions may be incorporated into internal operational budgets. In cases where funds are needed, you may explore a variety of sources, such as grants provided by public health departments or private philanthropy, or loans. To make the case for financing, consider comparing costs to the social cost of carbon associated with inaction.

6 - Monitor and report progress: Establish a system for monitoring and reporting progress on the interventions. This can involve tracking emissions reductions, improvements in resilience and adaptive capacity, and any other relevant metrics. It can generate data on financial savings and impact that should be communicated back to leadership. Regular reporting and evaluation can help identify areas for improvement, ensure interventions achieve their intended outcomes, and allow timely change of course if needed.