Supporting Health in a Changing Climate

Professor Sir Gregor Smith highlights how NHS Scotland and wider global healthcare systems can demonstrate that a climate conscious approach can ultimately be a path that leads to better care, and improved health outcomes for the people of Scotland.

Climate change is one of the most significant public health challenges of our time – perhaps the most significant. Its impacts are already being felt – affecting air quality, vector borne disease, food systems, infrastructure, and the conditions in which people live and work. These pressures are not theoretical; they are shaping patterns of illness, widening inequalities, and increasing demand on health and care services.

At the same time, healthcare systems themselves contribute to carbon emissions and environmental harm. This creates a dual responsibility: to respond to the health impacts of climate change while reducing our own environmental footprint. Planetary health and human health are inextricably interlinked.

For NHS Scotland, the impacts of a changing climate are not a separate agenda – they are integral to the planning of how we deliver sustainable, high-quality care that improves health outcomes while reducing environmental impact and tackling inequalities. It is a whole-system approach that recognises both environmental sustainability and service sustainability as fundamental to the future of health and care.

Central to this is the concept is looking at how we improve outcomes for people while making the best use of our resources and protecting the environment for future generations. This requires a shift in how we think about health – from treating illness to enabling health, from focusing on activity to focusing on value, and from short-term interventions to long-term population wellbeing.

Within this wider strategic approach, Realistic Medicine plays an important role. It supports a move towards value-based care – ensuring that treatment is appropriate, evidence-based, and aligned with what matters most to patients. By reducing unwarranted variation and avoiding unnecessary interventions, it contributes directly to our sustainability ambitions. The most harmful form of healthcare impacting our planet, is care that was unnecessary or unwanted in the first place.

Medicines are a clear example of where clinical practice and sustainability intersect. Pharmaceuticals are essential to modern healthcare, but they carry a significant environmental footprint – from manufacturing and distribution, to disposal in our water systems and ecosystems. NHS Scotland’s Climate Emergency and Sustainability Strategy highlights the importance of addressing this impact as part of delivering more sustainable care.

Through shared decision-making, regular review and appropriate optimisation of medicines, clinicians and patients can ensure that treatments provide real benefit and are consistent with careful and kind care. Where appropriate, deprescribing can improve outcomes, reduce harm, and minimise waste. This not only enhances patient care but also reduces emissions and supports more sustainable supply chains.

However, the opportunity goes far beyond medicines. Delivering the ambitions set out in the Climate Emergency and Sustainability Strategy means transforming how care is designed and delivered across the system.

This includes strengthening prevention and early intervention – supporting people to stay well for longer and reducing avoidable demand on services. It means expanding high-quality care in the community and making greater use of digital and local services to reduce the need for travel. It also involves designing pathways that are more efficient, and reducing unnecessary appointments and interventions, while improving patient experience.

There are also opportunities to connect health more explicitly with the natural environment. Approaches such as green health – supporting people to engage with nature – can improve physical and mental wellbeing while contributing to wider environmental goals. These are practical examples of how sustainable care can deliver multiple benefits at once.

Delivering this at scale is now our shared priority. The Climate Emergency and Sustainability Strategy challenges us to embed environmental impact alongside clinical and financial considerations in decision-making across the system. It calls for strong leadership, clinical engagement, and collaboration with partners to drive meaningful change.

NHS Scotland has a unique role to play – not only as a provider of care, but as an anchor institution with the ability to influence wider systems, from procurement and infrastructure to community wellbeing and economic development. By aligning clinical excellence with environmental responsibility, we can lead by example.

The ambition is clear: to demonstrate that a climate-conscious approach is not separate from delivering high-quality care, but essential to achieving it. By focusing on what truly adds value to people’s health, we can reduce harm, improve outcomes, and create a more sustainable future for generations to come.