Climate change is placing European healthcare systems under increasing pressure. Heatwaves, floods, wildfires and air pollution are increasing the demand for care whilst simultaneously disrupting healthcare provision and infrastructure. At the same time, the healthcare sector contributes substantially to environmental impact and accounts for about 5 per cent of greenhouse gas emissions. This creates a vicious circle: healthcare systems both contribute to climate change and are affected by it.

Dionne: ‘GOV4CARE was an opportunity I couldn’t pass up. It was the first time I’d seen such an explicit combination of ecological sustainability and climate resilience at the level of the healthcare system within a European research priority, linked to the ambition not only to measure, but also actually to use that knowledge to improve healthcare systems. All knowledge gained in this project is translated into practical decision support and tools for applying it.’

In her view, sustainability and climate resilience cannot be treated as separate objectives, because measures in these areas can affect the quality, accessibility, equity, costs, and other objectives of the healthcare system. Dionne: ‘That is why, in GOV4CARE, sustainability and climate resilience are integrally incorporated into the governance of healthcare systems: how do we measure performance, where and why do countries differ, which mitigation, adaptation and preparedness strategies actually work, what do they cost, and under what circumstances can they be implemented and scaled up?’

From 1 January 2027, GOV4CARE will develop a measurement tool and collect data across 31 European countries (EU27 + Norway, the UK, Switzerland and Iceland) to measure and compare the sustainability and climate resilience of healthcare systems. In addition, the project is mapping mitigation, adaptation, and preparedness strategies already in use, investigating which are effective, and then prioritising promising strategies to examine their implementation and scalability.

Examples of strategies that GOV4CARE will investigate in practice include sustainable food provision in care settings, sustainable procurement based on life-cycle criteria, digital-first care, the shift towards home care, heat health plans and early warning systems, climate-resilient infrastructure and continuity of care, and the preparation of primary, home, community and long-term care for climate-related risks.

To achieve this, a large, international consortium has been formed, combining expertise in healthcare systems and governance with, amongst other things, climate sciences, environmental sciences, public health, implementation sciences and modelling expertise. Ministries, national public health institutes, healthcare organisations and international and European networks are also involved. Dionne: ‘This combination is important because we not only want to develop new knowledge, but also want to translate that knowledge into practice together with the parties that steer and organise healthcare systems.’

Dionne: ‘In my research, I have long been exploring the question of how we can measure and compare the performance of healthcare systems, and, above all, how we can use that information to improve policy and decision-making. How can we strike a better balance in our healthcare systems between people, affordability and the planet’s limits?’

She explains that ecological sustainability and climate resilience are still not sufficiently integrated into the way we assess and manage healthcare systems, and that this is a key reason for setting up GOV4CARE. Dionne: ‘For example, we systematically measure and compare quality, accessibility, affordability and efficiency, but we pay far less attention to the ecological impact of healthcare and the extent to which healthcare systems are prepared for and resilient to the consequences of climate change. Yet it is precisely what we measure that ultimately determines what policymakers and administrators can focus on.’