Table of Contents  

Awofeso: Integrating the hospital sector into the UAE’s Green Economy Strategy

Introduction

The June 2015 update of the November 2009 Lancet publication on the health effects of climate change highlighted the complex relationships between climate change, emerging infectious diseases, extreme weather events, food insecurity and economic losses, all of which adversely impact local and global public health. The Lancet Commission on Health and Climate Change proposes policy responses to address the threat posed by anthropometric gas emissions and to facilitate the highest attainable standards of health globally, particularly for vulnerable populations already impacted by the double burden of communicable and non-communicable diseases and who contribute very little to greenhouse gas emissions. One of the proposals is for health professionals and the health sector to lead from the front in efforts to address climate change.1,2

The World Health Organization (WHO) has been playing a coordinating role in putting climate change atop the global health agenda priorities. For example, World Health Day 2008 sought to enhance public participation in the global campaign to protect human health from deleterious effects of climate change, and establish links between climate change and health and other development areas, such as waste management, buildings and construction, environment, food, energy and transport.3 Furthermore, subsequent to the 2013 Fifth Assessment Report of the Intergovernmental Panel on Climate Change, which documented more frequent heatwaves, hot days and hot nights over the past half-century,4 the WHO and the World Meteorological Organization published guidance on warning systems development for heatwaves.5

Over the past several years, initiatives for ‘greening’ the health sector have been proposed and pilot-tested by health policy and activist stakeholders keen on ensuring that the health care industry plays its role in addressing the threat of climate change. The discussion paper entitled Healthy Hospitals, Healthy People, Healthy Planet – Addressing Climate Change in Health Care Settings, co-authored by the WHO and the Health Care Without Harm, posits that the health sector can play important roles in mitigating climate change by analysing and addressing the health sector’s climate footprint in seven domains: energy efficiency, green building design, alternative energy generation, transportation, food, waste and water.6

Following the UN Conference on Sustainable Development (Rio+20) in 2012, which recognized the green economy as an important pathway for sustainable development, many nations are currently transitioning towards green economy settings as part of efforts to reduce poverty and growing inequity, enhance environmental sustainability and improve living standards through better health and decent jobs. A green economy may be defined as ‘an economy that results in improved human well-being and social equity, while significantly reducing environmental risks and ecological scarcities.’7 A green economy has three core characteristics: low-carbon, resource efficient and socially inclusive. These characteristics are exemplified by cities, emirates and nations investing in renewable energy (e.g. solar, wind, geothermal); green building and energy efficiency technology; energy-efficient infrastructure and transportation; and recycling and waste-to-energy. Green economies are expected to maintain, enhance and, where necessary, rebuild natural capital as a critical economic asset and source of public benefits.8 Variations understandably exist in the green economy priorities of different nations. The South African Green Economy Model, for example, focuses on preservation of natural resources, efficient agricultural practices, low-carbon transportation services and energy efficiency, as well as energy diversification mix.9 Launched in June 2014, the International Chamber of Commerce Qatar Green Economy Roadmap seeks to introduce internationally benchmarked policies to address social, environmental and economic innovation; collaboration between all sectors; integrated governance; balancing short- and long-term strategies and multilateralism, in order to transform the nation’s predominantly carbon economy into a sustainable economy for the future. Similar initiatives are being undertaken by other member nations of the Gulf Cooperation Council, focusing on agricultural, energy, transport, buildings and water resources sectors.10

Surprisingly, no country has so far prioritized the health sector as part of its green economy initiative despite the health sector accounting for USD 5.3 trillion of the global economy in 2007, and 10% of global gross domestic product (GDP) being spent on health in 2013.11 The health sector, broadly defined, includes hospital facilities and staff, health insurance providers, pharmaceutical and biotechnology companies, diagnostics and device manufacturing companies, non-governmental health-related organizations and health technology and information companies. According to the 2001 report of the Commission on Macroeconomics and Health, increased resources for health and a pro-poor focus could have saved 8 million lives a year by 2010 at a cost of USD 27 billion a year, and the resulting increased productivity would have yielded USD 186 billion a year.12 Subsequent global health-related initiatives, such as the Millennium and Sustainable Development Goals, have facilitated mortality and morbidity reductions, which currently account for 11% of recent economic growth in low and middle-income countries.13 The health sector creates economic opportunities not only through increased productivity, but also through job creation,14 as well as improved local and export earnings involving operating environment that incentivize local entrepreneurs, transnational hospital chains and other key players to invest in the national health sector. Globally, the health sector has created new jobs faster than any other sector over the past decade, especially for women. The health workforce in Europe and the USA currently accounts for, on average, 10% of the total workforce. Inadequate quantity, quality and distribution of health workers derail economic growth. For example, the World Bank estimated a 24% contraction of gross domestic product in Sierra Leone in 2015 as a result of the ebola epidemic, which laid bare the country’s grossly inadequate health workforce capacity.15

The health sector is both a threat to and an opportunity for productive green economies. A sustainable health care system is achieved by delivering high-quality care and improved public health without exhausting natural resources or causing severe ecological damage. In the USA, a study on carbon emissions from activities related to hospital care, scientific research and the production and distribution of pharmaceutical drugs estimated that the health care sector produces 8% of the country’s total carbon dioxide output.16 In the UK, it is estimated that the National Health Service (NHS) generates 18% of all emissions deriving from the UK non-domestic building stock, at a metered energy cost of GBP 600 million in 2011.17 Ironically, increased carbon emissions from the health sector may contribute to the morbidity and mortality that the sector seeks to address. Direct impacts of climate change from extreme weather conditions may result in heat stroke, exacerbation of cardiorespiratory disease and premature mortality. Indirect impacts of climate change include the potential for increases in the prevalence of food- and water-borne diseases.18 Hospitals, more than any other facet of the health sector, pose a significant threat to efforts to reduce carbon emissions: a major contributor to climate change. In developed nations, electricity already accounts for over 50% of a typical hospital’s energy costs, and with the increased use of energy-intensive specialist medical equipment, such as magnetic resonance imaging, consumption is set to increase. Although the Intergovernmental Panel on Climate Change did not focus on hospitals and health sector facilities in its climate change mitigation strategies,19 adoption of low-carbon measures in health sector settings will significantly benefit national economies, reduce greenhouse gas emissions and improve health outcomes.

The UAE’s Green Economy Strategy

Dubai hosted the inaugural World Green Economy Summit in April 2014, and the UAE leads 64 other nations so far committed to developing green economic models. It is increasingly recognized that a ‘triple win’ approach, in which social inclusiveness, economic growth and environmental preservation are addressed simultaneously, is required to override the anachronistic approach of trading off economic growth for environmental damage and social strife. It is now generally agreed that green economies have substantial potential to become a new engine of growth, a net generator of decent jobs and a vital strategy to eliminate persistent poverty. A modelling study in the UAE indicated that with 1–1.9% of GDP invested in the green economy annually until 2030, GDP would rise by a further 4.0–5.5% and trade will increase by at least a further AED 24 billion.20 The vision statements of Dubai’s green economy initiative are (1) enhancing public and private investments to catalyse green solutions to continuing economic growth, resilience and transformation of development pathways; (2) enabling south–south cooperation as a foundation for green growth; (3) applying sound social and environmental principles in economic investment decisions. Some of the objectives of Dubai’s green economy initiatives include reducing energy consumption by 30% and increasing the share of solar energy in total energy consumption to 75% by 2050. Dubai’s green economy initiative also entails promoting green jobs, which are those that contribute to preserving or restoring the environment, whether in traditional sectors, such as manufacturing, or in new sectors, such as renewable energy. This initiative demands integration among core stakeholders – education providers, technology designers, government, finance institutions and employees – to achieve renewable energy, sustainable transport, waste management and green buildings.

The nine sectors prioritized for Dubai’s green economy initiative are oil and gas; water and electricity; industry; buildings, construction and real estate; transport and logistics; waste management; land use and agriculture; financial services; and tourism and hospitality. In the oil and gas sector, substantial reduction of flaring of natural gas and utilization of emitted carbon dioxide in crude oil recovery are the main goals. In the water and electricity sector, the main goals are renewable energy projects, such as the 100-MW concentrated solar power plant in the western region of Abu Dhabi, UAE, and wind turbines designed to diversify energy sources. Mandatory efficiency rating of domestic electrical appliances and introduction of the UAE Lighting Standard in 2013 facilitate energy efficiency. In the industrial sector, Dubai introduced a waste-heat-based absorption chiller, which can reduce the amount of electricity required for cooling by 60%. EnPark is a free zone business park in Dubai, which was established to accelerate the growth of alternative energy and environment businesses. Masdar City, Abu Dhabi, aims to obtain 100% of its energy from renewable sources, including photovoltaics, concentrating solar power, wind and waste to energy. The city is designed to reduce the need for artificial lighting and air conditioning. The UAE is a leader in adopting district cooling systems, which consume 50% less electricity, as the preferred alternative to conventional air conditioning. Several comparable versions of green building codes, such as Abu Dhabi’s Estidama Pearl Rating System, are currently being implemented mandatorily in the UAE. In the first half of 2015, 88 million rides were recorded on the Dubai metro, and 1.8 million on Dubai trams. A similar low-carbon mass-transit system is being developed in Abu Dhabi. In the waste management sector, the UAE actively promotes biodegradable plastic and other long-lasting, reusable bags. The use of non-biodegradable bags was banned in the UAE in 2013. A project for extracting biogas from Dubai’s Al Qusais landfill site was launched in 2013 and registered under the United Nations Clean Development Mechanism. A USD 850 million 100-MW mass burn waste-to-energy facility in Mussafah, Abu Dhabi, is scheduled for completion in 2017. In the land use and agricultural sector, 87 commercial farms in the UAE currently use hydroponic farming technology, which requires up to 70% less water than standard farming, while also allowing a longer growing season and avoiding chemical fertilizer use. A comprehensive organic food certification system is in operation. The UAE has established energy service companies to provide competitive loans to upgrade the energy efficiency of new and existing buildings. These companies arrange initial financing of energy-efficient equipment, subject to a guaranteed level of energy saving. In the hotels and hospitality sector, the Emirates Green Building Council has certified about 30 green hotels. Environmental preservation and infrastructural development of ecotourist sites, such as Sir Bani Yas and the Mangrove Natural Reserve of Kalba, has enhanced species diversity and boosted tourism numbers to these sites.

The framework of the UAE Green Economy Strategy is structured into four parts comprising a total of 30 indicators: inputs, efficiency, outputs and policies. The inputs component has 10 indicators, and includes both natural asset base, such as land, marine, and mineral resources, and socioeconomic conditions, such as business environment, innovation and workforce skillset and productivity. The efficiency component is focused on sustainable production and consumption and has 10 measurable indicators: ecological footprint; greenhouse gas intensity; energy intensity; clean energy deployment; material intensity; water intensity; waste intensity; land use sustainability; marine resource use sustainability; and consumer attitude and behaviour. The policy section focuses on five areas: environmental expenditure; environmental regulations; fossil fuel subsidies; nature conservation; and environmental standards. The headline objective of the outputs section is well-being, a concept that is people focused and includes the presence of positive emotions and moods (e.g. contentment, happiness), the absence of negative emotions (e.g. depression, anxiety), satisfaction with life, fulfilment and positive functioning.20 High levels of well-being allow people to be better able to respond to difficult circumstances, to innovate and to constructively engage with other people and the world. Well-being indicator systems are often condensed into four broad domains: the economy, the environment, governance and society.21 The five well-being-related output indicators of Dubai’s Green Economy Strategy are non-oil economic contributions, standard of living, human development, quality of life and environmental health.

The UAE has made significant progress towards the attainment of a green economy. The outputs indicate several facts.

  1. Revenue from non-oil sectors increased from 57% of the total GDP in 2001 to 67% in 2013, while the share of non-oil export in total export rose from 17.5% in 2001 to 28.5% in 2013.

  2. The UAE’s gross national income (in purchasing power parity international dollars) in 2012 was USD 59 890, the 11th highest in the world. The UAE Human Development Index (HDI) value for 2013 is 0.827, which is in the very high human development category, putting the country in position 40 out of 187 countries and territories. The UAE’s HDI has been increasing by 0.78% annually over the past two decades.

  3. The UAE, with a score of 6.9/8, was ranked 20th, the highest in the Arab world, in the World Happiness Report 2015, showing the positive trend in both perceived happiness and quality of life for inhabitants.22

  4. The UAE’s Environmental Performance Index ranking improved dramatically from 152 out of 163 countries benchmarked in 2010 (score: 40.7) to 77 in 2012 (score: 50.91) and 25 out of 178 countries in 2014 (score: 72.91), the best in the Middle East and North Africa region. The UAE’s ranking has since declined to 92 out of 178 countries, with a score of 69.35.23

Hospitals and the UAE’s Green Economy Strategy

Although the UAE Green Economy Report, 2015 reported on various sectors, from airports to mega-events, there was no mention of greening the hospital sector.24,25 It is noteworthy that WHO’s Framework for Action on Health and the Environment 2014–201926 has a strategic indicator on greening the health sector, and aims to raise the number of countries in this region with national programmes for greening the health sector from zero to three. The UAE, a member of the WHO Eastern Mediterranean Region, is well positioned to lead the achievement of this strategic objective. Since the Oasis Hospital was established in Al Ain in 1964, the UAE hospital sector has grown significantly in tandem with the expansion of the health care sector and the Vision 2021 objective of establishing a world class health care system.27 As of 2015, the UAE has 108 hospitals throughout the seven emirates and the WHO reports that there are currently 19.3 physicians and 40.9 nurses and midwives per 10 000 persons in the UAE. The majority of UAE’s hospitals are located in Abu Dhabi (42), followed by Dubai (39) and Sharjah (16). In Dubai and Abu Dhabi, there are health care cities with a high concentration of hospitals that, in addition to treating residents, are crucial in the achievement of the UAE’s strategy to attract over 500 000 medical tourists by 2020. Dubai Healthcare City has 4000 clinical health care workers of all cadres working in 120 modern hospitals and medical facilities.

Hospital-based provision of health care services is an energy-intensive activity. The health sector is also a major consumer of water, medications and food, as well as a major producer of human and hazardous waste. For example, the 18 million tonnes of carbon dioxide emitted annually by the NHS in England is more than the total emissions from all aircraft departing Heathrow Airport. British hospitals contribute about 17% of total carbon emissions in the public sector.28 Substantial economic benefits accrue from implementing energy conservation measures and alternative energy initiatives in the health sector. There is currently no published study on the carbon footprint of UAE hospitals, but anecdotal evidence indicates that it is substantial and rising.

Most energy conservation initiatives in existing hospitals can be achieved at low cost. For example, hospitals in Brazil have been able to halve electricity consumption by retrofitting air-conditioning systems and replacing fluorescent lamps with more energy-efficient versions, thus making substantial savings, which can be invested in improving health care provision.29 The reduction of the carbon footprint in the hospital and other health sectors benefits well-being, as fossil fuel consumption associated with energy use produces not only carbon emissions, but also particulate matter, which increases the environmental burden of disease. Such hazardous emission products are more intense in hospitals in developing nations, which rely mainly on diesel-powered generators for energy.30 Hospitals’ commendable contributions to UAE wellness goals in the Green Economy Strategy are being impeded by unregulated carbon emissions. The health sector is yet to ‘lead from the front’ in efforts to mitigate climate change and to contribute proactively to green economy initiatives. It is important for health care quality indicators, such as the Legatum Prosperity Index™ (Legatum, Dubai, UAE) referred to in the UAE Vision 2021 strategy, to include hospital-based environmental sustainability measures.31

A major initiative to improve energy efficiency in hospital settings is the WHO’s seven elements of a climate-friendly hospital:6

  1. Energy efficiency: reduce energy consumption and the costs of hospitals through efficiency and conservation measures.

  2. Green building design: build hospitals that are responsive to local climate conditions and optimized for reduced energy and resource demands.

  3. Alternative energy generation: produce and/or consume clean, renewable energy onsite to ensure reliable and resilient operation.

  4. Transportation: use alternative fuels for hospital vehicle fleets; encourage walking and cycling to the facility; promote staff, patient and community use of public transport; site health care buildings to minimize the need for staff and patient transportation.

  5. Food: provide sustainably grown local food for staff and patients.

  6. Waste: reduce, reuse, recycle, compost; employ alternatives to waste incineration.

  7. Water: conserve water; avoid bottled water when safe alternatives exist.

The Global Green and Healthy Hospitals Network is composed of over 520 hospitals from six continents that are committed to reducing their ecological footprint and promoting environmental health. Founding members of the network include the Sustainability Unit of NHS England, Thailand’s Department of Health, the Healthier Hospitals Initiative in the USA, the Indonesia Hospital Association, the Australian Healthcare and Hospitals Association, the International Health Promoting Hospitals Network and dozens of individual hospitals from Australia, Brazil, China, Chile, Colombia, France, India and Nepal. Hospitals in the UAE are not yet part of this network, which recently developed a comprehensive environmental agenda for hospitals and health systems. The agenda document described a green and healthy hospital as follows:32

A green and healthy hospital is one that promotes public health by continuously reducing its environmental impact and ultimately eliminating its contribution to the burden of disease…by actively engaging in efforts to foster community environmental health, health equity and a green economy.

The author proposes a nationally coordinated approach towards green and healthy hospitals in the UAE, starting with the integration of the hospital sector into the UAE’s Green Economy Strategy. The aspects detailed in the section that follow need to be addressed by UAE hospitals as part of the green economy initiative.

Leadership

In hospital settings, the three core groups of leaders are the hospital governing board, senior administrators and licensed health care professionals who head clinical units. Adopting a green and healthy hospital initiative will facilitate the core goal of hospitals – providing safe, high-quality patient care – provided it is made a core organizational priority. Fostering action research on hospital energy conservation, promoting, developing and implementing green hospital construction, operations and maintenance policies will facilitate the goals of Dubai’s green energy initiative. Hospital leadership and stakeholders should identify ways through which sustainability practices can be incorporated into accreditation standards, such as those being conducted by the Joint Commission international.33

Chemicals

The health care sector of most developed nations is the single biggest user of chemicals, including those proven to have adverse effects on human health and environment. For example, mercury is a toxic substance once commonly found in hospital thermometers, blood pressure devices, laboratory chemicals, dental amalgam and cleaners, which green hospitals are actively eliminating the use of. For some hospitals in developing countries, mercury discharge remains higher than the limit set by the US Environmental Protection Agency (US EPA) (0.002 mg/l).34 Excessive use of chemicals, or use of unsafe chemicals, poses a threat to the occupational health and safety of health workers and the general public. It is important to implement comprehensive practices to minimize exposure to harmful cleaning and disinfection without reducing the effectiveness of infection prevention.35 Green hospitals should strive towards appropriate use of safer chemicals, materials, products and processes, going beyond the requirements of environmental compliance, without sacrificing quality of patient care. Hospitals in the UAE should consistently implement policies that require disclosure of chemical ingredients in products and materials and seek to ensure that all ingredients have undergone at least basic toxicity testing.36

Waste

Green hospitals seek to reduce the volume and toxicity of waste produced in the course of patient care, while implementing the most environmentally sound waste management and disposal options. Green hospitals develop comprehensive policies for waste management, including hospital wastewater, which may contain toxic chemicals and pathogens, at much higher levels than domestic wastewater and sewage. Proper sorting and reduction of hospital waste helps to reduce environmental hazards and reduced disposal costs – biohazardous waste is at least 10 times more expensive to dispose of than domestic waste. Hazardous waste includes plastic, which should be recycled or landfilled after disinfection instead of incinerated, since incinerating plastic produces high quantities of greenhouse gases and toxic pollutants, such as dioxins. In the USA, hospitals have significantly reduced reliance on medical waste incineration, which the US EPA identified as the largest source of dioxin contamination in the atmosphere in 1996. Since that time, the number of medical waste incinerators in North America has fallen from about 5000 to fewer than 100.37 Hospitals vary significantly in waste generation, but, on average, each bed-day generates 0.5 kg of clinical waste and 3.5 kg of general waste.38 With Dubai’s strategy to attract 500 000 medical tourists every year, waste management in hospitals is particularly important in implementing an inclusive green economy strategy.

Energy

Green hospitals seek to reduce fossil fuel energy use – which constitutes about 85% of total energy sources – as a means to improve and protect public health. Such hospitals adopt energy efficiency measures, as well as alternative, renewable energy use. Energy-efficient hospitals in northern Europe consume about 35% of the energy that North American hospitals average (320 kWh/m2 compared with 820 kWh/m2), while delivering comparable health care services. By adopting sustainable practices, most hospitals can cut energy consumption by at least 25% without adversely affecting patient care or interfering with staff comfort.39 There is a need for systematic measuring and benchmarking of hospital energy consumption and associated greenhouse gas emissions in the UAE. In the USA, the health sector spends USD 6.5 billion on energy annually, while 10.6% of total energy consumption in Brazil is by the health sector. These high operating costs may be reduced through practical measures, such as retrofitting and energy-efficient lighting.40,41

Water

Green hospitals implement a series of conservation, recycling and treatment measures to reduce hospital water consumption and wastewater pollution. A policy framework that aspires to water conservation within a hospital system will entail coordinated programmes, such as the Greening Our Hospitals’ Water programme in Victoria, Australian, which aimed to reduce potable water use by supporting innovative water saving and reuse projects in health services across the state. The programme supported innovative projects, such as dialysis water reuse, ozone-treated water for laundry use and the reuse of laundry grey water. These efforts resulted in a 12% reduction in potable water use in the participating hospitals over the review period.42

Transportation

Green hospitals seek to develop transportation and service delivery strategies that reduce their climate footprint and contribution to local pollution. The health sector’s fleets of ambulances, hospital vehicles, delivery vehicles and staff and patient travel exemplify a transportation-intensive industry. An ecological footprint study carried out by the UK NHS showed that 5% of all vehicle trips in England are related to NHS transport, which is responsible for 18% of the NHS carbon footprint.43 Reducing private or official car usage in favour of sustainable forms of transport improves the health of both humans and the environment. Decentralization of hospital services will assist in reducing transport-related costs as hospital locations become closer to the residence of patients and staff. E-health strategies, such as telehealth, will also help to reduce hospitals’ carbon footprint.44 UAE hospitals should optimize the energy efficiency of hospital fleet vehicles by using hybrid, electric or appropriate biofuel technologies.

Food

Green hospitals reduce their environmental footprint while fostering healthy eating habits in patients and staff by making changes in hospital service menus and practices. These include limiting the amount of red meat in hospital meals, cutting out junk and fast food and composting food waste. Organically produced food supports ecologically protective and restorative agriculture.45 UAE hospitals should be model centres that promote optimal nutrition and healthy food for patients and staff.

Pharmaceuticals

Green hospitals reduce pollution from pharmaceuticals by avoiding over-prescription practices, minimizing inappropriate pharmaceutical waste disposal and promoting manufacturer take-back of expired drugs. Ranking pharmaceuticals by their environmental impact may enable physicians to prescribe medicines that have low potential to damage the environment where a choice of drugs for a given condition is available. The pharmaceutical supply chain is one within which medications are produced, transported and consumed. An important aspect of environmental damage from pharmaceuticals is unethical disposal of unused pharmaceutical products in domestic rubbish or wastewater. Hospitals have an important role to play in this regard by restricting, to a feasible extent, the number of medications patients are allowed to self-administer, as well monitoring medication usage in patients’ homes, especially among the elderly, who use multiple medications simultaneously.46

Buildings

Green buildings make hospitals healthier places to work and visit by incorporating green building principles and practices into the design and construction of health facilities. While it is well established that good hospital buildings and physical environments influence patient and staff outcomes by reducing staff stress and fatigue and thereby increasing effectiveness in delivering care, improving patient safety, reducing stress and improving outcomes and overall health care quality,47 the important contributions of green hospital buildings to environmental sustainability and optimal health of patients and staff are less well appreciated. Green building principles take into considerations siting and land use, water and energy consumption, building materials sourcing practices and indoor environmental quality. Abu Dhabi’s Estidama, and other green building tools, should be more stringently applied to hospital construction such that new private and public hospitals should be mandated to strive towards a three-star rating and all existing hospitals should be mandated to upgrade to at least a two-star rating over a 3-year period.

Purchasing

Green hospitals create and implement environmentally friendly and ethical purchasing policies and source sustainably produced supply chain materials from socially responsible vendors. In a 2009 report, NHS England calculated that purchasing-related activities accounted for 60% of NHS England’s carbon footprint of 18 million tonnes of carbon dioxide per year.48 While procurement is entwined with most of the other facets discussed above, it merits separate discussion, as efforts aimed at minimizing wastage at the buying stage and working in partnership with suppliers to lower the carbon impact of all aspects of procurement will have a significant impact on reducing hospitals’ carbon footprint.49

Conclusion

The ultimate output of the UAE’s Green Economy Strategy is to improve well-being, a concept that is more closely linked with health than any other sector. The health sector’s contribution to the UAE economy is growing. With increased public and private investments in hospitals, the carbon footprint is rising, which can be feasibly addressed using best-practice approaches already being implemented in other sectors in the UAE, as well as internationally. The health sector is well-positioned to lead by example in advancing UAE’s green economy initiative and in reducing the carbon footprint. Incorporation of the health sector into the UAE’s Green Economy Strategy is overdue.

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