Engineering the Belém Vision: Addressing Healthcare’s Carbon Crisis Through Sustainable Procurement and Climate-Resilient Infrastructure

When COP30 convened in Belém, Brazil, in November 2025, it marked the first UN climate summit held in the Amazon region—a location symbolizing the frontline meeting point of climate, biodiversity, and human health [1]. Among the key outcomes was the Belém Health Action Plan, a strategic framework designed to mobilize the global community toward building climate-resilient and environmentally sustainable health systems [2]. The plan arrives at a critical moment: climate change is projected to cause up to 15.6 million deaths between 2026 and 2050, with health impacts costing between $8.6 and $15.4 trillion by mid-century [3].

Yet healthcare faces a profound paradox. The sector exists to heal and protect human health, but it simultaneously contributes significantly to the climate crisis that threatens the very populations it serves. Globally, healthcare accounts for approximately 4.5% of total carbon emissions [4]. In the UK, the NHS has committed to reaching net-zero by 2040 for direct emissions and 2045 for its supply chain—ambitious targets requiring fundamental transformation of how healthcare is delivered, procured, and powered [5].

The Belém Health Action Plan provides sixty recommended actions across three core pillars: climate-informed surveillance and monitoring systems; evidence-based policy and capacity building; and innovative, climate-resilient health technologies and supply chains [2]. While comprehensive, the plan’s scope risks overwhelming health systems already facing unprecedented resource constraints. For the NHS specifically, two areas demand immediate engineering focus: sustainable medical device procurement and climate-resilient infrastructure. Together, these represent the vast majority of healthcare’s carbon footprint and offer the greatest potential for measurable impact.

The Supply Chain Challenge

Medical device supply chains account for a staggering proportion of health system carbon footprints, reflecting the complexity, global reach, and resource intensity of modern healthcare technology. From raw material extraction and manufacturing to transportation, use, and disposal, medical devices carry substantial embedded carbon. Yet until recently, this has been largely invisible in healthcare decision-making.

The NHS is now changing that calculus. From April 2027, NHS suppliers will face mandatory public reporting requirements on their carbon emissions, with non-compliance potentially resulting in procurement exclusion [6]. This represents a seismic shift from voluntary sustainability commitments to enforceable mandates. The Healthcare Financial Management Association’s August 2025 Environmental Sustainability Guidance Map has begun unifying compliance frameworks, providing NHS organizations with structured pathways to meet these requirements [7].

The fundamental problem is fragmentation. Medical device supply chains are global, multi-tiered, and opaque. A single diagnostic device might contain components manufactured across a dozen countries, assembled in another, and distributed through complex logistics networks. Carbon accounting across these chains requires standardized methodologies, transparent data sharing, and collaboration between manufacturers, distributors, and healthcare providers—none of which currently exist at scale.

Moreover, sustainability criteria must be balanced against clinical performance, regulatory compliance, and patient safety. A more sustainable device that compromises diagnostic accuracy or increases infection risk is not a viable solution. This is where engineering thinking becomes essential: optimizing across multiple constraints, applying lifecycle assessment methodologies, and designing systems that deliver both clinical excellence and environmental responsibility.

Apian Drones at Southampton Hospital undergoing trials

The opportunities are substantial. Modular device design allows for component replacement rather than full-unit disposal, extending product lifespans and reducing waste. Sustainable materials such as biocompatible polymers, recycled metals and reduced packaging can significantly lower embedded carbon without compromising performance. Circular economy principles, including take-back schemes and refurbishment programs, can close material loops. Digital technologies enable remote diagnostics and predictive maintenance, reducing unnecessary equipment replacement and transportation emissions.

Yet implementation requires more than technical solutions. Procurement teams need clear guidance on evaluating sustainability claims and integrating environmental criteria into purchasing decisions. Regulatory frameworks must evolve to incorporate environmental impact alongside safety and efficacy. Manufacturers need both incentives and pressure to redesign products and supply chains; the Belém Health Action Plan provides a global mandate and the NHS April 2027 deadline creates urgency. The question is whether the engineering, policy, and commercial ecosystems can move quickly enough.

Infrastructure and Energy Systems

While supply chains represent a major share of healthcare emissions, infrastructure and energy systems are equally critical and more directly under NHS control. Healthcare facilities are energy-intensive environments, operating 24/7 with stringent temperature, humidity, and air quality requirements. Medical equipment, from imaging systems to ventilators, consumes substantial power. Heating, ventilation, and air conditioning systems are often outdated and inefficient.

The global picture reveals the scale of the challenge. Roughly 100,000 health facilities in sub-Saharan Africa lack reliable electricity, affecting nearly a billion people worldwide. Up to 70% of medical equipment in developing countries sits unused due to power failures [3]. Cold chains for vaccines, digital surveillance systems, early warning platforms, and telehealth services all depend on reliable power that serving populations don’t have. Closing the healthcare electrification gap by 2030 would cost $4.9 billion—less than one year of current global climate-health spending [3].

The NHS faces legally binding national targets aligned with the UK’s commitment to 68% emissions reduction by 2030 under the Climate Change Act [8]. Achieving this requires systematic infrastructure transformation: renewable energy integration, building retrofits, equipment upgrades, and intelligent energy management systems. The challenge is implementing these changes while maintaining clinical operations, managing constrained budgets, and avoiding disruption to patient care.

Climate resilience adds another dimension. The Belém Health Action Plan emphasizes not just reducing healthcare’s carbon footprint, but ensuring health systems can withstand climate impacts such as extreme heat, flooding, supply chain disruptions, and increased demand from climate-related health conditions [2]. Infrastructure must be both low-carbon and adaptive.

Low carbon heat and power (CHP) system

This requires engineering solutions that integrate multiple objectives. Building management systems can optimize energy use in real-time, balancing clinical requirements with efficiency. Heat recovery systems capture waste energy from medical equipment and HVAC. LED lighting, high-efficiency chillers, and smart controls reduce baseload consumption. Renewable energy including solar panels and heat pumps can decarbonize power supply while increasing resilience against grid disruptions.

Medical equipment presents particular challenges and opportunities. Imaging systems, sterilization equipment, and laboratory instruments are major energy consumers. Newer technology models offer significant efficiency improvements, but capital costs and procurement cycles slow adoption. Energy audits can identify high-impact replacement priorities while maintenance protocols can ensure equipment operates at peak efficiency. Procurement specifications can mandate energy performance standards, driving market transformation toward more efficient technologies.

Yet the barriers are not primarily technical. The engineering solutions already exist for most of these issues. The challenge is implementation at scale across a large, complex, budget-constrained system where NHS trusts vary widely in estates management capacity, sustainability expertise, and capital funding. Standardized frameworks, technical guidance, and shared learning are therefore essential, but so too is policy support—carbon budgets that create financial incentives, streamlined approval processes for retrofit projects, and integration of sustainability metrics into clinical and operational decision-making.

The Finance Gap

The Belém Health Action Plan launched with endorsement from more than 30 countries and 50 organizations, elevated health as a frontline climate priority [1]. Yet the launch came with no new financial commitments from endorsing nations. The sole funding announcement came from a coalition of philanthropies including the Gates Foundation, Wellcome Trust, and Rockefeller Foundation: a $300 million one-time grant to support climate-health adaptation measures [3].

That figure is dwarfed by estimates that low- and middle-income countries require at least $11 billion annually just for basic health adaptation—covering only disease control for malaria, dengue, diarrheal diseases, heat-related mortality, and essential surveillance improvements. This excludes respiratory illnesses, malnutrition, mental health services, additional infectious disease programs, workers’ health protection, supply chain adaptation, and health system decarbonization—most of what the Belém plan contains [3].

Current health-specific climate finance reaching those countries totals perhaps $500 to $700 million annually, representing 2% of adaptation funding and 0.5% of multilateral climate finance [3]. The gap between need and reality is colossal and for the NHS, the challenge is different but no less urgent: implement transformation while managing constrained budgets and maintaining clinical operations.

From Belém to Birmingham: The Path Forward

The Belém Health Action Plan sends a clear message: successful climate adaptation cannot be achieved without focusing on health systems, and health systems cannot fulfill their mission without addressing their climate impact [2]. For the NHS, this translates into immediate, concrete challenges in sustainable procurement and climate-resilient infrastructure.

Progress requires collaboration across disciplines and sectors, requiring engineers to work alongside clinicians, procurement specialists, policymakers, and manufacturers. Sustainability cannot be an add-on; it must be integrated into device development from the concept stage, into infrastructure planning from the design phase, and into procurement decisions from the specification stage.

A sustainable supply chain can reduce environmental impact, improve resilience to climate disruptions, and drive innovation in medical technology, and a climate-resilient infrastructure can lower operating costs, enhance patient and staff comfort during extreme weather events, and prepare facilities for future climate impacts. The NHS should then, be given both the mandate and the scale to drive transformation, not just within the UK, but as a model for health systems globally.

As Brazil’s Health Minister Alexandre Padilha stated at COP30: “The climate crisis is first and foremost a crisis of public health throughout the world. The time of warnings has finished. Now we are living in a time of consequences. The climate has already changed, so we have no alternative but to have public policies to adapt and face climate change” [3].

The question now is not whether healthcare can decarbonize, but how quickly can it be achieved? The Belém Health Action Plan has the potential to provide the framework on which the NHS can assure its April 2027 deadline while the engineering community provides the solutions. What remains is the collective will to implement them and at the pace and scale the climate crisis demands.

References

[1] COP30 Brasil (2025). COP30 approves Belém Package. Available at: https://cop30.br/en/news-about-cop30/cop30-approves-belem-package1

[2] World Health Organization (2025). The Belém Health Action Plan for the Adaptation of the Health Sector to Climate Change - Executive Summary. Available at: https://cdn.who.int/media/docs/default-source/climate-change/executive_summary_bhap.pdf?sfvrsn=31ac4a86_3

[3] Anderson, S. (2025). Brazil Wins Limited Backing For COP30 Climate-Health Plan, But Nations Commit No Finance. Health Policy Watch. Available at: https://healthpolicy-watch.news/brazil-cop30-belem-health-climate-plan/

[4] Health Care Without Harm (2019). Health Care’s Climate Footprint: How the Health Sector Contributes to the Global Climate Crisis and Opportunities for Action. Available at: https://noharm-global.org/climatefootprint

[5] NHS England (2022). Delivering a Net Zero National Health Service. Available at: https://www.england.nhs.uk/greenernhs/a-net-zero-nhs/

[6] NHS England (2024). NHS Standard Contract 2024/25: Supplier Requirements. Available at: https://www.england.nhs.uk/greenernhs/get-involved/suppliers/

[7] Healthcare Financial Management Association (2025). NHS Environmental Sustainability Guidance Map. Available at: https://www.hfma.org.uk/publications/details/nhs-environmental-sustainability-guidance-map

[8] UK Climate Change Committee (2025). Progress in Reducing Emissions: 2025 Report to Parliament. Available at: https://www.theccc.org.uk/publication/2025-progress-report-to-parliament/