Health mission in a warming world

Canterbury DHB found that coal burned in its hospital boilers produced the vast majority of emissions

The public service is mandated to lead the way in New Zealand’s efforts to mitigate global warming risks. Virginia McMillan finds out what this means for the health system’s big emitters

With Debbie Wilson as its sustainability manager, Counties Manukau DHB became a leader in the health sector’s push to reduce greenhouse gas emissions.

But even Counties now must put in extra effort to meet the Government’s carbon target announced in December 2020. It came via the Carbon Neutral Government Programme, which says the public service is to hit carbon neutrality by 2025; back in the day, Dr Wilson was championing a deadline of 2050.

Counties Manukau DHB – and, under the health reforms from 1 July, the Health New Zealand managers of its facilities – will need to knock 18 per cent off emissions per year.

That’s a lot more than the average of 4 per cent a year achieved in the 10 years the DHB has run initiatives targeting energy inefficiency and waste.

Dr Wilson had eight years at Counties Manukau but moved in 2020 to the Ministry of Health and, more recently, to interim Health New Zealand.

As kaitohutohu whakauka (principal advisor sustainability), infrastructure, she monitors environmental reporting from the DHBs.

The Zero Carbon Act is “amazing” legislation that has accelerated the health sector’s efforts to measure and manage down its greenhouse gas emissions, she says.

“Many in the sector have been engaged in this work for a decade or more, but [the act] is bringing everybody up to speed.”

Technically the Climate Change Response (Zero Carbon) Amendment Act 2019, the act has been widely criticised as too long, drawn-out (its target year for New Zealand to reach net zero emissions is 2050) and weak in its treatment of methane gas (largely from farmed animals).

However, the act is cited in the 2021/22 annual planning guidance for DHBs and they must report on their performance against that guidance.

It’s estimated the health sector contributes 3 to 8 per cent of New Zealand’s greenhouse gas emissions; it’s the largest emitter in the public sector. With this in mind, the document calls the Zero Carbon Act an opportunity and an imperative.

It says DHBs must measure, verify and report their emissions annually against credible reduction targets for 2025 and 2030.

DHBs were to measure emissions from July this year and report on them by December 2023 but, under Health NZ, a year’s grace is being given and its due date is December 2024.

Additional requirements are to phase out coal boilers, and reduce the size of vehicle fleets, as well as transition them to electric or hybrid vehicles.

The DHBs have so far largely done their own thing, but official advice is being prepared for the sector, with standardised methods for gathering emissions data and a framework for reporting.

From the $200 million State sector decarbonisation fund, the Energy Efficiency & Conservation Authority (EECA) is providing subsidised or free help to DHBs to analyse their energy inputs and reduce them, for example, using alternatives to fossil fuels.

Co-funding for new infrastructure can run into the millions of dollars.

Replacements for coal boilers and electric vehicle purchases are among projects EECA supports.

Canterbury DHB energy manager Tim Emson says the Toitū carbon reduce programme helped the DHB identify needed changes. It was found that coal burned in hospital boilers produced the vast majority of emissions.

Coal boiler replacement at Christchurch Hospital is well under way. Two new woody biomass boilers installed at the new energy centre are due to be operational late this year, Mr Emson says in a statement. The centre will halve the DHB’s overall emissions.

Burwood Hospital had biomass boilers installed in 2016 and Hillmorton Hospital’s LPG boiler was replaced by a woodchip one in 2013. At Ashburton Hospital, the coal-fired boilers will be replaced by ground-source heat pumps.

Grey Hospital & Health Centre at Greymouth incorporated a coal boiler when it opened in 2020.

Mr Emson says: “We are assessing options for reducing emissions at our Greymouth and Reefton [former aged care] facilities.”

Natural gas is a fossil fuel where large sums have been invested and suggestions of a phase-out are controversial.

Dr Wilson points out 150 gas boilers are still in use on DHB sites. This gas, she says, presents complex issues that will take time and resource to resolve. Meanwhile, EECA is co-funding alternatives for some hospitals’ gas boilers.

“With EECA expertise and leadership, I am confident we will defossilise.”

She says she’s impressed by DHBs that are “doing a great job”, for example, installing efficient LED lighting and upgrading plant so facilities use less energy. They’re also tackling food and organic waste, getting formerly single-use devices “remanufactured” for reuse and procuring more reusable products in the first place.

It’s understood Health NZ will be in charge of what is now DHB procurement and, if other buying agencies such as HealthAlliance and NZ Health Partnerships continue in the reformed system, the carbon neutral programme will apply to all these. Inevitably, Dr Wilson says, there will be emissions that can’t be whittled down to zero; these will have to be dealt with.

Pharmac is a massive buyer of medicines and devices and has long been called remiss by climate and health lobbyists, who say it’s failing to prioritise sustainably designed and produced products.

The agency is changing its ways. It has sustainability advisory groups and is following the carbon neutral programme.

The 2020/21 report says Pharmac has:

• introduced a new measure, “environmental sustainability of pharmaceutical contracting approaches”
• quizzed suppliers about their policies and practices, and
• obtained environmental information from about 25 per cent of its total contracted medicine and medical device supplier base.

“Over time, it will allow us to consider ways to incorporate sustainability outcomes in our discussions with suppliers,” the report says.

In a statement, director of operations Lisa Williams says Pharmac “emphasises” sustainability in its procurement processes.

“We also ask suppliers to consider dispensing efficiency and reducing wastage with their packaging,” Ms Williams says.

On the rare occasion when two brands of medicine have the same therapeutic benefits, Pharmac generally considers more favourably the one with less environmental impact. Options are provided for the sector but, for example, intravenous anaesthesia is preferred over high-emitting anaesthetic gases.

The ministry itself faces carbon-neutral obligations. Dr Wilson says the ministry was already measuring its carbon footprint, but tightened up in line with the programme.

“Whatever is under its financial control, it is measuring and reporting…and looking at where it can make fleet and energy improvements.”

As the ministry’s Sustainability and the health sector pointed out in 2019, low-impact building advice is most relevant when a health facility is being substantially renovated or built from scratch.

From 1 April this year, all new non-residential government buildings of over $25 million in value must meet a minimum Green Star rating of five; by next April, that applies to buildings of $9 million value and over. A five indicates “New Zealand excellence”.

The NZ Green Building Council’s website says Green Star considers a project’s direct environmental impacts like materials and water use, and also broader transport, indoor environment quality, and building management implications.

For smaller buildings, there’s the certification tool known as Core, from the International Living Future Institute in the US.

Dr Wilson says guidelines for health-sector new builds are being prepared. Underpinning this will be principles, such as resilient and “future fit” for the changing climate, healing for users, and regenerative for the surrounding area.

Designs will be expected to feature low-carbon materials and processes, and embed low carbon in a building’s lifecycle. Projects are to be informed by matauranga Māori, with Māori and environmental experts employed from the start.

The Taranaki Base Hospital redevelopment is something of a poster child here. The hospital’s new east wing has been designed to five-star certification – New Zealand’s first healthcare facility to aim that high. Also, rooftop solar panels will help ensure the site’s new renal unit can be certified as a net zero-energy consumer.

Another rating system, this one for large buildings’ energy use, is on its way as the Government extends the scope of the emissions-lowering actions it’s encouraging. Agencies that own or lease office accommodation at or above 2000sqm will need to get a NABERSNZ rating by December 2025. (The original acronym stands for National Australian Built Environment Rating System.) It’s likely there will be NABERSNZ guidance for the health sector.

Officials and engineering consultants are also doing a stocktake of State sector health assets and the risks they face from climate change.