Background Health-care services are necessary for sustaining and improving human wellbeing, yet they have an environmental footprint that contributes to environment-related threats to human health. Previous studies have quantified the carbon emissions resulting from health care at a global level. We aimed to provide a global assessment of the wide-ranging environmental impacts of this sector.Methods In this multiregional input-output analysis, we evaluated the contribution of health-care sectors in driving environmental damage that in turn puts human health at risk. Using a global supply-chain database containing detailed information on health-care sectors, we quantified the direct and indirect supply-chain environmental damage driven by the demand for health care. We focused on seven environmental stressors with known adverse feedback cycles: greenhouse gas emissions, particulate matter, air pollutants (nitrogen oxides and sulphur dioxide), malaria risk, reactive nitrogen in water, and scarce water use.Findings Health care causes global environmental impacts that, depending on which indicator is considered, range between 1% and 5% of total global impacts, and are more than 5% for some national impacts.Interpretation Enhancing health-care expenditure to mitigate negative health effects of environmental damage is often promoted by health-care practitioners. However, global supply chains that feed into the enhanced activity of health-care sectors in turn initiate adverse feedback cycles by increasing the environmental impact of health care, thus counteracting the mission of health care.

Summary This contribution presents the state of the art of economy‐wide material flow accounting. Starting from a brief recollection of the intellectual and policy history of this approach, we outline system definition, key methodological assumptions, and derived indicators. The next section makes an effort to establish data reliability and uncertainty for a number of existing multinational (European and global) material flow accounting (MFA) data compilations and discusses sources of inconsistencies and variations for some indicators and trends. The results show that the methodology has reached a certain maturity: Coefficients of variation between databases lie in the range of 10% to 20%, and correlations between databases across countries amount to an average R2 of 0.95. After discussing some of the research frontiers for further methodological development, we conclude that the material flow accounting framework and the data generated have reached a maturity that warrants material flow indicators to complement traditional economic and demographic information in providing a sound basis for discussing national and international policies for sustainable resource use.

Climate change confronts the health care sector with a dual challenge. Accumulating climate impacts are putting an increased burden on the service provision of already stressed health care systems in many regions of the world. At the same time, the Paris agreement requires rapid emission reductions in all sectors of the global economy to stay well below the 2°C target. This study shows that in OECD countries, China, and India, health care on average accounts for 5% of the national CO 2 footprint making the sector comparable in importance to the food sector. Some countries have seen reduced CO 2 emissions related to health care despite growing expenditures since 2000, mirroring their economy wide emission trends. The average per capita health carbon footprint across the country sample in 2014 was 0.6 tCO 2 , varying between 1.51 tCO 2 /cap in the US and 0.06 tCO 2 /cap in India. A statistical analysis shows that the carbon intensity of the domestic energy system, the energy intensity of the domestic economy, and health care expenditure together explain half of the variance in per capita health carbon footprints. Our results indicate that important leverage points exist inside and outside the health sector. We discuss our findings in the context of the existing literature on the potentials and challenges of reducing GHG emissions in the health and energy sector.