Singapore Healthcare Sustainability Symposium - Dr Janil Puthucheary

Good morning, everyone. Thank you for inviting me to join you at the Singapore Healthcare Sustainability Symposium.

The room is packed. We have a very strong turnout, and it’s a testament to the momentum spearheaded by our three public healthcare clusters since the inaugural edition in 2024. The progress is so good that now it’s becoming not a symposium, but a whole week of activity. It’s this ability to bring people together on an issue such as sustainability in healthcare. It’s a testament not just to the importance of the issue, but your ability to engage your teams, your trainees, your juniors, your partners on something that matters to all of us. My congratulations to NHG Health, SingHealth, and NUHS for all the work that you’ve put in into this very meaningful initiative. Something like this doesn’t happen because of a nice speech or a nice logo. It’s because individuals are really taking their effort and putting their passion and heart into this important subject. So thank you all for that.

This collaboration is critical. The healthcare sector is increasingly confronting the growing impacts of climate change, and that’s affecting our public health as well as our day-to-day lives. Hotter days mean higher chance of heat stress. Warmer temperatures increase the prevalence of vector-borne diseases like dengue. Drier weather also means a higher likelihood of haze. We’ve just experienced that, and with haze came an increasing prevalence of respiratory illnesses. Attendance at some of your clinics probably went up. Some of the burden of work certainly increased.

The reality is, we are not going to be able to stop climate change. It’s already happening around us. However, we can and we must take steps to limit the severity of its impact. Where clinically appropriate, using energy, materials and medical resources more efficiently can lower emissions, free up resources for patient care, and make the system more resilient. Greener Care and Better Health go hand in hand.

What we do, each individual act may be small. The sector as a whole may not transform the entire economy, but every bit makes a difference. Every percentage gained, every tonne of CO2 saved, it builds resilience because then where it’s not possible, and you still have to, for a variety of clinical reasons, use fossil fuel or use plastic, and it’s absolutely necessary. You then now have much more headroom to do so. So we can concentrate on what we need to do as we improve our climate behaviour.

Globally, the healthcare sector contributes around 5 per cent of greenhouse gas emissions per year, more than aviation and shipping combined. Singapore’s healthcare system is already relatively carbon efficient. Our carbon intensity is about 20 per cent lower than healthcare systems in other advanced economies. But there is more we can do.

About 90 per cent of our emissions are indirect. Much of this footprint is embedded in the goods and services that healthcare relies on: food, transport, logistics, keeping the lights and power on. Medicines and medical products alone making up about one-third.

That is an important point to understand: greener healthcare cannot be achieved by hospitals acting alone. We have to look across the system—how we build our infrastructure, how we deliver care, how we use resources, and how we equip our people. We have to look at those things which are specific to our domain – clinical decisions, medical products –  but we also have to embed some of the values and behaviours that you see across our society around the use of energy, the use of resources, and how we design our infrastructure. Let me give you some examples on how our public healthcare system is making progress in each of these areas.

We are building greener and more resilient infrastructure. In 2023, Yishun Community Hospital was the first healthcare institution to achieve the Green Mark Platinum Super Low Energy certification, one of Singapore’s highest green-building standards. Tan Tock Seng Hospital followed soon as the first acute hospital in 2024, and Serangoon Polyclinic as the first polyclinic in 2025. Others have since joined them. What started as a series of firsts is no longer firsts, and that means the momentum is growing. People are understanding how important this is, and more and more facilities are achieving that mark. This is becoming the norm of how we build healthcare infrastructure.

At the Institute of Mental Health, we have Singapore’s largest healthcare solar installation, a 3.2 megawatt-peak system, generating enough electricity each year to cover up to approximately 20 per cent of the hospital’s total electricity needs. Here at Woodlands Hospital, rain gardens meet an estimated 87 per cent of the campus’s irrigation needs. These are practical examples of infrastructure that use less energy and water, and are excellent for purpose for healthcare.

Then we look at clinical care. We are delivering more sustainable clinical care. One area which we can reduce the carbon footprint of clinical care is in the use of anaesthetic gases. Desflurane and nitrous oxide are potent greenhouse gases. Since 2019, our hospitals have reduced the use of desflurane by 45 per cent and nitrous oxide by 35 per cent, without compromising patient outcomes, which is the thing we must keep our eye on. In July 2026, Changi General Hospital announced that it had eliminated the use of desflurane from all surgical procedures, making it the first hospital in Singapore to do so.

Care teams are also replacing single-use items with reusable alternatives while not compromising safety. Sengkang General Hospital, for example, has replaced more than 112,000 disposable bags a year with reusable laundry bags. During COVID-19, specialists at the National Centre for Infectious Diseases found that reducing the use of disposable gowns significantly cut plastic waste while continuing to keep our healthcare workers safe. Each of these steps measured and audited, checked carefully for safety and quality, maintaining excellence all the way.

Our three healthcare clusters will take these efforts further as one public healthcare system. NHG Health, NUHS and SingHealth will broaden the adoption of sustainable clinical care, including exploring lower-carbon alternatives that maintain the same standard of patient care, and reducing tests and treatments that do not improve patient outcomes.

Third, we are building a more circular healthcare system. Some of the most effective ideas are sometimes the simplest. Medication boxes used to have a plastic viewing window so pharmacists and patients could identify the medicine inside. But any product that combines two types of materials, in this case plastic and paper, make the product much more difficult to recycle. Pharmacists at Tan Tock Seng Hospital redesigned them as a single-material paper box with openings that preserve visibility, while ensuring they still work with automated dispensing systems. All three healthcare clusters have since adopted the design, putting an estimated 4.4 million boxes a year on the path to recycling. This is an excellent example. Simple changes, piloted, innovated in one team within one institution, and now propagating across our entire public healthcare system.

In 2022, the National University Hospital partnered a Singapore-based start-up to turn selected hospital plastic waste, like syringes and surgical packaging, into NEWBitumen, a material used to pave roads around the hospital. It is a tangible example of how materials that would otherwise be discarded can be put to a new use. In all of these examples, there are lessons to be learnt outside of the healthcare system, and there are lessons that the healthcare system has learnt from sustainable initiatives from other industries and other domains. And I think this is a theme we have to keep returning to.

The next step is to make circularity more systematic. The three clusters will increase the use of reusable products, improve waste separation at source, and expand the recycling of materials such as stainless steel, linen and plastics.

Circularity must also extend beyond hospitals to the healthcare supply chain. In August this year, ALPS, the central procurement agency for public healthcare, worked with NTUC and the Healthcare Services Employees’ Union to bring the “Queen Bee” model to the healthcare sector. Under this model, a large anchor organisation helps smaller SME suppliers build their sustainability capability. This complements ALPS’s Price-Quality-Environment framework, which considers environmental impact alongside price and quality.

As we do this, we equip our people with the necessary skills and capabilities. The Centre for Healthcare Innovation’s (CHI) Sustainability Academy under NHG Health is building capability across the workforce. Sustainability champions networks are expanding across all three clusters, while innovation challenges are turning ground-up ideas into system-wide solutions.

We are also building these capabilities upstream where purchasing decisions are made. The CHI Sustainability Academy, together with ALPS and NanRise Pte Ltd, will launch the first green procurement course designed specifically for healthcare. It will help healthcare professionals consider sustainability more systematically in purchasing decisions, alongside cost, quality and clinical needs.

There is one final dimension I want to touch on. A sustainable healthcare system cannot only be environmentally sustainable. It has got to be sustainable on all fronts. We have heard about financial, resource sustainability, but we can also sustain the people and communities that we serves. At the Institute of Mental Health, the Beyond Production rehabilitation initiative enables patients living with mental health conditions to take part in supervised, productive work, from craft and art using recycled materials to barista training.

This reminds us about recovery going beyond getting better medically. It includes regaining confidence and independence, having opportunities to contribute, and finding purpose. As a sustainable institution, it reminds us that we can take steps to integrate our work with our patients out into the community, into the issues of sustainability and have them and our entire society, our entire community play a part. Every little bit helps. Raising awareness through the patients and families are very important. I am looking forward to visiting the IMH booth later to see some of the products handcrafted by our participants. Each piece is a reminder that a sustainable health system must care for the planet, while creating opportunities for the people it serves.

Let me close with three asks. To our industry and supply chain partners: work with us to develop practical, sustainable solutions. To our healthcare professionals: keep finding greener ways to deliver care. And to all of us: remember that sustainability starts even before we enter a healthcare facility. Stay healthy and prevent illness where we can.

If we do this well, we can build a healthcare system that delivers better health, uses resources wisely and stays resilient in a changing climate. At its heart, this is what Greener Care and Better Health should mean for Singapore. Thank you.