NHS Scotland climate emergency and sustainability strategy: 2022-2026

This document sets out plans for NHS Scotland to reduce its greenhouse gas emissions and impact on the environment, adapt to climate change and to better contribute to the United Nation sustainable development goals. It has been developed by the Scottish Government and NHS Scotland Assure.


1. A Policy for NHS Scotland on the Climate Emergency and Sustainable Development, DL (2021) 38

2. Professor Joanna Haigh CBE FRS E FRS, Co-chair of the Royal Society and The Academy of Medical Sciences Report: A healthy future – tackling climate change mitigation and human health together, 2021

3. Hoesung Lee, Chair of the Intergovernmental Panel on Climate Change (IPCC)

4. NHS Chief Executives minutes: June 2019 - gov.scot (www.gov.scot)

5. The Council of Economic Advisers (2014). The Cost of Delaying Action to Stem Climate Change

6. Managing the Health Effects of Climate Change, VOLUME 373, ISSUE 9676, P1693-1733, MAY 16, 2009

7. Health and climate change: policy responses to protect public health, The Lancet, Vol. 386, No. 10006

8. National Just Transition Planning Framework - Just Transition - A Fairer, Greener Scotland: Scottish Government response - gov.scot (www.gov.scot)

9. As discussed by the Royal Society 2021 Report – A Healthy Future tackling climate change mitigation and human health together, "efforts made by UK healthcare systems to reach net-zero emissions, could stand as a useful case study for wider sectors, as an exemplar of working towards net-zero within a complex system".

10. Green Book supplementary guidance: valuation of energy use and greenhouse gas emissions for appraisal, Table 1: Electricity emissions factors to 2100, kgCO2e/kWh

11. Figure 2 – Greener NHS – Delivering a Net Zero Health Service

12. Section B. Results – Net Sources of Scottish Greenhouse Gas Emissions - Scottish Greenhouse Gas statistics: 1990-2019 - gov.scot (www.gov.scot)

13. A route map to achieve a 20 per cent reduction in car kilometres by 2030 (transport.gov.scot)

14. Sir Robert Watson, then Chair of the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services, 2019

15. Intergovernmental Panel on Climate Change, Climate Change 2021: The Physical Science Base: Summary for Policymakers, section D.1

16. Jim Skea. IPCC Working Group III Co-Chair

17. Call for Emergency Action to Limit Global Temperature Increases, Restore Biodiversity, and Protect Health

18. Climate Change Committee Independent Assessment of UK Climate Risk

19. Climate Change Committee Independent Assessment of UK Climate Risk

20. S Kümmerer, 2009: The presence of pharmaceuticals in the environment due to human use: present knowledge and future challenges. J. Environ. Manage. , 8:2354–2358 European Environmental Agency, Pharmaceuticals in the environment, 2010

21. Oceanic And Human Health | NHS Ocean (healthcareocean.org)

22. Scottish land rights and responsibilities statement - gov.scot (www.gov.scot)

23. Land use - getting the best from our land: strategy 2021 to 2026 - gov.scot (www.gov.scot)

24. 5f457b3679645_LRRS Protocol on Good Stewardship of Land.pdf (landcommission.gov.scot)

25. Research from the World Health Organisation and National Institute for Health and Care Excellence shows contact with nature and access to greenspace is particularly good for our mental health and wellbeing

26. NHS Greenspace Demonstration Project - Unlocking the Potential of NHS Greenspace for Health and Wellbeing | NatureScot

27. Nature Scot Green Ways Health Case Studies

28. Larbert wins building with Nature award

29. NHS Lothian Greenspace and Health Strategic Framework | Greenspace Scotland

30. BiodiversityClimateChangeAssessmentSummary.pdf (nhslothian.scot)

31. Greenspace and Health Strategic Framework for Edinburgh & Lothians:

32. NHS Greenspace Demonstration Project - full report 2020.pdf (nature.scot)

33. World Health Organization Definition

34. Sustainable Design and Construction Guide (SDAC)

35. Cleaner Air for Scotland 2 - Towards a Better Place for Everyone Para. 23 available at: Cleaner Air for Scotland 2 - Towards a Better Place for Everyone - gov.scot (www.gov.scot)

36. Chief Medical officer's physical activity guidelines

37. Reported Road Casualties Scotland 2019

38. National Transport Strategy 2

39. Securing a green recovery on a path to net zero: climate change plan 2018–2032 – update, para 3.3.17

40. Road space reallocation in Scotland: A health impact assessment (publichealthscotland.scot)

41. Public Health Scotland. Scottish Government target for 20% reduction in car kilometres by 2030: implications for health and health inequalities.

42. Right to Request Flexible Working, DL (2021) 29

43. UK Government, Cycling_and_walking_for_individual_and_population_health_benefits

44. Electrifying last mile deliveries

45. NHS Scotland EV Infrastructure Guidance

46. Yu, D., Yin, J., Wilby, R.L. et al. Disruption of emergency response to vulnerable populations during floods. Nat Sustain 3, 728–736 (2020).

47. Developing Scotland's circular economy: consultation on proposals for legislation

48. Earth Overshoot Day

49. United Nations Environment Programme, Global Resources Outlook 2019, page 5

50. Procurement Reform (Scotland) Act 2014 s. 9

51. Sustainable Procurement Tool

52. SCENIHR (Scientific Committee on Emerging and Newly-Identified Health Risks), Scientific

Opinion on the safety of medical devices containing DEHP-plasticized PVC or other plasticizers on neonates and other groups possibly at risk. 2015.

53. Atkinson S, Ingham J, Cheshire M, Went S. Defining quality and quality improvement. Clin Med 2010;10:537–9.

54. Chief Medical Officer - annual report: 2020 to 2021

55. Statement on the climate emergency | Academy of Medical Royal Colleges and Faculties in Scotland (scottishacademy.org.uk)

56. For example see: A healthy future – tackling climate change mitigation and human health together (royalsociety.org)

57. BiodiversityClimateChangeAssessment.pdf (nhslothian.scot)

58. A Dose of Nature. Addressing chronic health conditions by using the environment. A summary of relevant research. Centre for Sustainable Healthcare

59. Centre for Sustainable Healthcare. Evidence of benefits

60. Royal College of General Practitioners. Sustainable Development, climate change and green issues. The Green Impact for Health Toolkit

61. Nature Scot – Green Health Partnerships

62. Licchetta, M, & Stelmach, M. Fiscal sustainability analytical paper: Fiscal sustainability and public spending on health. Office for Budget Responsibility, 2016

63. OECD (2017), Tackling Wasteful Spending on Health, OECD Publishing, Paris

64. Realistic Medicine – Shared decision making, reducing harm, waste and tackling unwarranted variation

65. Lavorini F, Corrigan CJ, Barnes PJ, Dekhuijzen PR, Levy ML, Pedersen S, et al. Retail sales of inhalation devices in European countries: So much for a global policy. Respir Med 2011;105(7):1099-103)

66. SIGN 158, British Guideline on the Management of Asthma (2019), page 88

67. The 2018 General Medical Services Contract in Scotland, p 39

68. COP24 Special Report Health And Climate Change COP24 Special report: Health & Climate Change (who.int)

69. Public Health Scotland Strategic Plan 2020-23

70. Community Wealth Building – Delivering a Wellbeing economy

72. Engaging communities in decisions relating to land: guidance - gov.scot (www.gov.scot)

73. Public Health Emergency – Community Resilience

74. Mapping flood disadvantage in Scotland 2015: report - gov.scot (www.gov.scot)

75. Climate Change Committee – UK Housing fit for the future

76. The NHSScotland Standards For Organisational Resilience. 2018. Section 9 Climate Change. Standard 38.

77. Scotland and the sustainable development goals: a national review to drive action - gov.scot (www.gov.scot)

78. UK Greenhouse Gas Inventory 1990 to 2019, p 295


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