Sustainability in healthcare: Investing today for a healthier tomorrow

• Sustainable development is more important than ever as the world faces an increasing threat from climate change
• The healthcare industry must work to improve health system outcomes while minimizing negative impacts on the environment
• Companies should consider three pillars to support sustainability in healthcare and introduce strategies to cover: the environment, society, and the economy

The concept of sustainability has evolved as concern grows about protecting the planet against climate change caused by human activities. Sustainability encourages us to think about how we use resources and how we can meet the needs of today without compromising the ability of future generations to meet their needs. In 2015 the United Nations (UN) established 17 Sustainable Development Goals (SDGs) with ambitious targets to achieve by 2030, as a universal call to action to improve the lives of populations around the world and mitigate the hazardous man-made effects of climate change.¹

The World Health Organization (WHO) defines a Sustainable Healthcare System as ‘a system that improves, maintains or restores health, while minimizing negative impacts on the environment and leveraging opportunities to restore and improve it, to the benefit of the health and well-being of current and future generations’.² The pharmaceutical industry can play an important role in achieving sustainability by finding ways to improve access to medicines, particularly in developing countries³ and working to mitigate any environmental impacts from their operations, as well as the products they develop, make, and commercialize.⁴

The UN’s goals cover three pillars of sustainable development: the environment, social development, and the economy.¹ Organizations must therefore consider an array of factors when making business decisions and put strategies in place that will support each pillar without negatively affecting the others.

The pillar perhaps most commonly associated with sustainability is the environment and how we are using our natural resources. Healthcare systems are known to have a considerable environmental impact and are reported to be responsible for up to 10% of emissions of greenhouse gasses and other air pollutants.⁵ Companies must therefore look at ways to reduce this impact as much as possible. Some examples are outlined below: 

• Establish strong product stewardship practices: Product stewardship aims to minimize the environmental impact and improve the safety aspects of any product a company develops. Product Stewardship also actively encourages all stakeholders, such as suppliers, retailers, and consumers to take on the responsibility of minimizing the environmental impact.⁶
• Use energy efficiently: The use of renewable energy on sites, as well as purchasing energy from renewable sources, is an integral component of a greenhouse gas emission reduction strategy, along with improving the energy efficiency of operations.⁷ Establishing meaningful renewable energy targets is a requisite first step.⁸ Organizations can also look at how they might better use existing resources, for example through simple changes such as motion sensor lighting, or recycling of water used in diagnostic testing.⁹
• Invest in efficient infrastructure and operations: Environmental considerations should be incorporated into plans for new buildings and purchasing of vehicles. Efficiencies can be found in supply chains by optimizing shipping and delivery routes and opting for more sustainable transportation options where possible. While the contribution of such projects may be small in terms of overall carbon footprint, investing in these projects demonstrates a strong commitment to environmental sustainability.¹⁰

Social sustainability in healthcare looks at enhancing the quality of life and improving well-being in a population.¹¹ The UN’s SDGs aim to ‘achieve universal health coverage, and provide access to safe and affordable medicines and vaccines for all’.¹² So how can the healthcare industry support this pillar?

• Make use of holistic, integrated evidence generation: Patient access and outcomes can be improved by utilizing real-world and clinical data, combined with expert discussion, to inform treatment decisions. Companies will need to generate and analyze vast volumes of real-world data and excel at communicating scientific evidence.¹³ Above all, it is imperative to help physicians navigate in a far more complex healthcare universe. 
• Expand access programs: One avenue to drive improved access to healthcare is dedicated enhanced access programs. These might include an array of social business, zero-profit, philanthropic, and patient assistance programs, which each differ in goals and methods.¹⁴
• Expand presence in the emerging markets: This is especially important in the fight against noncommunicable diseases like cardiovascular diseases, diabetes, and cancer, where the structural standards are higher, and the treatments are more costly and longer-term.¹⁵ Consider launching programs that focus on the affordability and availability of medicines, especially through PPP (private-public partnerships) or through vehicles such as differential pricing, where costs for therapies are adjusted by a healthcare system’s ability to pay.¹⁴
• Consider public-private partnerships: To ensure quality care across healthcare systems a skilled and competent healthcare workforce is required, with access to safe appropriately regulated medicines.¹⁶ Working in partnership with private and public-sector players can help healthcare systems build strong regulatory systems to support pharmacovigilance, good manufacturing and clinical practices, etc., which are vital, especially in lower-income countries, to improving healthcare capabilities and patient outcomes.¹⁷

Economic sustainability in healthcare systems looks at how the system can run most efficiently to balance the needs of patients and improve health outcomes with the resources available.¹¹ There are several areas for consideration for healthcare companies. 

• Embrace value-based care: Value-based care means shifting focus from “paying per pill” to looking at outcomes for patients as the main goal of healthcare.¹⁸  For example, an innovative contract between Harvard Pilgrim Health Care and AstraZeneca is based on the effectiveness of the Type II diabetes medicine exenatide (Bydureon) in real-world patients. If the medicine fails to meet agreed-upon outcome criteria in patients, Harvard Pilgrim will be charged a lower amount, meaning the health plan is charged based on value to the patient rather than the volume of medicine sold.¹⁹ A value-based approach also means breaking down silos in health system budgets and looking at opportunities to share both costs and savings.
• Make medicines more affordable and available: This may need to be done via a combination of various schemes and plans – classic patient assistance programs, differential pricing, second brands, and donations. In addition, this may also include new business models that incorporate sustainable access strategies to help make medicines more broadly available to a range of populations at different levels of the socioeconomic pyramid – and at scale – for maximum impact.¹⁴
• Utilize personalized or precision medicine: Thanks to the advancement of big data and the insights we can derive from it, we can better understand which specific patients would benefit most from a given treatment or therapy.²⁰ This means that rather than casting a wide net, we could identify the right treatment for the right patient at the right time, allowing for more effective treatments. This would also lead to cost savings.
• Invest in technology: Technology can enable the successful running of a sustainable healthcare system. Information technologies such as electronic health records allow systems to exchange health information and can facilitate decision-making and improve outcomes. However, challenges persist where platforms are not integrated and interoperable meaning that carers aren’t able to access the electronic health records needed to ensure the patient-centric care required.²¹ Innovation in the way healthcare is delivered by using digital technologies can help improve both access to and quality of care and give patients more power in their healthcare decisions through the use of wearables, telemedicine, or smartphones.²²

We can only determine whether strategies put in place are improving sustainability in healthcare by measuring their impact. This requires defining, tracking, and reporting on different metrics from traditional key performance indicators which focus on performance goals and results.²³ In line with sustainability reporting standards, the metrics fall into the categories of Environmental, Social, and Governance, or ESG metrics.²⁴

Reporting of ESG metrics is becoming critical to companies as investors are increasingly assessing ESG credentials to inform their decision-making, and favoring businesses with robust ESG frameworks.²⁴ Performances of companies are published in reports such as the Dow Jones Sustainability Indices which showcase best-in-class approaches to environmental, social, and economic performance.²⁵

The benefit of increased investment in sustainable companies is not limited to financial reward for the individual organization but can help the industry work towards hitting UN SDG targets. Investment based on ESG goals enables healthcare companies operating sustainably to continue and improve and encourages others to do the same. 

More solutions can then be offered to support sustainable healthcare systems as they aim to meet the needs of today without compromising the health and well-being of future generations. And healthy future generations are essential to run the healthcare industry of the future. As the UN states ‘healthy people are the foundation of a healthy economy’, therefore sustainability in healthcare makes good environmental, social, and economic sense.