'Sustainable development is good management. Consider the cost of energy - good management expects efficient energy use. Consider the difficulty in recruiting staff - good management develops skills to meet its needs from the local community. Consider disadvantaged communities - good management procures goods and services locally'

It is difficult these days to turn to any publication without some reference to climate change.

Economist Sir Nicholas Stern's report says scientific evidence of it and its potentially disastrous consequences is overwhelming. A shrinking of the global economy by a fifth is forecast, costing up to£3.68tr, with up to 200 million people becoming refugees through drought or flood. The evidence is clear that our day-to-day activity is having a dramatic effect on climate.

Actions towards a more balanced approach are captured in the umbrella term 'sustainable development', a phrase whose usual meaning is explained in the 1987 Brundtland Commission report Our Common Future: 'Development which meets the needs of the present without compromising the ability of future generations to meet their own needs.'

What should the NHS do? It is an immense organisation and, as such, has a significant impact.

Back in 2004, the Department of Health emphasised the vital role of the NHS in sustainable development.

In 2005, the UK sustainable development strategy Securing the Future set a target for the NHS to be a leader 'in sustainable procurement across EU member states by 2009'.

In 2006, the sustainable development action plan was launched along with a sustainable development toolkit and action pack.

In June 2006 a Framework for Sustainable Development on the Government Estatewas published. This set new targets to reduce carbon emissions from offices and government office road vehicles. It also set targets to increase energy efficiency and reduce waste. It set a goal of reducing carbon emissions in total by 0.15 million tonnes a year by 2010.

Yet only a small number of trusts have committed to reducing their carbon footprint by 15 per cent. Why are more NHS organisations not in the vanguard?

Sustainable development is good management. Consider the cost of energy - good management expects efficient energy use. Consider the difficulty in recruiting staff - good management develops skills to meet its needs from the local community. Consider disadvantaged communities - good management procures goods and services locally.

Anecdotes from some newly established primary care and foundation trusts suggest that sustainable development is being incorporated into the new organisations. Some procure food from local suppliers and use local community facilities for meetings. Moreover, some parts of the NHS have made significant progress with local procurement schemes. But others are struggling. An example is the challenge of eliminating waste produced by single-use equipment.

The NHS has a social contract with the public and a moral responsibility to lead by example. Sustainable development must underpin efforts to reduce health inequalities and should become an inherent consideration in good management.

The NHS cannot turn its back on sustainable development or wait for others to go first. Instead it should lead the way, before it is too late.

Dr Ruth Hussey is NHS North West regional director for public health.