Most Health Systems Track Climate Goals Wrong—This Fixes It

On a Monday morning, a hospital sustainability lead opens two dashboards. One shows patient safety metrics: infection rates, readmissions, and length of stay. The other shows climate commitments: net-zero targets, energy use, recycling rates. What’s missing is the bridge between them.

Are sustainability efforts actually improving health? Are they protecting quality—or quietly undermining it? And how can leaders tell the difference between real progress and good-looking pledges?

A new framework from The Lancet Commission on Sustainable Health Care tackles this exact problem, offering a rigorous, comparable, and grounded way to measure sustainability.

This is not another call for “doing better.” It’s a blueprint for accountability.

The Problem: Sustainability Without Measurement Is Guesswork

Health care contributes roughly 4–5% of global greenhouse gas emissions, yet most health systems still lack a consistent way to measure their environmental impact alongside health outcomes. Many countries have signed climate pledges, but few track whether those commitments translate into meaningful change on the ground. The result is a familiar public health tension:

• Sustainability teams track emissions.
• Quality teams track care outcomes.
• Policymakers track commitments.
• Almost no one tracks how these interact.

Without standardized measurement, health systems face three risks:

1. Greenwashing: reporting activity instead of impact
2. Fragmentation: disconnected metrics across departments
3. Blind spots: sustainability gains that quietly harm care quality—or vice versa

The Commission argues that sustainability is not a side project. It is a health care quality issue and should be measured with the same rigor as safety, equity, and effectiveness

The Evidence: A Framework That Connects Environment and Health

Rather than inventing something new from scratch, the Commission integrates four well-established approaches:

• The Donabedian model (structure → process → outcomes)
• Physical systems thinking (inputs, flows, waste)
• WHO’s climate-resilient health systems framework
• The CMS measure lifecycle used for quality metrics

The result is a two-domain measurement framework that captures how sustainability actually happens in health care.

The Two Domains

1. People, Policies, and Programmes: This domain focuses on governance and organizational capacity:

• Workforce training and resilience
• Leadership, financing, and regulation
• Management and accountability processes
• Care delivery outputs
• Patient and population health outcomes

2. Physical Systems: This domain tracks the material reality of health care:

• Energy, water, and material inputs
• Infrastructure and facilities
• Clinical service processes
• Emissions and waste outputs
• Environmental and downstream health impacts

Each domain follows the same causal logic: inputs → structures → processes → outputs → outcomes

This matters because it allows sustainability metrics to be benchmarked, balanced, and linked to care quality, not treated as standalone environmental checklists.

What This Means in Practice

This framework is designed to be used—not admired.

For Health Departments

• Align climate indicators with existing quality dashboards
• Use sustainability metrics as balancing measures, ensuring emissions reductions do not worsen access or outcomes
• Normalize emissions data by service volume (e.g., per bed-day or visit)

For Health Systems & Hospitals

• Move beyond facility-level certifications to system-level performance measurement
• Embed sustainability into workforce training, procurement, and clinical pathways
• Track emissions alongside patient safety and experience measures

For Policymakers & Funders

• Shift from counting pledges to funding measurable outcomes
• Require standardized reporting that links sustainability actions to health impact
• Support open, comparable data sources to reduce reporting burden

For Researchers

• Study which sustainability interventions improve both environmental and health outcomes
• Identify unintended consequences early
• Compare performance across systems, not just within them

Barriers to Watch

The authors are clear: measurement alone will not solve everything. Key constraints include:

• Data gaps, especially in low-resource settings
• Workforce capacity, where sustainability remains an add-on role
• Political pressure, especially where climate action is contested
• Short-term incentives that favor visible actions over meaningful outcomes

Without intentional investment, even the best framework can become another reporting exercise.

What’s Next

The Commission plans companion papers detailing specific indicators derived from this framework, using publicly available data and applicable at facility, system, and national levels

If adopted widely, this approach could:

• Enable real benchmarking across countries
• Reduce greenwashing
• Accelerate evidence-based climate action in health care
• Reframe sustainability as a core quality obligation, not a trade-off

Conversation Starters

• How might your organization link sustainability metrics to care quality today?
• Which indicators would reveal uncomfortable truths about current practices?
• What would it take to treat environmental impact like patient safety?

Bottom line: This framework doesn’t ask health systems to choose between caring for people and caring for the planet. It shows how to measure both—together, honestly, and at scale.