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Interventions that consider climate change, sustainability, and nature should be integral to health system functioning. Placing sustainability at the core of the NHS’s future offers opportunities to deliver better services, support healthier populations, and save costs.

The combined threats of climate change and biodiversity loss are a global public health emergency requiring urgent attention.12 The health impacts of these crises are far reaching, spanning the direct effects of changing weather patterns, such as heat waves causing cardiovascular events or severe dehydration; damage to health infrastructure through extreme weather events; system disruptions to the upstream determinants of health, such as reduced crop viability affecting nutritional status; and the direct health effects of fossil fuel combustion, such as respiratory diseases from air pollution.3 The NHS contributes about 5% of UK fossil fuel emissions and generates substantial waste,4 which feeds into a cycle where health systems experience the impacts of climate risks while simultaneously contributing to the processes that drive them.

Sustainability must be at the heart of the NHS as we look to the future, both to improve the health system today and to make it resilient to future shocks. As an anchor institution that touches the lives of every person in the UK, the NHS must be a powerful advocate and driver for the societal changes needed to respond to the climate and biodiversity crises. The interventions required are mitigation—reducing contributions to global warming by reducing greenhouse gas emissions and other waste; and adaptation—adjusting to current or expected climate change and its effects, with the aim of minimising harm and exploiting beneficial opportunities. Beyond reducing carbon emissions, sustainable healthcare must also consider the sector’s consumption and waste practices, alongside a shift in values related to the human-nature association that reduces inequalities and promotes health and wellbeing for …

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