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Poor must not shoulder responsibility for reducing healthcare carbon emissions

The pursuit of net zero healthcare risks targeting the poor and exacerbating existing unfair heath inequalities unless careful consideration is given to the re-allocation of healthcare resources. A group of global health researchers, writing in the Journal of the Royal Society of Medicine, say that as with pandemic measures, the burdens of climate impacts and cutting emissions are not equally shared.

The NHS in England has committed to ambitious net-zero targets – an 80% reduction in emissions under its direct control by 2028-2032 and across the supply chain by 2036-39, reaching net zero by 2040 and 2045 respectively.

According to the researchers, the most deprived people have poorer health, a lower life expectancy and consume a greater amount of health services. Given healthcare consumption is the ultimate driver of healthcare emissions, they write, this has important implications in terms of justice for the pursuit of net zero healthcare.

Lead author Dr Anand Bhopal, a PhD research fellow at the Bergen Centre for Ethics and Priority Setting, said: “Lifetime health costs among the poorest people are 10-20% higher than the least deprived. It seems likely that individual healthcare carbon footprints also follow a social gradient, with emissions highest amongst the worst-off.”

According to Dr Bhopal and his colleagues, healthcare carbon emissions represent almost a fifth of the per capita healthcare carbon footprint among the poorest people, compared with under a fiftieth among the richest.

The net zero agenda involves, in part, transforming how the NHS delivers care and changing the behaviour of individuals. Reducing carbon emissions within the healthcare system involves trade-offs, write the researchers, since a re-allocation of resources may displace spending from more cost-effective health interventions.

The researchers consider if those with the greatest means and total emissions caused outside the healthcare system should shoulder the responsibility to reduce their carbon footprint. They give the example of a return flight from London to New York which incurs four times the NHS’ per capita carbon footprint or almost the annual total emissions of an individual in the poorest decile.

“Those who depend on the public healthcare system, and who risk the most if health gains are sacrificed due to already existing health inequity, may find it doubly unfair to carry the burden of reducing carbon emissions,” added Dr Bhopal.

Notes to editors

How do we decarbonise fairly? Emissions, inequities and the implications for net zero healthcare (DOI: 10.1177/01410768221113069) by Anand Bhopal, Kristine Bærøe and Ole Norheim, will be published by the Journal of the Royal Society of Medicine at 00:05 hrs (UK time) on Wednesday 10 August 2022.

The link for the full text of the paper when published will be:  

For further information or a copy of the paper please contact:

Rosalind Dewar

Media Office, Royal Society of Medicine

DL: +44 (0) 1580 764713

M: +44 (0) 7785 182732


The Journal of the Royal Society of Medicine (JRSM) is a leading voice in the UK and internationally for medicine and healthcare. Published continuously since 1809, JRSM features scholarly comment and clinical research. JRSM is editorially independent from the Royal Society of Medicine, and its editor is Dr Kamran Abbasi

JRSM is a journal of the Royal Society of Medicine and it is published by SAGE Publishing.

Sara Miller McCune founded SAGE Publishing in 1965 to support the dissemination of usable knowledge and educate a global community. SAGE is a leading international provider of innovative, high-quality content publishing more than 1000 journals and over 800 new books each year, spanning a wide range of subject areas. A growing selection of library products includes archives, data, case studies and video. SAGE remains majority owned by our founder and after her lifetime will become owned by a charitable trust that secures the company’s continued independence. Principal offices are located in Los Angeles, London, New Delhi, Singapore, Washington DC and Melbourne. 

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