When concrete is used, design and construction teams can significantly reduce the material’s CO2 footprint by replacing some of the cement with other pozzolanic materials such as fly ash or slag, which reduce the very high energy intensity of cement production. Sustainable Design Challenge: Reducing the CO2 footprint of building materials: For many years, the energy debate in the health sector has focused on reducing the energy needs of construction operations. Considering the emissions associated with the life cycle of building construction and the operation of a health building, reducing the incorporated carbon emissions associated with the manufacture of building materials now has a direct impact on the carbon content. When a new building is the best option – often necessary to meet a programme, earthquake, site or other health criteria – there are a number of solutions that can reduce the reduced carbon content of building materials. Reducing the carbon incorporated in building materials is essential to reducing the overall environmental footprint of our buildings. Steel and concrete are not the only materials with a significant CO2 footprint; the building envelope and some interior products must also be taken into account. Concrete, steel and aluminium production account for more than 21% of all carbon emissions in the world, and a significant proportion of these materials are produced for the construction industry. This article is part of “Rising Up”, a special report first published in the October 2019 edition of Healthcare Design, in which sustainability leaders shed light on the industry’s major environmental design challenges, their contribution and the solutions needed to address them. For example, minimising the need for steel and concrete as much as possible and taking more account of the carbon footprint in product selection and specification can make all the difference. Better yet, design to reduce carbon emissions can often also reduce construction costs by saving materials. Design teams can make informed decisions about building design, specifications and construction that will significantly reduce these impacts. However, the relatively high CO2 footprint of these two materials makes them an easy target for rapid design changes, and a small additional effort can go a long way. We expect the renovation of this existing building to reduce the project’s CO2 emissions by 50-75% compared to a new building.