A Pathways Health White Paper · Version 1.0 · September 2025 Suggested citation: Pathways Health (2025). A Framework for Systemic Transformation: Achieving Climate-Resilient and Environmentally Sustainable Health Care Facilities. Nairobi: Pathways Health.
Climate-resilient and environmentally sustainable health care facilities are a prerequisite for quality, affordable care under Universal Health Coverage—and they can be achieved only through integrated, rather than siloed, interventions.[1,12] The global health care sector faces a dual mandate: it must protect populations from the escalating health impacts of climate change, while also reducing its own contribution to the crisis. Health care is estimated to account for between 4.4% and 5.2% of global greenhouse gas (GHG) emissions,[2,3,4] a level comparable to the annual output of hundreds of coal-fired power plants.[2] This creates a tension between the sector’s core mission to protect health and the environmental externalities of how that care is delivered.[1,12,13]
In this paper, we synthesize existing guidance and empirical evidence to propose a systemic framework for climate-resilient (CR) and environmentally sustainable (ES) health care facilities (HCFs). We treat CR and ES as interdependent objectives rather than parallel agendas. Climate-resilient facilities are able to anticipate, withstand, adapt to, and recover from climate-related shocks and stresses; environmentally sustainable facilities minimize harm across energy, water, sanitation, waste, and procurement.[1,13,14]
Our framework rests on two diagnostic pillars. First, Climate Vulnerability and Risk Assessments (CVRA) use approaches such as the Building Resilience Against Climate Effects (BRACE) framework, Geographic Information Systems (GIS), and facility-level tools (e.g., the Health Care Without Harm Element 1 Checklist) to characterize exposure, sensitivity, and adaptive capacity for health systems and the communities they serve.[18,20,21] Second, environmental footprint accounting applies the GHG Protocol (Scopes 1, 2, and especially 3) and Life Cycle Assessment (LCA) methodologies to quantify emissions and environmental impacts across the full health care value chain, including supply chains where most emissions are concentrated.[5,22,24–26]
We organize the transformation of HCFs around four foundational domains, adapted from WHO guidance:[1,17]
Across these domains, we identify interventions that simultaneously strengthen CR and advance ES (for example, solar microgrids that both decarbonize energy use and provide autonomous backup power during grid failures).[15,16] The framework is supported by an enabling environment of governance, policy alignment, and sustainable financing, including the use of methodologies like the Return on Sustainability Investment (ROSI™) to quantify the financial value of decarbonization and resilience investments.[9–11]
Conceptually, our argument links a clear problem (climate risk, emissions, and equity gaps) to a framework (four foundational domains and two diagnostic pillars: CVRA and GHG/LCA) and then to implementation pathways (governance, finance, community, and research).
The framework is intended to support policy-makers, planners, and facility managers—particularly in low- and middle-income (LMIC) settings—in designing integrated interventions, strengthening equity, and informing a future research agenda on climate–health system interactions. In practice, this logic can be operationalized by digital platforms that integrate assessment data, provide decision-support dashboards, surface supply-chain emissions and resilience risks, and link facilities to appropriate financing mechanisms for prioritized interventions.
Health care systems are designed to protect and promote health, yet they contribute significantly to the environmental degradation that drives climate change. Recent analyses estimate that the global health sector is responsible for approximately 5.2% of global carbon dioxide emissions,[4] with emissions in OECD countries averaging around 4.4% of national totals.[3] This is roughly equivalent to the annual emissions of hundreds of coal-fired power plants.[2]
This situation creates an ethical and strategic dilemma: the sector is highly vulnerable to climate-related hazards, while simultaneously contributing to their magnitude.[12,13] Decarbonizing health care should therefore be understood as a core public health intervention, not merely an environmental co-benefit. Reducing GHG emissions from health care—particularly from energy use and supply chains—constitutes a form of primary prevention, lowering exposure to climate-sensitive risk factors such as fine particulate air pollution, which contributes to cardiovascular and respiratory disease.[8]