Summary Course GW4016MV Sustainable Healthcare Organisations
Include lectures!
Week 1: Impact
Learning objectives:
Understand the impact that healthcare has on the environment
List the different dimensions of healthcare’s impact on the environment
Being able to distinguish between scope 1, 2 and 3 emissions
For a specific healthcare service or product, identify in which ways it may impact the
environment
Literature:
Lenzen, M., Malik, A., Li, M., Fry, J., Weisz, H., Pichler, P. P., ... & Pencheon, D. (2020). The
environmental footprint of health care: a global assessment. The Lancet Planetary
Health, 4(7), e271-e279.
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.
Introduction
Greenhouse gas emissions and climate change are an important pathway of the negative
health impact resulting from the environmental footprint of health care. The health-care
sector causes a large share of the total footprint. Panel of indicators that are relevant to
health outcomes and that enable a cycle of adverse feedback to be captured:
1. greenhouse gas emissions,
a. Changing climate due to an increase in greenhouse gas emissions will lead to
an increase in disease and injury incidents—eg, as a result of heat waves,
cyclones, floods, and droughts, which in turn will lead to a potential increase
in healthcare costs and greenhouse gas emissions.
2. particulate matter (PM), air pollutants (nitrogen oxides [NOx] and sulphur dioxide
[SO2]),
a. The same cycle of adverse feedback exists for emissions of PM, NOx, and SO2,
which cause an increase in air pollution and health-care costs because of
respiratory disease incidence, in turn further increasing the air pollution
footprint of health care.
3. malaria risk,
a. Deforestation creates favourable conditions for the spread of malaria and
other vectors, which again increases health-care costs and the environmental
footprint of infectious disease treatment.
4. reactive nitrogen in water, and
a. Mostly entering healthcare operations though supply chains (indirect
contribution to total footprint).
5. scarce water use.
, a. Water scarcity is measured as water consumption weighted by a scarcity
index. It is responsible for insufficient access to clean water, resulting in
cholera, diarrhoea, and typhoid fever.
Various environmental impacts of the operation and procurement practices of health-care
sectors harm population health.
The origin of environmental impacts is distributed differently between on-site contributions
and supply chains in low-income countries compared with middle-income and high-income
countries.
- for health-care systems in developing countries, interventions that improved the
technical efficiency of basic provisioning systems (eg, energy, buildings, and
transport) could allow better healthcare provision while reducing environmental
impact.
- in high-income countries, higher environmental efficiency is accompanied by high
health-care expenditures and reported wasteful practices. Interventions should focus
on reducing waste (particularly reducing the use of unnecessary plastics, single-use
items, drugs, journeys, and interventions more generally). Reducing pollution is
equally important, especially greenhouse gas emissions, including anaesthetic gases
and asthma inhaler propellants, and air pollution, especially from health-care-related
transport.
Two further priorities apply to health-care systems in both high-income and low-income
countries.
1. First, they must adapt the current models of health-care provision to the
environmental impacts already occurring, including more frequent, more intense,
and longer heatwaves, floods, fires, and other extreme events.
2. The second priority is to understand that health services can not only reduce harm,
but can also add social and health benefits to the communities they serve in addition
to the direct health benefits from high-quality care (adding so-called social value).
,Rodríguez‐Jiménez, L., Romero‐Martín, M., Spruell, T., Steley, Z., & Gómez ‐Salgado, J.
(2023). The carbon footprint of healthcare settings: A systematic review. Journal of
Advanced Nursing, 79(8), 2830–2844.
Carbon footprint is the sum of direct and indirect emissions of GHGs secondary to a process,
a product or an organization and is calculated in Carbon Dioxide equivalent (CO2e).
The Greenhouse Gas Protocol (2022) classifies carbon emissions in three scopes:
1. scope 1 or direct emissions are those related to the use of energy (without including
purchased electricity) and on which the organization has direct control,
a. for example, the use of fuel for heating;
2. scope 2 or indirect emissions are those related to purchased electricity or the use of
electricity that has been produced somewhere else; and
3. scope 3, which encompasses the rest of indirect emissions emitted by an organization
and of which production is not controlled by the organization.
Between 15% and 50% of the total emissions corresponded to scopes 1 and 2 emissions,
whereas scope 3 emissions ranged between 50% and 75% of the total emissions.
Disposables, equipment (medical and non-medical) and pharmaceuticals represented the
higher percentage of emissions in scope 3.
- Staff travel and building infrastructure were also found to have a significant impact
on the emissions, ranging between 10% and 15%. Water, waste and patient travel
represented low levels of emissions. Data regarding carbon emissions secondary to
catering were limited.
- the two largest contributors of scope 3 carbon emissions were medical equipment
(13.1%) and pharmaceuticals (12.1%), and that is mainly due to the emissions caused
by manufacturing, packaging and transport of goods.
Conclusion: Most of the emissions corresponded to scope 3, which includes the indirect
emission occurring as a consequence of the healthcare activity, as this scope includes a
wider range of emission sources than the other scopes.
Regarding scopes 1 and 2,
- the geographic location of the analysed functional unit might influence the results.
o little use of heating and air conditioner in this functional unit because of the
specific weather conditions
- Another factor that could influence scopes 1 and 2 emissions was the age of the
buildings.
o new hospitals produced less carbon emissions derived from energy and
electricity than an old one.
- Overall, scopes 1 and 2 emissions proved to be linked, as those studies that found
higher levels of emissions in scope 1 had lower emissions in scope 2, and vice versa.
o Reducing scopes 1 and 2 emissions can be achieved by introducing renewable
energy in healthcare units as well as the use of insulation materials in the
renovation and construction of new buildings.
o Furthermore, optimized electrical installations by improving air conditioning
and heating systems could lead to a further reduction in energy use.
, o Energy efficiency improvements could lead to a 47.0% reduction in energy
use.
The use of certain anaesthetic gases can have a significant impact on the environment.
- anaesthetic gases such as desflurane versus isoflurane and/or sevoflurane could lead
to a 46.0% increase.
o the use of anaesthetic gases with low global warming potential, as well as
limiting their use when possible, could reduce the carbon footprint.
It is important to understand that the carbon footprint of an item represents indirect
emissions for the user; however, its production will require energy and electricity (scopes 1
and 2); thus, most carbon emissions come from energy that might be direct or indirect
depending on where it is used.
Interventions to reduce the environmental impact.
Interventions such as the installation of solar panels in roofs and parking lots in hospitals,
changing to a vegetable-based hospital menu, replacing telemedicine for face-to-face
appointments when possible, promoting active transport and/or introducing effective
lighting and energy appliances, have shown to have a significant impact in the reduction of
carbon footprint.
- the carbon footprint of a hospital supply chain could be minimized by reducing the
demand of goods and services.
o This can be achieved by restricting unnecessary patient attendance and
diagnostic testing, minimizing human error and/or avoiding duplication of
processes, such as previous consultations or testing in different services.
However, this raises the question whether admissions versus ambulatory patients would
increase or decrease carbon emissions as, for example, the use of transport-related
emissions would be greater.
- telemedicine could significantly reduce the carbon emissions secondary to travelling
as well as the demand in healthcare settings. The use of telemedicine could mean an
opportunity to reduce attendances in settings such as primary healthcare, where the
carbon emissions secondary to patient and staff travelling are much higher than in
other healthcare settings.
Using low-impact imaging when appropriate and limiting unnecessary testing is
recommended to reduce the carbon footprint.
Human errors such as incidents related to drugs or treatments may also lead to an increase
in the carbon footprint.
- For example, the wrong administration of a drug can lead to anaphylaxis and,
therefore, to an increase in the items and resources used.
- Another example could be a surgery that is not properly performed, and, as a result,
another surgery needs to be carried out, leading to the utilization of more resources
as well as longer hospital stay of the patient.
Include lectures!
Week 1: Impact
Learning objectives:
Understand the impact that healthcare has on the environment
List the different dimensions of healthcare’s impact on the environment
Being able to distinguish between scope 1, 2 and 3 emissions
For a specific healthcare service or product, identify in which ways it may impact the
environment
Literature:
Lenzen, M., Malik, A., Li, M., Fry, J., Weisz, H., Pichler, P. P., ... & Pencheon, D. (2020). The
environmental footprint of health care: a global assessment. The Lancet Planetary
Health, 4(7), e271-e279.
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.
Introduction
Greenhouse gas emissions and climate change are an important pathway of the negative
health impact resulting from the environmental footprint of health care. The health-care
sector causes a large share of the total footprint. Panel of indicators that are relevant to
health outcomes and that enable a cycle of adverse feedback to be captured:
1. greenhouse gas emissions,
a. Changing climate due to an increase in greenhouse gas emissions will lead to
an increase in disease and injury incidents—eg, as a result of heat waves,
cyclones, floods, and droughts, which in turn will lead to a potential increase
in healthcare costs and greenhouse gas emissions.
2. particulate matter (PM), air pollutants (nitrogen oxides [NOx] and sulphur dioxide
[SO2]),
a. The same cycle of adverse feedback exists for emissions of PM, NOx, and SO2,
which cause an increase in air pollution and health-care costs because of
respiratory disease incidence, in turn further increasing the air pollution
footprint of health care.
3. malaria risk,
a. Deforestation creates favourable conditions for the spread of malaria and
other vectors, which again increases health-care costs and the environmental
footprint of infectious disease treatment.
4. reactive nitrogen in water, and
a. Mostly entering healthcare operations though supply chains (indirect
contribution to total footprint).
5. scarce water use.
, a. Water scarcity is measured as water consumption weighted by a scarcity
index. It is responsible for insufficient access to clean water, resulting in
cholera, diarrhoea, and typhoid fever.
Various environmental impacts of the operation and procurement practices of health-care
sectors harm population health.
The origin of environmental impacts is distributed differently between on-site contributions
and supply chains in low-income countries compared with middle-income and high-income
countries.
- for health-care systems in developing countries, interventions that improved the
technical efficiency of basic provisioning systems (eg, energy, buildings, and
transport) could allow better healthcare provision while reducing environmental
impact.
- in high-income countries, higher environmental efficiency is accompanied by high
health-care expenditures and reported wasteful practices. Interventions should focus
on reducing waste (particularly reducing the use of unnecessary plastics, single-use
items, drugs, journeys, and interventions more generally). Reducing pollution is
equally important, especially greenhouse gas emissions, including anaesthetic gases
and asthma inhaler propellants, and air pollution, especially from health-care-related
transport.
Two further priorities apply to health-care systems in both high-income and low-income
countries.
1. First, they must adapt the current models of health-care provision to the
environmental impacts already occurring, including more frequent, more intense,
and longer heatwaves, floods, fires, and other extreme events.
2. The second priority is to understand that health services can not only reduce harm,
but can also add social and health benefits to the communities they serve in addition
to the direct health benefits from high-quality care (adding so-called social value).
,Rodríguez‐Jiménez, L., Romero‐Martín, M., Spruell, T., Steley, Z., & Gómez ‐Salgado, J.
(2023). The carbon footprint of healthcare settings: A systematic review. Journal of
Advanced Nursing, 79(8), 2830–2844.
Carbon footprint is the sum of direct and indirect emissions of GHGs secondary to a process,
a product or an organization and is calculated in Carbon Dioxide equivalent (CO2e).
The Greenhouse Gas Protocol (2022) classifies carbon emissions in three scopes:
1. scope 1 or direct emissions are those related to the use of energy (without including
purchased electricity) and on which the organization has direct control,
a. for example, the use of fuel for heating;
2. scope 2 or indirect emissions are those related to purchased electricity or the use of
electricity that has been produced somewhere else; and
3. scope 3, which encompasses the rest of indirect emissions emitted by an organization
and of which production is not controlled by the organization.
Between 15% and 50% of the total emissions corresponded to scopes 1 and 2 emissions,
whereas scope 3 emissions ranged between 50% and 75% of the total emissions.
Disposables, equipment (medical and non-medical) and pharmaceuticals represented the
higher percentage of emissions in scope 3.
- Staff travel and building infrastructure were also found to have a significant impact
on the emissions, ranging between 10% and 15%. Water, waste and patient travel
represented low levels of emissions. Data regarding carbon emissions secondary to
catering were limited.
- the two largest contributors of scope 3 carbon emissions were medical equipment
(13.1%) and pharmaceuticals (12.1%), and that is mainly due to the emissions caused
by manufacturing, packaging and transport of goods.
Conclusion: Most of the emissions corresponded to scope 3, which includes the indirect
emission occurring as a consequence of the healthcare activity, as this scope includes a
wider range of emission sources than the other scopes.
Regarding scopes 1 and 2,
- the geographic location of the analysed functional unit might influence the results.
o little use of heating and air conditioner in this functional unit because of the
specific weather conditions
- Another factor that could influence scopes 1 and 2 emissions was the age of the
buildings.
o new hospitals produced less carbon emissions derived from energy and
electricity than an old one.
- Overall, scopes 1 and 2 emissions proved to be linked, as those studies that found
higher levels of emissions in scope 1 had lower emissions in scope 2, and vice versa.
o Reducing scopes 1 and 2 emissions can be achieved by introducing renewable
energy in healthcare units as well as the use of insulation materials in the
renovation and construction of new buildings.
o Furthermore, optimized electrical installations by improving air conditioning
and heating systems could lead to a further reduction in energy use.
, o Energy efficiency improvements could lead to a 47.0% reduction in energy
use.
The use of certain anaesthetic gases can have a significant impact on the environment.
- anaesthetic gases such as desflurane versus isoflurane and/or sevoflurane could lead
to a 46.0% increase.
o the use of anaesthetic gases with low global warming potential, as well as
limiting their use when possible, could reduce the carbon footprint.
It is important to understand that the carbon footprint of an item represents indirect
emissions for the user; however, its production will require energy and electricity (scopes 1
and 2); thus, most carbon emissions come from energy that might be direct or indirect
depending on where it is used.
Interventions to reduce the environmental impact.
Interventions such as the installation of solar panels in roofs and parking lots in hospitals,
changing to a vegetable-based hospital menu, replacing telemedicine for face-to-face
appointments when possible, promoting active transport and/or introducing effective
lighting and energy appliances, have shown to have a significant impact in the reduction of
carbon footprint.
- the carbon footprint of a hospital supply chain could be minimized by reducing the
demand of goods and services.
o This can be achieved by restricting unnecessary patient attendance and
diagnostic testing, minimizing human error and/or avoiding duplication of
processes, such as previous consultations or testing in different services.
However, this raises the question whether admissions versus ambulatory patients would
increase or decrease carbon emissions as, for example, the use of transport-related
emissions would be greater.
- telemedicine could significantly reduce the carbon emissions secondary to travelling
as well as the demand in healthcare settings. The use of telemedicine could mean an
opportunity to reduce attendances in settings such as primary healthcare, where the
carbon emissions secondary to patient and staff travelling are much higher than in
other healthcare settings.
Using low-impact imaging when appropriate and limiting unnecessary testing is
recommended to reduce the carbon footprint.
Human errors such as incidents related to drugs or treatments may also lead to an increase
in the carbon footprint.
- For example, the wrong administration of a drug can lead to anaphylaxis and,
therefore, to an increase in the items and resources used.
- Another example could be a surgery that is not properly performed, and, as a result,
another surgery needs to be carried out, leading to the utilization of more resources
as well as longer hospital stay of the patient.
