Skip to main contentSkip to footer
Picture of a map of the world on a protective face mask
Brighton & Sussex Medical School

The BSMS Sustainable healthcare group

BSMS > About BSMS > BSMS Sustainable Healthcare Group

BSMS Sustainable Healthcare group

The BSMS Sustainable Healthcare Group is a leading group in research and education relating to environmental, social and financial elements of sustainability in health and healthcare.

Our core functions are to:

  • Research and influence policy, knowledge, attitudes, and behaviour relating to sustainability in health and healthcare
  • Evaluate the environmental and social (including labour rights) impacts of healthcare and develop responses to mitigate these 
  • Collaborate in development of lean health service design
  • Build capacity in teaching and learning on sustainable health and sustainable healthcare


BSMS hosted a virtual panel discussion at the COP26 World Health Organisation Health Pavilion.The event, held on Friday 5 November 2021, brought together key international voices from the field of sustainable healthcare to discuss how the environmental impact of healthcare can be mitigated: exploring the interplay of research, clinical leadership, institutions, and industry. 

Speakers included Dr Chantelle Rizan (BSMS, UK), Dr Forbes McGain (Western Health, Australia); Dr Cassandra Thiel (New York University, US); Dr Rengaraj Venkatesh (Aravind Eye Hospital, India); Dr Fiona Adshead (Sustainable Healthcare Coalition, UK); Dr Frances Mortimer (Centre for Sustainable Healthcare, UK); and Dr Richard Smith (UK Health and Climate Change Alliance). The event was chaired by Professor Mahmood Bhutta, co-founder of the Sustainable Healthcare Group at BSMS, and Green Lead for University Hospitals Sussex (UK). 

Watch a full recording of this webinar below.

surgeon in an operating theatre

What is sustainable healthcare?

We use a triple bottom line definition of sustainability, taking into account environmental, social and financial elements. Healthcare systems and processes can only be considered sustainable where all three elements (also termed ‘People, Planet and Profits’) intersect and are upheld. 

Importance of environmental sustainability

Climate change is the greatest threat to public health in the 21st century, but provision of healthcare itself impacts on our environment. For example, the NHS generates around 22 million tonnes of carbon dioxide equivalents (CO2e) each year in England, and 5.4% of net UK greenhouse gas emissions. The US healthcare industry generates over 1.7 million tonnes of plastic waste per year, and this is likely to rise given our increasing reliance on single-use plastics. The NHS is a major contributor to air pollution, responsible for 3.5% of all road travel in England.

Importance of social sustainability

Provision of healthcare also impacts on the lives of patients, their families, allied healthcare professionals, and those within the healthcare supply chain. The majority of the products we use within healthcare are manufactured overseas, and there are reports of widespread violations of labour rights in the manufacture of medical gloves, face masks, surgical instruments, and medical textiles.

Importance of financial sustainability

Healthcare spending has increased in line with an ageing population and medical advances. For health systems to remain financially viable requires efficient use of our resources and improved systems for delivery of care as well as an increased focus on disease prevention.

Venn diagram to show the three parts of sustainability healthcare system

Image of single use plastic medical equipment


Research projects

We pursue a number of research interests in the sustainability of health systems. For instance, we use hybrid carbon footprinting methods to identify carbon hotspots within the operating theatre, life cycle assessments of the environmental impact of reusable versus single-use surgical items, and quantify the carbon footprint of healthcare waste and decontamination processes, to identify environmentally preferable options. We have also led action-research projects aimed at addressing precarious working conditions and modern slavery in the production of healthcare goods, have evaluated risk of labour rights abuse in healthcare supply chains and led national and international policy debates on this topic. 

Research repository

  • Rizan C, Lillywhite R, Reed M, Bhutta MF. Minimising carbon footprint and financial costs of steam sterilisation and packaging reusable surgical instruments. British Journal of Surgery. 2021. Published online ahead of print (available at: PMID: 34849606
  • Harris H, Bhutta MF, Rizan C. A survey of UK and Irish surgeons’ attitudes, behaviours and barriers to change for environmental sustainability. Annals of the Royal College of Surgeons of England. 2021;103:725-729. PMID: 34719956
  • Rizan C, Bhutta MF. Environmental impact and life cycle financial cost of hybrid (reusable/ single-use) instruments versus single-use equivalents in laparoscopic cholecystectomy. Surgical Endoscopy. Published online ahead of print (available at: PMID: 34559257  
  • Bhutta MF, Trueba M et al. Forced Labour in the Malaysian Medical Gloves Supply Chain before and during the COVID-19 Pandemic: Evidence, Scale and Solutions. July 2021. Read it here >
  • Rizan C, Bhutta MF. A strategy for net zero carbon surgery. British Journal of Surgery *Available online ahead of print. Doi: 10.1093/bjs/znab130. Read it here >
  • Rizan C, Reed M, Bhutta MF. Environmental impact of Personal Protective Equipment supplied to health and social care services in England in the first six months of the COVID-19 pandemic. Journal of the Royal Society of Medicine. 2021;114(5):250-263. PMID: 33726611. Read it here >
  • Rizan C, Bhutta MF, Reed M, Lillywhite R. The carbon footprint of waste streams in a UK hospital. Journal of Cleaner Production. 2021;286:125446. Doi:10.1016/j.jclepro.2020.125446. Read it here >
  • Trueba ML, Bhutta MF, Shahvisi A Instruments of health and harm: how the procurement of healthcare goods contributes to global health inequality Journal of Medical Ethics  Published Online First: 24 August 2020. doi: 10.1136/medethics-2020-10628 
  • Starup-Hansen J, Dunne H, Sadler J, Jones A, Okorie M. Climate change in healthcare: Exploring the potential role of inhaler prescribing. Pharmacol Res Perspect. 2020 Dec;8(6): e 00675
  • Rizan C, Steinbach I, Nicholson R, Lillywhite R, Reed M, Bhutta MF. The carbon footprint of operating theatres: a systematic review. Annals of Surgery. 2020; 272(6):986-995. Read it here >
  • Rizan C, Reed M, Mortimer F, Jones A, Stancliffe R, Bhutta MF. Using surgical sustainability principles to improve planetary health and optimise surgical services following COVID-19. 2020; The Bulletin. 102 (5). 177-181. Read it here >
  • Rizan C, Mortimer F, Stancliffe R, Bhutta MF. Plastics in healthcare: time for a re-evaluation. Journal of the Royal Society of Medicine. 2020; 113(2):49-53. Read it here >
  • Rizan C, Das P, Low R, Harden S, Flaherty B, Welland T, Bhutta MF. A streamlined pathway for patients with unilateral tinnitus: our experience of 22 patients. Clinical Otolaryngology. 2018; 44(2): 191-196. Read it here >
  • Bhutta MF. Time for a global response to labour rights violations in the manufacture of health-care goods. Bull World Health Organ. 2017 May 1;95(5):314-314A. Read it here >
  • Bhutta MF. Fair and ethical trade in health procurement Lancet. 2008 Dec 6;372(9654):1935-7. doi: 10.1016/S0140-6736(08)61826-7. 
  • Bhutta MF. Fair trade for surgical instruments. BMJ. 2006 Aug 5;333(7562):297-9. doi: 10.1136/bmj.38901.619074.55. PMID: 16877453.

‘Planetary Health Edition of the Royal College of Surgeons of England Bulletin (July 2020), guest edited by Chantelle Rizan and Professor Bhutta, exploring sustainability in surgery. Read it here > 

students study during lecture


Teaching and learning on sustainable healthcare

The key learning outcomes for sustainable healthcare

  1. Describe how the environment and human health interact at different levels
  2. Demonstrate the knowledge and skills needed to improve the environmental sustainability of health systems
  3. Discuss how the duty of a doctor to protect and promote health is shaped by the dependence of human health on the local and global environment 

Education on sustainable health and healthcare can therefore be framed as understanding how the environment impacts on health (eg air pollution as a risk factor for respiratory disease), the impact of healthcare on the environment (eg the carbon footprint of prescribing), ways to reduce the environmental impact of healthcare (eg lower carbon inhalers) and health promotion strategies (eg physical activity to improve mental health). 

The General Medical Council Outcomes for Graduates state that: “Newly qualified doctors must be able to apply the principles, methods and knowledge of population health and the improvement of health and sustainable healthcare to medical practice”.


Undergraduate curriculum at BSMS

Teaching on sustainable health and healthcare in the undergraduate curriculum includes: 

  • Year 1: ‘Environment and Health’ session looks at the interactions between the environment and health using air pollution as an example.  
  • Year 2: ‘Sustainable Healthcare’ which examines the impact of healthcare on the environment and ways in which healthcare can be made more sustainable 
  • Year 3: ‘Sustainable prescribing’ identifies the significant contribution made by prescribing to the NHS carbon footprint and identifies ways to reduce this including medicines optimisation and changing inhalers.  
  • Year 4: ‘Climate change and Health’ in the Global health day looks at the global health threat posed by climate change. From 2021, ‘Sustainable healthcare’ examines in more detail the ways that healthcare impacts on the environment and uses case studies from the NHS to demonstrate how sustainable healthcare practice and Quality Improvement (QI) can reduce these impacts and improving patients experience. Within their placements in ENT / neuro and ophthalmology, students are required to identify examples of waste (either physical or wasted clinical activity) and to discuss how QI could be used to reduce this waste and lead to more sustainable clinical practice. 


Educational Events

The SHARE conference, organised jointly between University of Brighton School of Health Sciences and BSMS, is an annual conference which aims to share good practice between healthcare professionals, students and service users on topics related to sustainability and health and healthcare practice. Read more about the conference via the link below.

Read more about the conference here >

Green Medicine Society

The BSMS Green Medicine Society is a student-run organisation that raises awareness of the impact that climate change has on health and also the impact that healthcare has on climate change and the wider environment, as well as looking at ways to make healthcare more sustainable. They run talks, seminars, workshops and extracurricular events to promote medical student engagement in planetary health. If you would like to join or get involved, please contact the society at or follow them on social media.


SHARE conference 2021

Members of the Sustainable Healthcare Group at BSMS were involved in the Sustainable Healthcare Academic Research and Enterprise (SHARE) conference 2021. To see the keynote talks and find out more about the conference, visit the link below:

Click here for the official webpage 

Image of the seven sisters cliff in Sussex

Useful links and resources

Useful links

Centre for Sustainable Healthcare

Greener NHS

BMA website

Royal College of Surgeons of England webinar in which Chantelle Rizan and Professor Bhutta discuss the evidence surrounding environmental and financial cost of reusable versus single-use medical equipment, and barriers and opportunities to moving towards a circular economy.


Royal College of Surgeons of England webinar in which Prof Bhutta and Chantelle Rizan discuss ways of improving environmental and social sustainability of surgery in the below webinar video.

Chantelle Rizan discusses the interplay between healthcare and the environment, and her research in the field. Listen to the podcast here >

Prof Mahmood Bhutta discusses modern slavery, PPE and the NHS. Listen to the podcast here >

Contact us

Email Dr Anna Jones at