In reply: I thank McGain and colleagues for their commentary on my Editorial.1 While the science is clear and the data indicate serious action must be taken in the next decade,2 I concur that the major changes needed in the health care system to achieve a sustainable reduction in emissions have not yet materialised in Australia. I agree both a bottom up (leading by example) and a top down (systems) approach is ideally required, and I support the idea of creating a Healthcare Sustainable Development Unit or equivalent. The details would need to be worked out, including whether such an entity should be national or embedded in each state and territory, and how it could optimally work with health professionals across the system. Based on the UK experience as you point out, such an approach has the potential to both reduce health care carbon emissions while creating savings; a win‐win situation.
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