Daniel Eriksson, CEO, Nordic Center for Sustainable Healthcare discusses the Nordic solutions with Björn Almér of Skane Care
“When people talk about sustainability, they rarely start with hospitals. Yet the uncomfortable truth is that healthcare is one of the planet’s largest polluters. Depending on the study, the sector produces between 4–6 per cent of global CO2 emissions, and in Europe, the climate impact of healthcare exceeds that of aviation.
Add to that the use of volatile anaesthetic gases, mountains of single-use plastics, and pharmaceutical residues that end up in rivers and drinking water, and it becomes clear: healthcare’s environmental footprint is both vast and largely unacknowledged. But it’s also one of the most powerful places to make change, because hospitals are central institutions in their communities. If hospitals recycle, conserve energy, and source responsibly, they become role models.
That idea sits at the heart of my work at the Nordic Center for Sustainable Healthcare (NCSH), which I helped to found in 2015. We started as a small initiative in Malmö, Sweden, bringing together hospitals, medtech companies, researchers, and policymakers who wanted to make sustainability a reality.
Ten years later, we have members from all over the world — from Yale University in the US to Auckland Health District in New Zealand, to Indian and Middle East health authorities. We run conferences in Europe and North America, and we collaborate with governments on white papers, training, and pilot projects. We’re working with partners in the UAE and Saudi Arabia to bring Nordic know-how to the region — from clean energy systems to sustainable hospital design and circular medtech.
What makes us different is that we’re independent and hands-on. We are not a policy think tank; we are a network that helps hospitals, companies, and governments implement real solutions — from waste systems and energy recovery to green procurement and nitrous oxide reduction.
And the timing has never been better. Twenty years ago, people would tell me: “We can’t think about sustainability, we have patients to treat.” Today, every conversation I have from Stockholm to Dubai starts with sustainability. Governments are setting targets, companies are demanding proof of climate claims, and funders are offering support.
The scale of the challenge
Healthcare is roughly 10 per cent of GDP across developed economies. In the United States, it’s even higher: around 17 per cent. With that kind of scale, even small improvements have an enormous impact. A good rule of thumb is that about 10 per cent of everything consumed — from electricity to paper clips — is used in healthcare. It’s a massive sector, and the supply chains stretch across the world. Much of our pharmaceutical manufacturing, for example, takes place in India and China, where emissions from production exceed those from the buildings and operations of health systems like the NHS.
But healthcare can also be part of the solution. A hospital isn’t just a building that treats patients; it’s often a small city with its own logistics, waste, transport, and energy systems. If you decarbonise a hospital, you can influence the entire community around it. District heating, bioenergy, water treatment, and transport planning all connect to it. That’s what we’ve been building in the Nordics for decades.
What makes the Nordics different?
First, we work in systems. No hospital would ever build its own small biogas plant, because the city already has one. In Malmö, for example, all food waste from homes and hospitals goes to a municipal biogas facility that’s been running for more than 25 years. That gas then powers the city’s buses and even hospital vehicles. Everyone contributes to — and benefits from — the same infrastructure.
Second, environmental management in healthcare is not new in Scandinavia. Many hospitals have had environmental plans since the 1980s and 1990s. We have strong laws on waste, energy, chemicals, and water, and healthcare must comply like every other industry. There’s no “special treatment.”
Third, and perhaps most importantly, there’s trust — what we call “the Nordic gold.” We trust our governments and each other. It means regulations are enforced, people follow them, and the whole system moves in the same direction. Sadly, this trust is declining as our societies become more polarised, but it remains one of our great strengths.
Finally, we take a holistic approach. I often say: “We’re not the best in anything, but we’re in the top five percent in everything.” Some hospitals around the world focus on one flagship project — the greenest roof, the lowest carbon building — and present it at conferences. We don’t chase trophies; we integrate sustainability across energy, water, chemicals, buildings, procurement, and waste. It’s not glamorous, but it works.
Many Nordic successes
One of my favourite examples is nitrous oxide destruction. Nitrous oxide, often used in maternity care as pain relief, is a greenhouse gas 320 times more potent than CO2. In Sweden, we’ve had nitrous oxide capture and destruction systems installed in maternity wards since the early 2000s, built into ventilation. A few years ago, a hospital in the UK piloted the same technology and the BBC covered it as the country’s ‘first climate-neutral birth’. I smiled, because we’d been doing it for 20 years. That’s what happens when good ideas fail to spread across borders.
Similarly, our hospitals are connected to citywide district heating and cooling networks. If you build a new hospital here, even without a sustainability strategy, it will automatically plug into one of the cleanest energy systems in the world.
At NCSH, we see sustainability as a new industry that cuts horizontally across the old ones. It’s not purely medtech, cleantech, or life sciences but a combination of all three. The pandemic proved that last point beyond doubt. Hospitals that relied on single-use imports suffered when supply chains froze. Those with their own laundry, sterilisation, and maintenance teams carried on. The greenest hospitals were also the most resilient.
This thought process is what makes the Nordic model so powerful. It’s not about innovation for its own sake; it’s about systemic consistency.
Fixing problems
We’ve seen many well-intentioned projects fail because they ignore practical realities. In India, we audited hospitals where NGOs had proudly installed solar panels on the roof. When we arrived, we discovered that none of them were connected. The panels were there for the photograph, but the hospitals had no budget for electricians to integrate them. The state pays their electricity bills, so there’s no incentive to spend their limited funds connecting panels they don’t need.
At another hospital, we found open dumps of medical waste — used HIV tests, surgical gloves, even removed organs. When the monsoon rains came, the runoff contaminated the groundwater, which was then pumped up for hospital drinking water. The story made national headlines in the Hindustan Times and led to real change. But it showed how basic systems and maintenance, not just technology, are often the real barriers.
That’s why one of our key recommendations in India was to establish a maintenance organisation for hospitals. Sustainable infrastructure only works if someone keeps it running.
India plans to build 1,400 new hospitals in the coming years. If digital-first care, remote monitoring, and smart diagnostics can reduce that number to 1,000, the avoided construction — concrete, steel, HVAC, and transport — saves more carbon than any recycling programme ever could.
Digital health is an infrastructure strategy. It allows emerging economies to provide access to care without repeating our resource-intensive Western model. The same logic applies to the Middle East, where smaller, centralised countries can leapfrog straight to sustainable, digital, preventive care if they choose to act.
The human input
Sustainability isn’t just about technology; it’s also about how we organise people. The Nordic countries have long embraced task-shifting — giving nurses, midwives, and pharmacists greater responsibility. In Sweden, nurses can prescribe repeat medications, lead clinics, and manage care autonomously.
This approach is both efficient and empowering. It ensures the right person does the right job and frees doctors to focus on complex cases. Other systems still force patients to wait for a doctor to perform basic tasks that trained nurses could easily handle. Sustainable healthcare means using all our human resources wisely, not just our material ones.
When we founded NCSH, we hoped a few colleagues from Denmark might join so we could justify the ‘Nordic’ name. Instead, we built a global network. What keeps me inspired is that every year, the interest grows, from policymakers, companies, and clinicians alike. In reality, the world doesn’t need another Nordic model; it needs local ownership of global solutions.”
CONTACT INFORMATION
www.skanecare.com / www.nordicshc.org