Source: Tennison, I., et al, February 2021: Health care’s response to climate change: a carbon footprint assessment of the NHS in England, The Lancet1. Data rounded to nearest full percentage point, so numbers may not add up to the totals above.

The chart shows the contributors to carbon emissions in percentage terms by end use, for the National Health Service in England for 2019.

Category of end usePercentage of total emissions
Pharmaceuticals and chemicals21%
Non-medical procurements14%
Business services11%
Food and catering6%
Building energy10%
Water and waste5%
Anesthesia and inhalers5%
Fleet and business travel4%
Patient and visitor travel6%
Staff commute4%

In saving and improving lives, the resource-intensive healthcare industry contributes to major environmental challenges ranging from greenhouse gas emissions to hazardous waste. Innovative solutions exist to reduce this footprint, however.

Healthcare generates around 4% of global CO2 emissions, and a higher proportion in wealthier economies.2 The industry also relies on water-intensive processes and consumption has continued to rise.3

Hospitals meanwhile generate vast quantities of physical waste: US hospitals generate an average of 13kg of waste per bed each day.4 This is largely a function of ubiquitous single-use, disposable items like syringes and personal protective equipment.

Hospital waste volumes may fall from their pandemic peaks. Irrespective, the combination of new medicines, tightening regulations and cost pressures facing hospitals support demand for solutions that can reduce the environmental impact of the healthcare sector. We see opportunities in three niche areas.

First, drug transport (pharmaceuticals and chemicals). Cell and gene therapies demand precise, temperature-controlled transportation that protects the integrity of high-value products. Cold chain logistics providers like Cryoport partner with the life sciences industry, supporting active cell and gene therapy clinical trials and transporting approved products.5 Bespoke reusable containers replace polystyrene foam, substituting single-use materials and reducing associated emissions.6

Second, medical instruments. In-house sterilisation processes have become more efficient, with the potential to reduce use of single-use plastic equipment and water. Sterilisers and washers, when combined with a basic management system, can reduce water usage by 35%. Advanced models can offer up to a 99% reduction by recirculating used water.7

Third, non-hazardous waste. Specialist companies work in partnership with hospitals to securely capture non-hazardous medical waste – through drop boxes and bins in operating and rooms, doctors’ offices and laboratories – and then responsibly manage it. In 2022, US company Stericycle diverted nearly 46,000 tonnes of plastic from landfills with reusable containers for sharps and pharmaceutical waste.8

Circular solutions can deliver significant cost reductions for the healthcare sector. For example, a three-year study showed that transitioning from disposable to reusable bins (robotically sanitised offsite) cut one hospital’s waste volume by over 65%. The hospital also saved over 30% on waste disposal costs and nearly 70% on associated labour.9

By reducing costs for hospitals across the supply chain, and helping the healthcare sector do less environmental harm, innovative companies can contribute to the transition to a more inclusive and sustainable economy.

References to specific securities are for illustrative purposes only and should not be considered as a recommendation to buy or sell. Nothing presented herein is intended to constitute investment advice and no investment decision should be made solely based on this information. Nothing presented should be construed as a recommendation to purchase or sell a particular type of security or follow any investment technique or strategy. Information presented herein reflects Impax Asset Management’s views at a particular time. Such views are subject to change at any point and Impax Asset Management shall not be obligated to provide any notice. Any forward-looking statements or forecasts are based on assumptions and actual results are expected to vary. While Impax Asset Management has used reasonable efforts to obtain information from reliable sources, we make no representations or warranties as to the accuracy, reliability or completeness of third-party information presented herein. No guarantee of investment performance is being provided and no inference to the contrary should be made.

1 Tennison, I., Roschnik, S. et al, February 2021: Health care’s response to climate change: a carbon footprint assessment of the NHS in England.

2 IEA, 2022: Here’s how healthcare can reduce its carbon footprint

3 Lenzen, M., et al, July 2020: The environmental footprint of health care: a global assessment. The Lancet Planet Health
-Practice Greenhealth, 2023: WASTE – Understand hospital waste streams, how to measure them, and how to reduce waste at your facility
-Singh, N., Ogunseitan, O. et al, 2022: Medical waste: Current challenges and future opportunities for sustainable management, Critical Reviews in Environmental Science and Technology

4 Practice Greenhealth, ibid

5 Cryoport, January 2022

6 The manufacture of 1kg of Styrofoam, a brand of polystyrene foam-based packaging material widely used for transporting live specimens, creates 1.16 kg of carbon emissions – Source: Teorra, January 2023: What is the carbon footprint of packaging?

7 Steris, 2023

8 Stericycle, 2023 Pharmaceutical Waste Disposal for Healthcare Facilities (

9 Daniels Health, 2023 Waste Optimization | Daniels Health

Joseph Cordi, CFA®

Senior Research Analyst

Joseph is a senior member of our research team and covers the healthcare sector.

Before joining Impax in 2022, Joseph worked in a similar role for Citi Investment Management where he covered the healthcare, consumer staples, and financials sectors. He also supported the firm’s core, dividend, and thematic strategies.

Joseph has a master’s degree in biotechnology from Johns Hopkins University and a bachelor’s degree from George Washington University, where he graduated magna cum laude. He is a CFA® charterholder and holds the FINRA Series 7 and 66 registrations. Joseph is a registered representative of Foreside Financial Services, LLC.

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