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The scorecard initiative was set up in response to the climate and ecological emergency; the most significant health threat of our time. The climate crisis affects health in a myriad of ways, disproportionately impacting vulnerable communities who have done the least to cause it. Tackling the climate crisis requires health systems to acknowledge and address the drivers of planetary destruction, including neo-colonialism, an extractive economy in pursuit of limitless growth, and militarism. The health sector has a crucial role to play in changing the climate trajectory. We must work collectively to make it happen. 

This initiative focuses on bringing about justice-driven change within health organisations, focusing primarily on professional bodies. In 2019, we began writing a checklist of achievable climate actions that we wished health organisations would take. We involved a range of experts from environmental finance consultants, to climate educators at the Centre for Sustainable Healthcare, to Medact climate campaigners. Together we developed the scorecard which breaks down climate action into manageable steps.


  • Support health organisations in moving towards a just, healthy and sustainable world at the rate and speed required to ensure a liveable planet for all.

  • Enable health professionals to know what climate action has been taken by their membership organisation 


  • A framework of achievable yet ambitious actions is used to score organisations across four domains.

  • Cross-organisational learning is facilitated by sharing examples of good practice.

  • Progress is monitored by repeating the scorecard biennially.



A working group of experts in the field of climate, nature and health developed a framework of climate actions that were considered ambitious yet achievable for health organisations. Four core domains were identified: internal operations; finance; education and training; and advocacy. Questions were written to cover the highest impact areas. We involved a range of experts to maximise the content validity.

Weighting was determined according to the estimated impact of each question on mitigating the climate and ecological emergency. Questions considered to have the greatest impact have the most points attached. There is no gold standard way to do this, so we consulted many resources and external experts in order to identify the key areas and weight them accordingly. The scores were refined through an iterative process.



We invite UK-based health professional bodies (medical, nursing, allied health, pharmacy and psychology).


Health organisations complete the questionnaire. The questionnaire is self-reported and includes suggestions of evidence which helps verify the answers. The questionnaire is then marked by the scorecard team. During the marking process, organisations may be contacted to seek clarification on some answers. Finalised scores are shared with the organisation. 


We group organisations into categories according to size and nature, and present their scores for each domain, ranking them by their total score. We also publish individual reports for each organisation, outlining actions taken and next steps. 



The initiative is led by Eleanor Cooke and Amelia Cussans and supported by

Will Nash. We are NHS doctors and researchers in the field of climate and health.


We are immensely grateful to everyone who has given their time to link between the scorecard initiative and their health organisation:


Alan Barnes, Heather Baid, Laura Burton, Isobel Braithwaite, Cara Campbell, Charlotte Cheeseman, Matthew Clarke, Rosemary Lugg, Jenny Girdler, Anya Gopfert, Sivan Greene, Natasha Guildford, Hilde Gundersen, Sara Harford, Alice Harpur, Karen Herndon, Jo Hindley, Charlotte Hurry, Kamilla Kingsley, Gareth Morgan, Will Nash, Jack Oliver-Blaney, Thomas Payne, Alexander Robertson, Andrew Savill, Aimee Serisier, Sarah Sheard, Natalie Smith, Timothy Spruell, Will Stableforth, Victoria Stanford, Andrew Stevenson, Olivia Stevenson, Mike Tomson, Louise Weissel.


We also thank the following people, whose skills and expertise has been instrumental in the development of the initiative:

Rob Abrams, Nick Bailey, Matt Beresford, Yaso Browne, Chester Cornford, Alice Clack, Ben Eder, Nuala Hampson, Richard Hixson, Terry Kemple, Tracy Lyons, Joel Moreland, Frances Mortimer, Elaine Mulcahy, Elizabeth Robertson, Richard Smith. 

doctors at a climate demonstration with a banner reading first do no harm



The Climate and Health Scorecard Initiative has been endorsed by the following organisations: 





​After the second round (2022-23), all participating organisations were invited to give feedback. 15 responses demonstrated that:

  • 93% of respondents found that participating in the CHSI helped their organisations identify areas where they can improve their environmental practices. 

  • 75% of organisations reported making changes as a result of participation in the CHSI

  • 73% reported that receiving scores encourages climate action

  • 87% reported that receiving individualised report cards is valuable in developing their organisation’s climate strategy

  • Reported changes as a result of the scorecard initiative included: carbon footprinting the organisation; changing banks and pension providers; advocacy; and gaps within action plans;  establishing an environmental group.



"The report cards are so clear and easy to engage with, enabling us to give positive recognition across the organisation of actions have already completed. At the same time, it clearly sets out what more needs to be achieved. Having the achieved actions and next steps alongside each other, makes this process feel manageable."

"The scorecard has allowed us to develop an action plan and identify easy wins."

“This and the results of the previous iteration which were published earlier in October have generated useful discussion in our own college about what further action we can take in this area, and it has been very helpful to learn from activities happening in other healthcare organisations across the UK.”

"It [the survey] was a good exercise and has given us food for thought from which we have developed a set of actions."

“This report is extremely useful for our strategic motives moving forward and I’m sure will help influence what steps we make next.”

"I think that the scorecard is going to be used as a template for change. It breaks up the multitude of actions into manageable portions."

"We plan to use this as a baseline for future work.  There is much to do!"

"Thank you for organising this initiative, and being so helpful throughout the process. We really felt listened to, and appreciate the opportunity to participate and develop our action plan. Well done for producing some excellent outputs!"

The Domains

Internal operations


& training


  • My health organisation is not UK-based, can I participate in the initiative?
    Although we are reporting on UK health organisations at present, we would love to collaborate with international partners; please do get in touch with us using the contact form below.
  • How is the score weighting determined?
    Weighting was determined according to the estimated impact of each question on mitigating the climate and ecological emergency. Questions that carry the greatest impact have the most points attached. There is no gold standard way to do this, so we consulted many resources and external experts in order to identify the key areas and weight them accordingly. The scores were refined through an iterative process.
  • Do you work with the Planetary Health Report Card?
    The scorecard initiative and Planetary Health Report Card (PHRC) formed independently around the same time (2019-2020). Our methodologies are similar but we focus on different sorts of health organisations. PHRC report on medical schools whereas we primarily report on professional bodies (of medical, nursing, allied health, psychology and pharmacy organisations). We have met with PHRC on a few occasions to exchange learning. Please check out their work here!
  • Can organisations withdraw from the initiative?
    Organisations can withdraw from the scorecard initiative at any time.
  • How often will the scorecard initiative take place?
    We plan to repeat biennially. We are mindful of the time required for organisations to complete the questionnaire, however we hope that this will be considerably quicker each year, as organisations will be able to consult their previous answers and update them, rather than filling out the questionnaire from scratch.
  • Do you receive funding?
    At the moment our work is unfunded. We were commissioned by the UK Health Alliance on Climate Change (UKHACC) to produce a report on their members' progress on meeting their 11 Commitments, which are measured by the scorecard. The report is hosted here on UKHACC's page on the 11 Commitments.
  • Why is the questionnaire so long?
    We accept that the participation rate would be higher if the questionnaire was brief. Following the pilot we have aimed to simplify the questions and have removed any that were identified as lower impact. We explored the option of distilling the questionnaire to a small number of high impact questions, however we have also received feedback that the breadth and depth of the questionnaire are valuable in terms of providing a list of actions that organisations could take. We are always open to further feedback on the questionnaire and how it could be improved.
  • Can organisations challenge their score?
    Yes; we complete the questionnaires collaboratively with organisations. Once the questionnaires are cross-checked and finalised, we return them to organisations to review before the final scores are published. We do not amend scores post-publication.
  • When will the next round of the climate and health scorecard initiative take place?
    The next round will be assessing climate action over the two year period of 1 January 2024 to 31 December 2025. The results will be published in early 2026.
  • How was the questionnaire constructed?
    We wrote a checklist of achievable climate actions that we wished health organisations would take. Core domains were identified and questions were written to cover all essential areas. We involved a number of experts to maximise the content validity.
  • How do you measure your impact?
    We collect feedback from organisations who participate in the scorecard initiative. Many organisations have told us that the initiative has helped them develop a more robust and ambitious climate strategy. We formally collect qualitative data from participants at the end of each round. See feedback above.
  • How is data stored?
    Questionnaire data is stored in a password-protected data centre that is only accessed by the project leads.
  • What types of health organisation can take part in the scorecard initiative?
    At present we are scoring UK-based health professional bodies (medical, nursing, allied health, pharmacy and psychology); unions; journals; and regulators.
  • How do organisations benefit from participating?
    All health organisations are in the process of tackling climate change and ecological degradation. There is much work to do and the scorecard breaks up this monumental task into manageable steps. We make it easier for organisations by providing a framework to guide their strategy, and by writing an individualised report detailing actions taken as well as next steps. It is also an opportunity to showcase great work.
  • Do you score NHS Trusts, primary care networks (PCNs) or integrated care systems (ICSs)?
    At the moment we do not score Trusts, PCNs or ICSs, but we are looking to adapt our questionnaire for these types of organisations.
  • Why do you publish your findings publicly?
    We want members of health organisations to be able to see what progress has been made by their organisation. Without this information it is difficult to know how their organisation can improve. It can also useful to look at the positive examples so that organisations can exchange learning and ultimately act faster on the climate and ecological emergency.
  • Who wrote the questionnaire?
    The questionnaire was written by a working group of experts in the field of climate change and health. Due to the scope of the questionnaire, we involved a range of experts from environmental finance consultants; to climate educators at the Centre for Sustainable Healthcare; to Medact climate campaigners. See 'our team' above for the full list of brilliant people who have contributed to this initiative.
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