The Green Print: Advancement of Environmental Sustainability in Healthcare

Sherman, Jodi D.; Thiel, Cassandra L.; MacNeill, Andrea; Eckelman, Matthew J.; Dubrow, Robert; Hopf, Harriet W.; Lagasse, Robert S.; Bialowitz, Joseph; Costello, Anthony; McGain, Forbes; Stancliffe, Rachel; Anastas, Paul T.; Anderko, Laura; Baratz, Mark E.; Barna, Stefi; Bhatnagar, Urvashi; Burnham, Jason P.; Cai, Yizhen; Cassels-Brown, Andy; Cimprich, Alexander; Cole, Heidi; Coronado-Garcia, Lorea; Duane, Brett; Grisotti, Gabriella; Hartwell, Arthy; Kumar, Varshini J.; Kurth, Ann; Leapman, Michael; Morris, Daniel S.; Overcash, Michael; Parvatker, Abhijeet G.; Pencheon, David; Pollard, Adam; Robaire, Bernard; Rockne, Karl J.; Sadler, Blair L.; Schenk, Beth; Sethi, Tushar; Sussman, L. Scott; Thompson, Jeff; Twomey, Janet M.; Vermund, Sten H.; Vukelich, Daniel; Wasim, Natasha; Wilson, Debbie; Young, Steven B.; Zimmerman, Julie; Bilec, Melissa M.

doi:10.1016/j.resconrec.2020.104882

Cited by 187 publications

(165 citation statements)

References 101 publications

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“…Interventions to mitigate MDI emissions include conversion to dry powder inhalers (with no gas propellant) when feasible, expanding patient education efforts to maximise correct usage, and incentivising pharmacy take-back programmes to safely dispose of partially spent MDIs. 36 Although only a small component of health-care activity, emissions from anaesthetic gases and MDIs can make up a substantial proportion of health-care emissions and should be considered with a dedicated stream of analysis.…”

Section: Discussionmentioning

confidence: 99%

Health care's response to climate change: a carbon footprint assessment of the NHS in England

Tennison¹,

Roschnik²,

Ashby

et al. 2021

The Lancet Planetary Health

483

268

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Background Climate change threatens to undermine the past 50 years of gains in public health. In response, the National Health Service (NHS) in England has been working since 2008 to quantify and reduce its carbon footprint. This Article presents the latest update to its greenhouse gas accounting, identifying interventions for mitigation efforts and describing an approach applicable to other health systems across the world. Methods A hybrid model was used to quantify emissions within Scopes 1, 2, and 3 of the Greenhouse Gas Protocol, as well as patient and visitor travel emissions, from 1990 to 2019. This approach complements the broad coverage of top-down economic modelling with the high accuracy of bottom-up data wherever available. Available data were backcasted or forecasted to cover all years. To enable the identification of measures to reduce carbon emissions, results were disaggregated by organisation type. Findings In 2019, the health service's emissions totalled 25 megatonnes of carbon dioxide equivalent, a reduction of 26% since 1990, and a decrease of 64% in the emissions per inpatient finished admission episode. Of the 2019 footprint, 62% came from the supply chain, 24% from the direct delivery of care, 10% from staff commute and patient and visitor travel, and 4% from private health and care services commissioned by the NHS. Interpretation This work represents the longest and most comprehensive accounting of national health-care emissions globally, and underscores the importance of incorporating bottom-up data to improve the accuracy of top-down modelling and enabling detailed monitoring of progress as health systems act to reduce emissions. Funding Wellcome Trust.

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Section: Discussionmentioning

confidence: 99%

Health care's response to climate change: a carbon footprint assessment of the NHS in England

Tennison¹,

Roschnik²,

Ashby

et al. 2021

The Lancet Planetary Health

483

268

View full text Add to dashboard Cite

show abstract

“…Educational reforms are needed to empower providers to take planetary health action, including embracing the profes sional duties of resource stewardship and environmentally preferable practice. 7 The codification of rational resource use into evidence-based clinical practice guidelines confers the added benefits of standardising best practices and augmenting medicolegal protection.…”

mentioning

confidence: 99%

“…Most published work on health-care sustainability and institutional action towards this goal has focused on decarbonising operations within health systems. 7 Optimising building environmental performance, decarbonising hospital energy supplies, and electrifying transport fleets are integral to net zero strategies. Decarbonisation of the UK's electrical grid has been the largest contributor to the NHS' reduced greenhouse gas emissions to date.…”

mentioning

confidence: 99%

Planetary health care: a framework for sustainable health systems

MacNeill

McGain

Sherman

2021

The Lancet Planetary Health

142

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“…Consequently, researchers attempting to include the impacts of producing equipment and consumables in their analyses, for example, are required to estimate the material composition of each item, match each material to the most appropriate unit process in an inventory database, and make assumptions about production processes. Inventory compilation and subsequent impact assessment of individual items or pharmaceuticals, therefore, have great utility for improving the accuracy and completeness of higher-level analyses ( Sherman et al. 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Operating in a Climate Crisis: A State-of-the-Science Review of Life Cycle Assessment within Surgical and Anesthetic Care

Drew

Christie

Tyedmers

et al. 2021

Environ Health Perspect

103

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BACKGROUND: Both human health and the health systems we depend on are increasingly threatened by a range of environmental crises, including climate change. Paradoxically, health care provision is a significant driver of environmental pollution, with surgical and anesthetic services among the most resource-intensive components of the health system. OBJECTIVES: This analysis aimed to summarize the state of life cycle assessment (LCA) practice as applied to surgical and anesthetic care via review of extant literature assessing environmental impacts of related services, procedures, equipment, and pharmaceuticals. METHODS: A state-of-the-science review was undertaken following a registered protocol and a standardized, LCA-specific reporting framework. Three bibliographic databases (Scopus ® , PubMed, and Embase ® ) and the gray literature were searched. Inclusion criteria were applied, eligible entries critically appraised, and key methodological data and results extracted. RESULTS: From 1,316 identified records, 44 studies were eligible for inclusion. The annual climate impact of operating surgical suites ranged between 3,200,000 and 5,200,000 kg CO 2 e. The climate impact of individual surgical procedures varied considerably, with estimates ranging from 6 to 1,007 kg CO 2 e. Anesthetic gases; single-use equipment; and heating, ventilation, and air conditioning system operation were the main emissions hot spots identified among operating room-and procedure-specific analyses. Single-use equipment used in surgical settings was generally more harmful than equivalent reusable items across a range of environmental parameters. Life cycle inventories have been assembled and associated climate impacts calculated for three anesthetic gases (2-85 kg CO 2 e=MAC-h) and 20 injectable anesthetic drugs (0:01-3:0 kg CO 2 e=gAPI). DISCUSSION: Despite the recent proliferation of surgical and anesthesiology-related LCAs, extant studies address a miniscule fraction of the numerous services, procedures, and products available today. Methodological heterogeneity, external validity, and a lack of background life cycle inventory data related to many essential surgical and anesthetic inputs are key limitations of the current evidence base. This review provides an indication of the spectrum of environmental impacts associated with surgical and anesthetic care at various scales.

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The Green Print: Advancement of Environmental Sustainability in Healthcare

Cited by 187 publications

References 101 publications

Health care's response to climate change: a carbon footprint assessment of the NHS in England

Health care's response to climate change: a carbon footprint assessment of the NHS in England

Planetary health care: a framework for sustainable health systems

Operating in a Climate Crisis: A State-of-the-Science Review of Life Cycle Assessment within Surgical and Anesthetic Care

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