Note: This transcript has been auto-generated and lightly edited for clarity. It may contain minor errors.

welcome to the Sustainable Healthcare Podcast. My name is Frederik Dam van Deurs and I am your host. Today I’m a partner in Green Innovation Group and Care Pathway Consulting, and today I have three guests in the studio and I’ve been really excited about this episode ’cause I have Fiona and Keith and Natalie from the Sustainable Healthcare Coalition, an organization run out of the uk.

That are quite renowned in our industry for working on sustainability in the healthcare sector and decarbonizing healthcare and producing a lot of knowledge material to help all of us that are working on that mission. I’m a little bit giddy to get started. Without further ado, welcome to the studio to the three of you.

I showed you some questions that we could run through, and the first one is: Who are you and what do you like to do when you’re not decarbonizing Healthcare? Fiona, would you like to go first?

Hello everybody. I’m Fiona Adshead. I chair the Sustainable Healthcare Coalition. And when I’m not Decarbonizing Healthcare, I love walking in nature.

And I’m particularly keen on art and the history of art. ’cause it reminds me that human beings can be infinitely creative and it connects us with our past.

Okay.

And Natalie, how about you?

Hi, I’m Natalie. I am the community of practice moderator at the Sustainable Healthcare Coalition. And I am a mom of two young boys. So when I’m not decarbonizing clinical trials, I am running around hopeful most of the time in nature. Sometimes by bike, but mostly running around

Neat.

And Keith.

Yes. Hello. Keith Moore. I’m the program coordinator for the Sustainable Healthcare Coalition. And I’ve been with it forever. It started back in 2011 and I was a pharmaceutical industry voice on it to start with. Jump ship to sit alongside Fiona and running it about six, seven years ago.

Like Fiona and Natalie, I think most of my passions involve nature and health. I’ve got two teenage boys who I like to play golf with and a spaniel who keeps me running around. So yeah, that’s us.

Thanks a lot for sharing. I like getting that extra bit of texture in it and visualizing you walking around in the woods and thinking about arts. That really did something for me.

Natalie, you mentioned the event in London. There’s an event coming up in London on November 4th, 2025. In case you listen to this a couple of years from now, can you tell our listeners a little bit more about this event? Who should participate if they haven’t signed up already?

Sure thing. We’re very excited to be hosting the first conference of the Community of Practice. Earlier in the year, the Sustainable Healthcare Coalition launched this community of practice for sustainable clinical trials, and we’ve seen an incredible uptake with people joining the community.

We can put the link on LinkedIn so that people can join the community when they hear the podcast. When we saw the uptake, we figured this community feels ripe for an in-person event, and we wanted to infuse the community with all that inspiration and extra energy that comes from actually meeting humans in person.

We decided to organize the conference, which is happening on the 4th of November. It is going to be a relatively small meeting with 80 people. We have a number of registered people, but if you haven’t registered, everything’s not lost. Just do it very quickly. We can also put the link to registrations together with the podcast.

It’s going to be a very packed day with a lot of interesting conversations. We’re going to be talking about what we want from the community, who is part of the community, who’s welcome in the community. We’re going to be talking about individual stories of decarbonization, like the individual.

Initiatives that are already happening right now. We’re going to be talking about the power of collaboration and how multi-stakeholder conversations are the key to unlocking real impact way beyond individual initiatives. The part that I’m most excited about is that together we’re going to be designing what 2026 is going to look like for the community.

So yeah, very excited about this interesting and intense day.

I’m really looking forward to it. If we’re looking at the Sustainable Healthcare Coalition, and you alluded a little bit to it before Keith when it started and you basically took part since 2011, maybe Fiona and Keith, I think you’ve both been a part of it since the beginning, haven’t you?

Can you walk us through the early days and the origins.

Let me start at the start. Fiona joined us about six, seven years ago. The NHS England then had a sustainable development unit that commissioned a report on the carbon footprint of the NHS as an organization, and that told them a lot of their footprint is in the supply chain, what we now call scope three emissions.

A lot of that is associated with pharmaceuticals and medical devices. They have no particular way of talking to the pharma and the med tech industries except through procurement, which is not a very helpful place to talk about novel ideas like decarbonizing healthcare and improving sustainability.

They asked us to come round the table with them to discuss these issues. If pharma and med tech really was a big slice of the CO2 pie, and if it was, what could we do collaboratively to address it? I say we because I was part of the pharma industry at the time. It has proved a fabulous forum for discussing systemic issues, systemic blocks and systemic opportunities to change the carbon footprint of healthcare, not just the NHS.

Of course, industry is multinational, healthcare is multinational. Therefore it very quickly grew out of the UK and became a forum for system to system, supplier to consumer conversations about what we can do, working together to move the needle on sustainability. That’s where we are now.

Fiona, did you want to add to that about where we are and where we’re going?

One of the questions that the NHS, our Health Service asked when we were first established is: how do we know when we’re making progress? How can we measure impact? That’s a lot of what we’ve done.

We’ve used practical areas of work like measuring the impact of clinical trials or care pathways to bring people together to work. I think it’s through trying to solve those practical problems that people build relationships and understand that we all need to work together if we’re going to solve a system problem.

So we’ve started from small UK origins to really working globally.

My mind always goes to: is it a group of like-minded people that enjoy being there, or is it a formalized incorporated company structure? Is it an association or an NGO? How is it actually structured?

We started off as an informal round table about three, four years ago. We recognized that the activities of the coalition and the projects that we’re involved in were becoming so large that they needed a proper company structure. We’re now a not-for-profit registered company.

It remains at its heart exactly what it started out to be: a platform for people to come together to connect across the system boundaries of commercial and public service, profit and not-for-profit, to talk about these big questions around what sustainable health and sustainable healthcare really mean.

That’s where we are today. Part of the results of that is the conversations we’ve been having about clinical trials and building this community of practice that Natalie leads for us.

Thanks a lot for clarifying that, Keith. One of the things I really enjoy about the work that comes out from the Sustainable Healthcare Coalition is some of these massive knowledge pieces where you can tell there’s been a lot of thought and effort put into the papers and the guidance documents that are coming out.

If one of our listeners are wanting to decarbonize healthcare in their own country outside of the uk, what steps should they take? What’s a good place to start?

The steps are universal. We’ve applied them in the uk and in other countries as well. Currently we’re looking at particularly European countries: Portugal, Spain, Denmark and Netherlands, and we’re seeing what we can do there. The problems are universal. The solutions are universal. We’re joining people together.

What we’re starting to see is a library of case studies and example worked examples to get people started on their own problems. A lot of the ways of working and a lot of the solutions will actually be the same no matter what geography you’re working in.

If you were to pick the three most important problems to start with in general, I’m putting you a little bit on the spot here with how you just said that, but if you were to pick the three key problems that we should address first, which would they be?

Let’s go into the 10-year plan that the NHS has built, because I think that’s got a lot of universal applicability. The first part of that plan is around how you actually deliver healthcare. Hospitals are big, resource-heavy places to run and they require people to move to the hospital, so there’s a big travel burden with them.

Thinking about how the care delivery is modeled and getting it closer to the patient will reduce the resource need and reduce the carbon footprint associated with it. The second thing is that the world is changing as we’ve discussed just running this podcast. It’s an increasingly digital world and there’s a lot that digital tools can do to empower patients to look after their own health journey and to improve the resource efficiency for care providers to deliver that care to them.

The third part is the most sustainable patient and patient care journey is actually the one that never gets sick. I think there needs to be a lot more emphasis put onto the prevention agenda rather than the treatment of sickness. Do those three things and you get a long way towards decarbonizing healthcare and make it more pleasant and more effective for the patient as well.

That’s one of the things that typically doesn’t get as much speaking time as it should. When we’re talking about prevention and we’re in the industry right now, there’s a lot of talk about being patient-centric, putting the patient first and not looking at someone suffering from a chronic disease, but looking at multi-morbidity and comorbidities as a patient needing treatment no matter the number of diagnoses or diseases at play. If we think about it and take it a few steps back and we’re looking at the case of disease in general, then prevention is always the most desirable outcome. Just preventing disease onset is such a key goal for us to target as a society and also to recognize as a benefit. I’m really happy you bring that up. Keith, Fiona, you were nodding while Keith was talking about prevention. Can you give us a little bit more texture on what you see as the case for prevention and the complexities within that?

What’s inside the box when we’re looking at prevention from a healthcare perspective?

One of the big issues is that prevention isn’t something that you do to people. It’s something where you need to have an active partnership with people. One of the areas we’ve been interested in is how do you work with public patients to support them in their own care. That can be in prevention before they get ill, but it can also be when they already have a condition. A lot of our case studies where we’ve been looking at how you decarbonize care pathways look at ways of supporting people to help themselves or their children.

We’ve looked, for example, at Smart Inhalers for children and shown that by using those digital approaches where people have advice in the moment when they’ve got a problem, it improves health outcomes, it reduces environmental impact and it reduces cost. That’s one way. We’ve also been looking at how you design prevention into the system.

We’ve done case studies looking at the impact of immunization. For example, having a seasonal flu jab, very topical here in Europe at the moment, reduces a huge amount of demand on the healthcare system and also of course reduces cost. Or you can look at the impact that drugs designed to reduce the progression of diseases have. We’ve looked at that for kidney disease. There are all sorts of ways you can design that into a care pathway. We need to really think broadly about how we do that. As you’re absolutely right, it requires not just patient response, but it also requires the healthcare system to have an active partnership.

That means responding differently. It means supporting patients differently. What we’ve learned through this work is that patients always want to have their health put first, and we need to do this really carefully because we absolutely want to make sure that people don’t feel that environment would come first in care.

It always has to be people’s health, and then we need to think about the options and how we can do that in a way where we can reduce environmental impact, but always having their best interests at heart.

But you bring up the case of CKD which I think is super interesting.

CKD is chronic kidney disease and it’s a disease that has five stages depending on the level of your kidney function. That function is basically degrading as you get more and more sick. In stages one through four, you can still maintain a relatively normal life. When you reach stage five, it’s kidney failure and you need to go either into dialysis treatment or have a kidney transplantation. When we are looking at chronic kidney disease as a knot that we would like to disentangle, around 10% of the global population is believed to have chronic kidney disease, and 90% of those 10% are diagnosed.

In most healthcare systems, you would have the diagnosis run in the primary sector. The tricky thing about CKD or chronic kidney disease is that it doesn’t show a lot of symptoms early on where you can treat it. Have you been tactical in ways of how might we find the patients to provide the treatment while the disease is still in an early stage, but not causing a lot of problems for the patient? Therefore they’re not very likely to start treating it. But if you’re at risk of going into a dialysis treatment or kidney transplant, I dare say that’s a life-changing event to have that disease onset.

Did you approach the problem of who carries that responsibility of early detection?

We haven’t addressed that specifically, but we’re part of a broader collaboration called care, which is a Horizons program within Europe, and that’s looking at that issue with patient groups about how can we communicate. It’s interesting, the concept of who carries the burden. Ultimately, if you’ve got the early stages of renal disease or kidney disease, you as a patient carry the burden. The answer is everybody has to. If it’s a systems problem, we all need to work together. People often want to find a simple solution, someone’s problem. But in essence, we need to work together to make it work. I think we need to think about how things like high blood pressure and diabetes and other conditions are often precursors and the cause of these kind of problems. We need to also think about how we can build that into places where people live their lives: workplaces, communities, schools, as well as primary care.

We really need to think broadly about these kind of campaigns. That’s one of the challenges of sustainability or prevention: you need to think broadly about how you reach people. But the easier you make it to reach people and the more you personalize approaches, the more likely you are to be successful.

I say that from having focused on this long before I went into sustainability. It’s a subject that’s close to my heart.

Thanks a lot Fiona for shedding a little bit more light on that. I’m a huge fan of the work that you have done and published in this area and of bringing that disease maintenance and guideline-directed medical treatment adherence into the attention of what it means to be a healthy healthcare system.

Is also that we help patients get the treatment that they need when they need it. But when I’m looking at the Sustainable Healthcare Coalition from the outside, I see two overarching major themes appearing. One of them is the general care pathway: how might we decarbonize healthcare at large, where you have developed the carbon calculator, a fabulous tool to get started. When we started working with this, it was one of the only resources there was. Your alternative was to do a cost extrapolation on your spend and then put a carbon factor on it. No matter who you were and where you were in the world, this was infinitely much better because you had actually taken the time to break down activities and materials in a typical healthcare setting.

That would be one side of it. But then there’s the other side, which is the clinical trials track where you have also built a clinical trial carbon calculator.

That’s absolutely right.

Can you walk our listeners through why is this a sensible division? Why is it not all just decarbonizing healthcare?

Why did clinical trials need to get its own leg?

It is a good question. It’s really very analogous to a care pathway when you run a clinical trial. It’s just a care pathway delivered for a specific purpose, not just to help the patient, but to get a research finding from the work that you’re doing.

Going back to the start of the conversation that the SHC has been involved in, first of all, we were looking at products, what is the carbon footprint of a drug or a medical device? That was a great thing to answer. We came up with a world-first standard on how to do that assessment and it tells you part of this story, but not all of it. What’s really important as we’ve been talking about through today is the fact that these products are used in care pathways and it’s the impact of the drug or the product on the health, on the patient and on the care pathway and the delivery system. That really gives you the big picture of how these things are going to be either sustainable or unsustainable.

About five years ago, we started thinking about clinical trials because there were some assessments done about the global health systems carbon footprint, and it came through that about 5% of the entire footprint is associated with clinical research. Questions started to be asked about what we can do.

Is there something we can do to pick up on the care pathway thinking and apply that specifically to clinical trials? The answer is yes. We’ve worked in collaboration for the last five years with people to come up with a similar framework for how you assess these clinical trials. I think they do need their own special set of rules because they’re not just care pathways.

Of course, the idea that a village is required to raise a child is just as applicable to getting a clinical trial delivered. There’s contract research organizations, sponsor pharma and med tech companies, regulators, ethics committees, and clinical laboratory services.

All kinds of things are associated with that activity that aren’t associated with ordinary care pathway delivery. It’s been a very interesting learning curve for me who’s worked in industry but not in clinical trials, to learn about what those are, where the elements are, and how to go about helping people understand and give people the tools so they can understand for themselves where the hotspots are in their clinical trial activities and what the opportunities might be for reducing those hotspots.

What do you see as the main hotspot? Again, if we’re doing the same exercise and we had to, I know it’s a little bit tricky and I’m trying to prevent my own knowledge from tripping me when I’m asking this question. But if you were to nominate three places to start, if you are the vice president or senior vice president of a major pharmaceutical company’s R&D department, what would be the three things you would look at to decarbonize clinical trials?

The first thing would be to do an assessment of your trials to answer the question for yourself because the hotspots are starting to be recognized. But it’s early days for this framework, and the calculator’s only been in existence for less than a year. We haven’t got a lot of feedback yet from people on what the results are.

A couple of our collaborators, AstraZeneca and Johnson & Johnson, have put peer-reviewed papers out looking at the hotspots of their trials, and that’s really useful. We’re not really sure if those are outliers or if they’re reflective of common practice. The things that we’re talking about are things like participant travel, trial management activities, moving site monitors and trial monitors around the globe to manage these trials.

We’re talking about things like laboratory services and logistics involved in getting trial products to hospitals, to the trial delivery sites in a sensible manner. Those are the sorts of things that we’re talking about. Overlay on that the idea that there’s digital tools out there to decentralize trials, to do e-recruitment of patients into trials, and what they might be able to do to help further reduce the environmental burden of these trials. There’s a lot of areas that we want to look at, but it’s still early days and we haven’t got a lot of readout yet to share with you and your listeners, Frederik.

I appreciate that. One thing that we have learned in our work is that the carbon intensity of the investigational product or the active product ingredient that you’re investigating, the drug that you’re investigating, really dictates what strategic direction you can take for decarbonization further on.

If you have a very high carbon intensity drug, it does make a lot of sense to review how much you reduce the scrap rate of the samples or the kits that you put out, the supply kits. The funny thing about clinical trials is also that you tend to have an oversupply, so you can always meet demand because it’s really critical to have a treatment ready if a patient decides to enroll at a certain point in time. It’s absolutely critical that they can then get onboarded for the trial not to fail. So there’s a number of sensitive areas where for other trials where the API may not be super carbon-intensive, lowering the scrap rate of the kits doesn’t make as big of a dent in the carbon accounting compared to patient travel, which takes up a lot more in that one.

Then maybe you should look at not having patients flying around, but picking sites and patients that are close to one another. That’s definitely something that we have seen. That builds on your first point, Keith, that the first thing you should do is really assess your own trial portfolio and figure out for your therapeutic areas and the compounds that you’re working on what is meaningful in your context.

That really resonated a lot with me. We are reaching the end of this episode. I hope that our listeners have learned a lot about the Sustainable Healthcare Coalition. I got a lot more texture from just reading papers and now having conversations with the organization as well.

I’m really happy about that. Unfortunately, our listeners can’t see you, but they’ll be able to put your voices and imagine what you look like while they’re listening. So finally, something that’s going on a lot in my professional network is reflections on the current political climate we’re in during fall 2025. The geopolitical situation has not been looking too great for a while.

We just had the most recent edition of the Planetary Boundaries Assessment conclude that instead of six out of nine planetary boundaries being crossed, we’re now at seven out of nine boundaries being crossed, only two years later. There’s plenty of reason to be put down in our line of work. But despite these loud signals from science and nature, what gives you hope in times like these?

For me, I think it’s going back to that point about human nature. People’s creativity and every day we see examples of colleagues who are really trying to make a difference. There are loads of examples of action, and I think it’s easy to be an optimist if you focus on the positive and what people are doing. It also depends on your model of change.

Governments and others can have a big impact on the world. Of course they can, but I very much follow the Margaret Mead approach: never forget that a small group of people can change the world. In fact, that’s the only way it’s ever changed. You have to get out of bed every day and believe that what you do can ignite passion amongst people.

I see so many examples of people who are really trying to make a difference. That’s what keeps me hopeful. We are really committed at the coalition to bring people together for that kind of shared action. That’s what the community of practice is all about, and that’s what our forthcoming events are all about.

Fiona, I need to bring you some kind of prize because you’re the first guest on the podcast who named Margaret Mead. As an anthropologist, that really resonates strongly with my background. I’m going to figure out something to bring to you.

To bounce back on what Fiona was saying: I am in daily touch with the community of practice, and that is just reason enough for hope. There is so much goodwill and energy going in the direction of sustainability. Sometimes you forget that the word includes other people as well. If you’re having a down day, just hop on, you’re going to have fun.

That’s a good one to look into the community and maybe have a little bit of a positive spin, echo chamber effect going on, Keith.

I really do believe there’s good cause for hope partly because of the impact of enlightened self-interest. If people believe in climate change or not, if people believe the environment is a crisis point or not, it really doesn’t matter because the things that we’re coming forward with as solutions are actually about optimization of systems, about saving resources and costs, as well as environmental and material resources. Why wouldn’t you do it if you happen to improve the environment by accident? On the back of making system improvements for healthcare and for the industry supplying it, that’s brilliant.

You don’t have to be that as the prime driver.

No. There’s also a suffering ideology stemming from the origins of sustainability practice where it has to be a sacrifice for it to be true. I remember from 10, 11 years ago someone who was also working in sustainable technology space.

She was driving an electric vehicle and she said, when I sit in a modern car, it feels like ancient technology. I think now that it’s getting more common to drive and see electric vehicles, I’ve had the exact same feeling when I sit behind an internal combustion engine steering wheel.

There’s so much work to do: you have to clutch in and out and shift the gears and it just feels stupid and cumbersome. You’re absolutely right there, Keith, that the enlightened self-interest is going to do a lot of the work for us. When the sustainable choices are quite often quite sensible in healthcare, and particularly if we can talk about preventing disease onset, that is infinitely a better experience as a patient than having any kind of disease. I’ve always preferred being well to being sick. I think I’m not unique in that.

absolutely.

With those words, thank you so much for coming on the show. I had a really good time chatting with you and I look forward to coming back and discussing more about Care Pathways and the Care Pathway approach.

We will include the notes in the show notes with a link to the event and a link to the SHC website so listeners can go and check things out if there are any documents you referenced. Thank you so much for coming on the show. Until next time, please remember to share the show, give us any feedback that you want, link it to someone who should listen, and if you give us a rating and review, it means a lot in the algorithms to promote the material. Once again, I’ve been your host today. My name is Frederik Dam van Deurs from Green Innovation Group and Care Pathway Consulting.

It’s been a pleasure to have you on. Have a great day.