Rising greenhouse gas emissions (GHGEs) are responsible for climate change and have both direct and indirect implications for health. Over 160 parties have communicated their CO2 reduction targets to the UNFCCC for 2030 and 2050, i.e. for the EU a target of at least 40% below 1990 levels, for Asia and the APAC region a range from 25% to over 40%. The main drivers for GHGE are the energy industry, agriculture, transport, and household consumption, but the healthcare sector globally contributes an estimated 5-8% of the total GHGE. The majority of healthcare sector CO2 emissions come from procurement of goods and services, hospitals and pharmaceutical industry. Some countries have developed different strategies to curb the healthcare GHGE such as taxation and green public procurement (GPP); GPP may also include procurement of pharmaceuticals and devices (e.g. Sweden, UK). Besides, manufacturers have developed sustainability strategies and reduction plans for GHGE and waste. At product level companies have started to review and improve the carbon footprint (PCF) by mapping the CO2 profile throughout the life cycle (“cradle to grave”). Priorities are in high volume indications with routine use of disposable devices, e.g. inhalers, diabetes injectors. Inhalers for respiratory patients contribute to GHGE as most contain propellants. The UK NHS has reported that propellants from inhalers account for 8% of the NHS’s entire carbon footprint. More than 640 million inhalers are used globally every year. However, product HTA and appraisals typically favour low cost inhalers and do not consider benefits to the system such as less waste and less CO2e. Budget Impact Analyses may include the monetary value of a more favourable PCF using a social cost of carbon (SCC), estimated at 36 to 220 US$/tCO2e. Such analysis may inform decisions which contribute to the national efforts to reduce CO2 emissions.