Environmental and Climate Health Policy
How ASF integrates environmental sustainability and climate health into standards, governance and operations
Foreword
Climate change is the defining health threat of the twenty-first century. The WHO COP28 Health Declaration (2023), signed by 147 countries, names healthcare systems both as significant contributors to global greenhouse gas emissions and as first responders to the health consequences of a changing climate [1]. The Paris Agreement on Climate Change (2015) establishes binding obligations for the countries in which ASF operates [2]. The Lancet Countdown on Health and Climate Change documents annually the measurable health burden of climate-related hazards that facilities ASF accredits are already managing [3].
An accreditation body that writes quality standards for healthcare facilities without addressing environmental sustainability and climate health is writing standards that are already partially obsolete. JCI revised its standards in 2024 to include environmental sustainability criteria. The Australian Council on Healthcare Standards (ACHS) has a dedicated sustainability chapter. The Haute Autorité de Santé (HAS) requires hospitals to have a plan vert. ASF’s standards will do the same [4–6].
This policy establishes the framework. The specific criteria will be developed through the standard revision process — governed by the same evidence-based methodology and public consultation requirements as every other criterion ASF publishes. This policy is the commitment; the criteria are the implementation.
1. Scope
This policy covers three distinct levels of ASF’s work:
- Standards content: Environmental sustainability and climate resilience criteria that ASF will embed in its published organisational standards
- Accreditation process: How surveyors assess climate and environmental health preparedness as part of the survey
- ASF’s own operations: The environmental footprint of ASF as an organisation — travel, digital infrastructure, and paper use
2. International Framework
ASF’s approach to environmental and climate health is grounded in the following international frameworks, in addition to the WHO and JCI references above:
3. Environmental Criteria in ASF Standards
The following environmental and climate health criteria will be incorporated into ASF organisational standards through the standard revision process. Where a criterion already exists (e.g. waste management in the Hospital Standard), this policy commits to strengthening it in the next revision. Where no criterion yet exists, this policy commits to developing one.
Every accredited facility must have a written climate risk assessment identifying the specific climate hazards relevant to its location (floods, heat, drought, storms, wildfire) and a response plan for each. The plan must be tested, dated, and updated when the facility’s risk profile changes. This extends the existing emergency preparedness criteria in all seven organisational standards.
Safe management of clinical waste, pharmaceutical waste, and sharps — including segregation at source, documented disposal routes, and staff training — is already a criterion in the Hospital and Ambulatory standards. This policy commits to extending this criterion to all seven organisational standards, and to strengthening it in the next Hospital and Ambulatory revision to align with WHO’s Health-Care Waste Management guidelines (2022 edition).
The next revision of the Hospital Standard and the Long-Term Care Standard will introduce a criterion requiring facilities to document their energy and water consumption baseline and to have an improvement plan in place. In the Crisis and Transitional categories, the criterion will be adapted to the available infrastructure — the focus is on efficient use of available resources, not on achieving a specific benchmark that may be unreachable in a fragile-system context.
Antimicrobial resistance (AMR) is classified by WHO as an environmental health threat — the spread of resistant organisms through wastewater and the environment is a direct consequence of healthcare antibiotic use. The Hospital Standard v3.0 (September 2026) strengthens the AMR stewardship criterion. The Primary Health Clinic and Ambulatory standards will receive corresponding criteria in their next revisions.
Healthcare is one of the largest institutional consumers of single-use plastics globally — primarily through PPE, sterile packaging, and single-use medical devices. WHO estimates healthcare generates approximately 0.5 kg of hazardous waste per bed per day. ASF standards already require safe clinical waste disposal; the next revision cycle will add criteria requiring facilities to document their single-use plastic and PPE waste volumes, have a written procurement policy that prioritises reusable alternatives where clinically safe to do so, and participate in any national healthcare plastics-reduction initiative available in their jurisdiction. The Crisis and Transitional category adaptation will focus on documented safe disposal pathways rather than reduction targets.
The 2026 revision cycle will introduce criteria addressing heat health planning — including cooling provisions for vulnerable patients (elderly, paediatric, immunocompromised) and protocols for managing climate-sensitive disease presentations (heat stroke, vector-borne disease, respiratory illness exacerbated by air quality events). These criteria will be applied across all relevant organisational standards.
4. The Four-Category System and Environmental Equity
Environmental equity is inseparable from health equity in ASF’s context. The facilities in the Crisis and Transitional categories — those serving fragile-system and conflict-affected populations — often operate in the environments most severely affected by climate change, with the least capacity to respond. This creates a genuine tension: the Transitional-category facility in a flood-prone sub-Saharan African region needs climate resilience criteria more urgently than its Standard-category counterpart in a stable high-income setting, but has fewer resources to meet them.
ASF’s response to this tension is the same as for all other equity issues: the Universal Floor — the minimum requirements that apply regardless of category — is set at what any facility, regardless of resource level, can genuinely achieve. Category-specific environmental criteria are then calibrated against the actual resources available in that category, not against an aspirational standard developed in a high-income context. The equity review checklist (ASF-EDI-001-v1, Section 8) specifically includes a resource equity question that must be applied to all environmental criteria.
5. Surveyor Competency in Environmental Health
As environmental health criteria are introduced into ASF’s standards, the ASF Surveyor Training Standard will be updated to include environmental health assessment competency in the training curriculum. By the next revision of the Surveyor Training Standard (scheduled September 2029), Module 1 (Standards Interpretation) will include a dedicated component on environmental health criteria, and at least one scored assessment scenario in Domain D (Competency Assessment) will test the surveyor’s ability to assess climate resilience and waste management criteria in a simulated survey.
6. ASF’s Own Environmental Footprint
ASF cannot require environmental commitments from the facilities it accredits without making equivalent commitments in its own operations. The following commitments apply to ASF’s own operations with effect from January 2027:
- Travel: ASF will maintain a log of all international travel undertaken on ASF business. Where a meeting can be conducted remotely without material loss of outcome, remote conduct is the default. Where in-person travel is necessary, economy class is the standard for journeys under eight hours.
- Digital infrastructure: ASF’s website and digital platforms are hosted with providers who disclose their energy sourcing. ASF will review its hosting providers’ environmental credentials at each contract renewal from 2027, prioritising providers who have published a Science Based Target (SBT) for emissions reduction consistent with the 1.5 degrees Celsius pathway of the Paris Agreement.
- Paper: ASF’s printed publications are produced on FSC-certified paper. Digital-first publication — with print as an option, not the default — is ASF’s policy for all documents published from September 2026 onwards.
- Reporting: ASF’s Annual Activity Report will include a brief environmental footprint section from the 2027 report onwards, covering travel emissions (tonnes CO₂e), digital hosting energy disclosure, and paper consumption.
7. Implementation Timeline
References
- World Health Organization. COP28 UAE Declaration on Climate and Health. Dubai: WHO; 2023.
- United Nations. Paris Agreement. New York: UN; 2015.
- Romanello M, et al. The 2024 report of the Lancet Countdown on health and climate change. The Lancet. 2024;404(10467):1847–1922.
- Joint Commission International. Joint Commission International Accreditation Standards for Hospitals, 8th edition. Oakbrook Terrace (IL): JCI; 2024. Chapter: Environment of Care.
- Australian Council on Healthcare Standards. EQuIP National Guide. Sydney: ACHS; 2023. Standard 1.6 — Sustainability.
- Haute Autorité de Santé. Référentiel de certification des établissements de santé. Saint-Denis: HAS; 2023.
- World Health Organization. Operational Framework for Building Climate Resilient Health Systems. Geneva: WHO; 2015.
- United Nations. Sendai Framework for Disaster Risk Reduction 2015–2030. New York: UN; 2015.
- World Health Organization. Safe Management of Wastes from Health-Care Activities, 3rd edition. Geneva: WHO; 2022.
- ISO. ISO 14001:2015 — Environmental Management Systems. Geneva: ISO; 2015.
- World Health Organization. No Time to Waste: Addressing the Challenge of Plastic Waste in Healthcare. Geneva: WHO; 2023.
- Whitmee S, et al. Safeguarding human health in the Anthropocene epoch: report of the Rockefeller Foundation–Lancet Commission on planetary health. The Lancet. 2015;386(10007):1973–2028.
