Our power, our planet: medicine and environmental stewardship

INTRODUCTION The theme for Earth Day 2026, ‘Our Power, Our Planet,[1] serves as a powerful call to action, urging collective reclamation of our shared future through sustainable practice. Nowhere is this more resonant than in medicine, where a profound and often overlooked paradox exists: the very systems designed to heal humanity are significant contributors to the environmental degradation that harms it. In healthcare, ‘power’ has a dual meaning. It is the electrical power that cools operating theatres and drives imaging suites, as well as the professional power embedded in clinical decisions—what we prescribe, investigate, procure and discard. Both forms of power carry consequences and demand accountability. The scale of the healthcare sector’s environmental footprint is substantial.[2] Healthcare facilities operate around the clock, consuming immense energy for lighting, heating/cooling and medical equipment.[3,4,5] Beyond energy, the sector’s consumption of water and generation of waste—from single-use plastics to hazardous pharmaceutical by-products—place further strain on planetary resources.[6] Globally, healthcare systems are responsible for up to 5% of greenhouse gas (GHG) emissions, more than the aviation and shipping industries combined.[7] In financial year (FY) 2023, the total GHG footprint of Singapore’s healthcare system was 4.1 million metric tonnes of carbon dioxide equivalent (MtCO2e).[2] This is comparable to the emissions generated from powering all households in Singapore for more than 1 year.[8] Singapore is well-positioned to translate this theme into healthcare action—not because it has a perfect system but because its system is designed for learning at speed: a dense care network, strong public sector stewardship, integrated clusters, a mature digital backbone and procurement structures capable of shifting markets.[2] These characteristics make Singapore a plausible living laboratory, where low-carbon care can be tested, measured, refined and scaled without compromising standards, and the results extrapolated to the region. Sustainable healthcare should not be treated as an add-on to quality, but as a quality discipline as fundamental as infection control or medication safety.[5] MEASURE WHAT MATTERS AND ACT Quality improvement moves from anecdote to impact only when systems start measuring outcomes consistently. Singapore’s FY2023 GHG report revealed that medicines and medical products were the largest contributors to its healthcare footprint, at 1.33 MtCO2e (32% of total emissions [Figure 1]).[2] This figure stems directly from clinical choices—the type of inhalers, anaesthetic agents or dressings.[9,10] Crucially, these data do not merely identify the problem but also show where change is already happening.Figure 1: Breakdown of greenhouse gas emissions across Singapore’s healthcare sector by scope and categories in financial year 2023. (Data extracted from: Ministry of Health, Singapore. Delivering quality care sustainably in Singapore. 17 September 2025).Anaesthesia is a flagship example.[11] Nationally, Singapore has achieved significant reductions in the use of desflurane and nitrous oxide in recent years, driven by anaesthetists, sustainability teams and procurement experts.[12] Some hospitals have virtually eliminated desflurane and achieved more than 90% reductions in nitrous oxide by replacing leaky pipeline systems with efficient canister approaches.[13] At the departmental level, sustained interventions, including choice of gas, pipeline changes, reuse of circuits where appropriate, operating theatre ventilation optimisation and education, have delivered substantial results, including a reduction of more than 95% in desflurane use within 3 years in one programme.[14] Decarbonisation is often a proxy for operational excellence—less waste, fewer leaks, better standardisation and more appropriate care.[14,15] Singapore’s commitment to climate mitigation takes a whole-of-nation approach to reach net zero emissions by 2050, supported by the Singapore Green Plan 2030.[16,17] HOSPITAL AS CLIMATE-RESILIENT INFRASTRUCTURE In a warming city, the hospital is both a sanctuary and a vulnerable node. Singapore’s emissions analysis notes that building energy demand is driven by cooling in a hot and humid climate, which creates an opportunity to generate globally relevant evidence for tropical and subtropical health systems.[18] Beyond an engineering concern, the International Federation of Gynaecology and Obstetrics (FIGO) opinion committee has recently identified extreme heat exposure in early pregnancy to be associated with adverse obstetric outcomes, including preterm births, preeclampsia and gestational diabetes mellitus.[19] Singapore’s approach includes new hospitals designed to stringent green standards with a framework approach to embed sustainability into infrastructure development. Through the Green Frontiers Framework, a mandate is set for Green Mark Platinum Super Low Energy certification for new developments and major retrofits, supported by guidebooks and checklists that translate ambition into engineering practice.[2] Beyond carbon reduction, these standards ensure the reliability of care delivery amid increased climate stressors, such as heat events, vector risks, intense rainfall and supply chain disruptions.[20] At the facility level, Woodlands Hospital showcases climate-smart design and operations, including biophilic features, north–south orientation to reduce solar heat gain, maximised wind flow, active-living staircases, solar photovoltaics, sensor-controlled systems, rain gardens with significant irrigation savings and a food waste digester that converts substantial food waste into non-potable water.[21] Beyond design, it integrates environmental considerations into quality improvement through the Sustainable Quality Improvement framework with carbon calculation tools—an explicit link between ‘green’ and ‘good care’.[21] The dual role of hospitals as both contributors to and buffers against environmental harm is particularly relevant in reproductive health. FIGO highlights that pregnancy presents a uniquely vulnerable window, during which even low-level environmental exposures can disrupt placental function, alter fetal epigenetic programming and contribute to outcomes such as preterm birth, fetal growth restriction and neurodevelopmental impairment. Thus, developing healthcare infrastructure that can endure climate-related stresses is not solely a matter of service continuity, but also protecting vulnerable populations.[19] WASTE AS A SYSTEM SIGNAL, NOT A BIN PROBLEM Waste is often framed as a moral issue. In reality, waste reduction has dual benefits: it reduces disposal emissions and decreases upstream manufacturing and transport emissions by lowering demand.[22] We spotlight some local examples of ‘system waste’ initiatives. The National University Health System has a broad waste strategy with specific quantified outcomes: a food waste biodigester processing 62 tonnes of waste, actions on packaging and plastics (including phasing out plastic bags and removing bottled water from meetings) and ward-level ‘sort-at-source’ systems, with large increases in recycling rates and substantial projected recovery when scaled across wards.[23] Other highlights include high-innovation recycling pilots such as conversion of hard-to-recycle plastics (including personal protective equipment and surgical packaging) into alternative road-paving materials, as well as recycling non-infectious stainless steel instruments and trays at meaningful volume.[23] The clinical takeaway is not ‘everyone must become a recycling expert’. Rather, waste signals where clinical workflows are misaligned with value—for example, excessive opening of ‘just-in-case’ consumables, over-ordering leading to expiry, and duplicative investigations that generate packaging and processing waste.[22] Addressing these issues is both greener and safer. A CALL TO ACTION FOR THE MEDICAL COMMUNITY This Earth Day, the medical community must embrace both its power and its responsibility to lead the next phase of sustainable healthcare. This begins with institutional commitment: hospital administrators and healthcare leaders must embed sustainability into core strategic planning, along with clear, ambitious targets for emissions reduction and resource stewardship tracked with the same rigour as safety and quality indicators.[24] It also demands innovation in clinical practice, where clinicians actively reduce low-value and duplicative testing, normalise the use of reusable options where safe, and partner with operations and procurement teams to redesign workflows and policies that lower waste without compromising care.[25] A parallel shift towards prevention is essential—strengthening preventive medicine and public health education to reduce avoidable, resource-intensive hospitalisations and address upstream drivers of chronic disease.[25] Environmental exposures are a key contributor: air pollution and endocrine-disrupting chemicals are linked to endometriosis, hormonally mediated cancers and infertility.[26] Protecting our environment is not peripheral to our mission; it is preventive medicine. Finally, clinicians must recognise their role as trusted societal voices. Policy advocacy is not optional but integral to protecting health, and the profession should actively support policies that accelerate a just transition to a greener economy and a more resilient, sustainable healthcare system. CONCLUSION Earth Day themes can feel distant from ward realities. Yet ‘Our Power, Our Planet’ is unusually well-aligned with healthcare. Clinicians have the power to set defaults, standardise practice, choose effective options with lower carbon footprints and turn sustainability into a quality norm. Singapore’s healthcare system has already demonstrated that environmental stewardship and clinical excellence can move together—through green building leadership, near-elimination of refrigerant-related emissions, low transport emissions enabled by public infrastructure, and a growing portfolio of clinician-led innovations. At the same time, the FY2023 national footprint—4.1 MtCO2e, with about 90% in Scope 3—makes clear that the next phase must shift from ‘hospital greening’ to system redesign, especially in medicines, products, procurement and supply chains.[2] The call to action of Earth Day 2026 is, therefore, not a simple slogan but a professional challenge—to treat decarbonisation as ‘do no harm’, make sustainability a feature of quality care and leverage Singapore’s system capabilities to generate solutions worth exporting to the wider region. If our healthcare system can deliver world-class outcomes, it can deliver world-class stewardship—not someday, but now—because the future patient is already in today’s waiting room. Acknowledgement We thank Dr Aniza P Mahyuddin for her assistance with proofreading and administrative support during the manuscript preparation. Financial support and sponsorship Nil. Conflicts of interest Choolani M is a member of the SMJ Editorial Board and was thus not involved in the peer review and publication decisions of this article.