Countries around the world are falling short of their international commitments to improve the sustainability of their healthcare systems, according to a new study co-led by Yale's Jodi Sherman.

The shortfalls range from a failure to assess and monitor greenhouse gas emissions effectively to a lack of planning to make healthcare systems, procedures, and oversight more robust and sustainable. These deficiencies severely hamper the likelihood of achieving significant sustainability gains in what is one of the more carbon-intensive sectors, authors of the study say.

"The healthcare sector is responsible for nearly 5% of global greenhouse gas emissions, and results in 4 million Disability Adjusted Life Years [a measure of years lost due to ill health, disability, or early death] lost annually," said Jodi Sherman, an associate professor of anesthesiology at Yale School of Medicine and of epidemiology in environmental health sciences at Yale School of Public Health, and co-senior author the new study.

"At the same time, people need more healthcare to treat climate and pollution-related diseases, and health systems must increase their resilience to severe weather-related events," Sherman said.

The study is published in The Lancet Planetary Health.

For the study, an international team of researchers analyzed the progress, or lack of progress, made by the more than 80 countries that agreed to key initiatives of the COP26 Health Program—which emerged from the 26th United Nations Climate Change Conference (COP26) in 2021, in Glasgow. The COP26 Health Program promoted a tiered system of national commitments for achieving climate-resilient, low-carbon health systems.

But according to the study, only 30% of the countries making commitments reported having conducted essential vulnerability and adaptation assessments of their healthcare systems.

Although 85 countries and areas agreed to commit to adopting low-emission or net-zero healthcare systems, those nations account for only 26% of global healthcare emissions. Further, just 11% of those countries even assessed their healthcare emissions. The study also notes that less than half of the countries have integrated healthcare into their national climate strategies.

The study identifies critical gaps in monitoring sustainable healthcare progress through existing or proposed World Health Organization indicators. The authors said such indicators do not adequately reflect progress in sustainability and, in fact, raise concerns about "greenwashing"—the notion of reporting data that gives a false sense of sustainability progress without achieving meaningful results.

"The lack of independent monitoring and the absence of robust, outcome-oriented indicators for sustainable healthcare is deeply concerning," said Iris Martine Blom, the study's first author and a physician and Ph.D. candidate at the London School of Hygiene & Tropical Medicine.

"Without meaningful tracking, we risk giving the illusion of progress while the real work of transforming our health systems remains unfinished," she said.

The study's authors say countries must develop and integrate more robust outcome indicators for healthcare systems. Such monitoring, they said, is essential to ensure that international commitments result in real-world progress.