Hospitals must lead – not only for better patient outcomes, but for the healing of our planet. The next chapter in healthcare leadership will be written by those who can drive change for both.

As a healthcare management and leadership educator, I spend most of my days guiding tomorrow’s health leaders – those who will steer our hospitals, health systems, aged care services and primary care, set policy and author the next chapter in healthcare. I remind my students that leadership is more than a title: it is an obligation – a call to confront the greatest challenges facing our communities with vision and courage, and to safeguard ethics and professional goals in the pursuit of a sustainable future.

I have walked the bright corridors of hospitals and witnessed first-hand the marvels of modern medicine. I have seen teams fight furiously for one life at a time – children breathing with ease again after an asthma attack, an older patient recovering from pneumonia, families relieved after a successful surgery. These everyday miracles of care and science are what draw many of us to this profession – and what make the role of health services leader or educator or clinician so rewarding.

Yet every time I walk past the glowing lights and the hum of machines, I am reminded of a quieter crisis – one woven into the very fabric of our healing environments. Hospitals, meant as sanctuaries for recovery, are themselves powerful sources of environmental harm. I don’t feel it’s just a paradox, but a profound ethical challenge for leaders and practitioners in health. In today’s world, this means embracing climate-ready leadership as a core competency for all health professionals, essential for a sustainable future.

Australian hospital emissions in a global context

In 2021–22, the Australian healthcare sector produced about 23.5 million tonnes of CO₂-equivalent emissions, which accounts for approximately 5% of the nation’s total emissions. Of this, hospitals and healthcare services contributed the largest share – 13.79 million tonnes, representing 59% of total health sector emissions. Hospitals remain the most carbon-intensive part of the health system, responsible for well over half of all healthcare emissions in the country.

In hospitals, the main sources of greenhouse gas and CO₂ emissions are from energy use, medical gases, travel and the supply chain (procurement of devices, drugs, and consumables). The majority of hospital emissions (see Table 1) arise not from on-site activities alone, but from what is purchased (goods and services), underscoring the importance of focusing on supply chain decarbonisation along with energy efficiency and local renewables.

Table 1: Typical emission profile in hospitals

Note: Table prepared using global data from multiple sources using conservative estimates; reflects an approximation only. Sources: 1, 2, 3, 4, 5

Globally, healthcare is responsible for 4.4–5.2% of total greenhouse gas emissions, equivalent to two gigatons of CO2. G20 countries account for more than three-fourth of all healthcare emissions worldwide. In most OECD countries, hospitals account for the largest segment of health-sector emissions, mirroring Australia’s pattern. Without action, emissions are projected triple by 2050, reaching six gigatons per year.

What has Australia done?

The Australian Government rolled out the National Health and Climate Strategy (2024-28), calling for baseline reporting, better energy use and collaboration with states and industry to track progress. There are some bright spots: solar panels popping up on hospital roofs, greener procurement policies, and a patchwork of sustainability plans in places like Victoria and New South Wales.

But here’s the rub – Australia still doesn’t have a nationwide, enforceable net zero roadmap for healthcare like the UK NHS does. We’re great at tracking energy use, but the biggest slice of emissions (the “hidden” carbon from making, shipping, and disposing medicines, devices and consumables) is barely on the radar in many hospitals. Plus, there’s huge variation between states, with some leading and others lagging.

Building the foundations for climate-ready health leadership

When it comes to workforce education, there is a critical gap in structured training for the healthcare workforce around climate action, sustainable procurement and environmental health principles. Traditional health education programs have prioritised clinical excellence and operational efficiency, yet sustainability — essential for the long-term resilience of our health system — remains a peripheral concern in most training curricula.

Across Australia, many emerging health leaders report limited exposure to topics such as climate-resilient health care, life-cycle analysis of hospital products, environmental health risks, or green hospital accreditation frameworks. This is supported by recent reviews and professional commentary, which highlight that structured teaching in these areas remains rare within most medical, nursing and healthcare management curricula; content is often sporadic, optional, or based on individual educator initiative, rather than embedded as a standard part of professional training.

Recent initiatives — like climate health “grand rounds” and advocacy by organisations such as Doctors for the Environment Australia — are beginning to fill this void, but these efforts are currently the exception rather than the rule. The Australasian College of Health Service Management (peak body for healthcare managers and executives in Australia and New Zealand) has introduced a new mandatory course “ Professional and social responsibility for health leaders” as a component for certification as a health manager or executive.

Yet these changes are only the beginning – I believe we must go further. Health leadership education should set the standard by weaving planetary health, sustainability and decarbonisation into the very fabric of its curriculum. We need to forge partnerships with health services, share real-world emission-reduction case studies and inspire students to treat planetary health as integral to human health. Such teaching should be evidence-based and forge a greater teaching-research alliance.

By making climate action integral to health leadership education, we prepare the next generation to lead hospitals and health systems that heal both people and the planet. Surely, the next chapter in healthcare leadership will be written by those who can drive change for both.

For more information: _https://www.flinders.edu.au/people/madhan.balasubramanian_

The views expressed in this article may or may not reflect those of Pearls and Irritations.