CHALLENGES FOR THE DECARBONIZATION OF HEALTHCARE
DOI:
https://doi.org/10.56238/bocav24n73-004Keywords:
Carbon Footprint, Environmental Impact, Greenhouse Gases, Health Services, SustainabilityAbstract
The article discusses the challenges of decarbonization in the health sector, which is responsible for 4.4% of global greenhouse gas (GHG) emissions, but which is also a victim of the climate crisis. It aims to present evidence on the main contributions of this sector to Climate Change and for this, it carries out a review of recent studies that identify as the main sources of direct and indirect GHG emissions: energy consumption in hospitals; pharmaceutical products; anesthetic gases; disposable materials; transportation and management of solid waste. The supply sector is responsible for 71% of total emissions. The article also presents decarbonization strategies, such as: energy efficiency; replacement of disposable materials with reusable ones; sustainable management of solid waste; transportation with renewable fuel; "green" purchases and rational use of anesthetics and highlights that these measures are necessary to make health systems more resilient and environmentally sustainable.
References
ALSHQAQEEQ, F. et al. Quantifying hospital services by carbon footprint: a systematic literature review of patient care alternatives. Resources, Conservation and Recycling, vol.154, 104560, 2020. DOI: https://doi.org/10.1016/j.resconrec.2019.104560
AMERICAN HOSPITAL ASSOCIATION. The Health Care Leader’s Guide to Sustainability and Environmental Stewardship. Chicago: AHA, 2025.
AMERICAN METEREOLOGICAL SOCIETY. Climate Change. 2019. Disponível em: <https://www.ametsoc.org/sites/ams/assets/File/aboutams/statements_pdf/AMS_Statement_Climate_Change_April2019.pdf> Acesso em 29/07/2025.
ANG K.L. et al. Carbon footprint of non-melanoma skin cancer surgery. BJS Open, vol.8, n.5, 2024. DOI: https://doi.org/10.1093/bjsopen/zrae084
BELKHIR, L.; ELMELIGI, A. Carbon footprint of the global pharmaceutical industry and relative impact of its major players. Journal of Cleaner Production, vol.214, 2019. DOI: https://doi.org/10.1016/j.jclepro.2018.11.204
CHARLESWORTH, M.; SWINTON, F. Anaesthetic gases, climate change, and sustainable practice. Lancet Planet Health, vol.1, n.6, 2017. DOI: https://doi.org/10.1016/S2542-5196(17)30040-2
CHAWLA, S. et al. Electricity and generator availability in LMIC hospitals: improving access to safe surgery. J Surg Res, vol.223, 2018. DOI: https://doi.org/10.1016/j.jss.2017.10.016
CHUA, A. L. B. et al. The environmental impact of interventional radiology: an evaluation of greenhouse gas emissions from an academic interventional radiology practice. Journal of Vascular and Interventional Radiology, vol.32, n.6, 2021. DOI: https://doi.org/10.1016/j.jvir.2021.03.531
CHUNG, J.W.; MELTZER, D.O. Estimate of the carbon footprint of theUS health care sector. JAMA, vol.302, n.18, 2009. DOI: https://doi.org/10.1001/jama.2009.1610
CIAIS, P. et al. “Carbon and Other Biogeochemical Cycles”. In: STOCKER, T.F. et al. IPCC, 2013: Climate Change: the Physical Science Basis. Contribution of Working Group I to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change New York: Cambridge University Press, 2013.
CONNOR, A.; LILLYWHITE, R.; COOKE, M.W. The carbon footprint of a renal service in the United Kingdom. Quarterly Journal of Medicine, vol. 103, n.12, 2010. DOI: https://doi.org/10.1093/qjmed/hcq150
CONRARDY, J. et al. Reducing medical waste. Association of Operating Room Nurses Journal, vol.91, n.6, 2010. DOI: https://doi.org/10.1016/j.aorn.2009.12.029
CRONK, R.; BARTRAM, J. Environmental conditions in health care facilities in low- and middle-income countries: Coverage and inequalities. International Journal of Hygiene and Environmental Health, vol.221, n.3, 2018. DOI: https://doi.org/10.1016/j.ijheh.2018.01.004
CUNHA, M. F.; PELLINO, G. Environmental effects of surgical procedures and strategies for sustainable surgery. Nature Reviews Gastroenterology & Hepatology, vol.20, n.6, 2023. DOI: https://doi.org/10.1038/s41575-022-00716-5
DICONSIGLIO J. Reprocessing SUDs reduces waste, costs. Materials Management in Health Care, vol.17, n.9, 2008.
DREVINSKAS, E.; SHING, E; VERBEET, T. Trade in medical goods stabilises after peaking during pandemic, 2023. World Trade Organization. Disponível em: <https://www.wto.org/english/blogs_e/data_blog_e/blog_dta_23may23_e.htm> Acesso: 03/12/2025.
ECKELMAN, M.J.; SHERMAN, J. Environmental Impacts of the U.S. Health Care System and Effects on Public Health. PLoS One, vol.11, n.6, 2016. DOI: https://doi.org/10.1371/journal.pone.0157014
ECKELMAN, M.J.; SHERMAN, J.D.; MACNEILL, A.J. Life cycle environmental emissions and health damages from the Canadian healthcare system: an economic-environmental-epidemiological analysis. PLOS Medicine, vol.15, n.7. 2018. DOI: https://doi.org/10.1371/journal.pmed.1002623
FENG, R.; LI, Z. Current investigations on global N2O emissions and reductions: prospect and outlook. Environmental Pollution, v. 338, 2023. DOI: https://doi.org/10.1016/j.envpol.2023.122664
FERRERO, A. et al. The carbon footprint of cataract surgery in a French University Hospital. Journal Français d’Ophtalmologie, vol. 45, n.1, 2022. DOI: https://doi.org/10.1016/j.jfo.2021.08.004
FRIEDERICY, H. et al. Greenhouse gas emissions due to inhalation anaesthetics in the Netherlands, usage data and a survey of preferences among Dutch anaesthesiologists. European Journal of Anaesthesiology Intensive Care, vol.4, n.1, 2024. DOI: https://doi.org/10.1097/EA9.0000000000000065
GADANI, H.; VYAS, A. Anesthetic gases and global warming: Potentials, prevention and future of anesthesia. Anesthesia, Essays and Researches, vol.5, n.1, 2011. DOI: https://doi.org/10.4103/0259-1162.84171
GATENBY, P.A.C. Modelling the carbon footprint of reflux control. International Journal of Surgery, vol.9, n.1, 2011. DOI: https://doi.org/10.1016/j.ijsu.2010.09.008
HASIYA, Y. et al. Travel-associated carbon emissions of patients receiving cancer treatment from an urban safety net hospital. Future Hospital Journal, vol.11, n.4, 2024. DOI: https://doi.org/10.1016/j.fhj.2024.100174
HEALTH CARE WITHOUT HARM, Arup. Health care’s climate footprint: how the health sector contributes to the global climate crisis and opportunities for action. Reston: HCWH, 2019.
INTERGOVERNMENTAL PANEL ON CLIMATE CHANGE. Climate change 2023: synthesis report. sixth assessment report. Contribution of Working Groups I, II and III to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. Geneva: IPCC, 2023.
ISHIZAWA, Y. General anesthetic gases and the global environment. Anesthesia & Analgesia, vol.112, n.1, 2011. DOI: https://doi.org/10.1213/ANE.0b013e3181fe02c2
JERIN, A. et al. Recent progress on carbon footprint assessment of healthcare services. Environmental Research Communications, vol.6, n.10, 2024. DOI: https://doi.org/10.1088/2515-7620/ad7e83
LACROUTE, J. et al. The carbon footprint of ambulatory gastrointestinal endoscopy. Endoscopy, vol.55, n.10, 2023. DOI: https://doi.org/10.1055/a-2088-4062
LENZEN, M.; MALIK, A.; MENGYU, L. The carbon footprint of Australian health care. The Lancet Planetary Health, vol.2, n.1, 2020.
LIM, A.E.; PERKINS, A.; AGAR, J.W. The carbon footprint of an Australian satellite haemodialysis unit. Australian Health Review, vol. 37, n.3, 2013. DOI: https://doi.org/10.1071/AH13022
LIU, Y. et al. Nitrous oxide use in Australian health care: strategies to reduce the climate impact. Anesthesia & Analgesia, vol.137, n.4, 2023. DOI: https://doi.org/10.1213/ANE.0000000000006620
MACNEILL, A.; LILLYWHITE, R.; BROWN, C. The impact of surgery on global climate: a carbon footprinting study of operating theatres in three health systems. The Lancet Planetary Health, vol.1, n.9, 2017. DOI: https://doi.org/10.1016/S2542-5196(17)30162-6
MALIK, A. et al. The carbon footprint of Australian health care. The Lancet Planetary Health, vol.2, n.1, 2018. DOI: https://doi.org/10.1016/S2542-5196(17)30180-8
MCALISTEr, S. et al. The carbon footprint of pathology testing Medical Journal of Australia, vol.212, n.8, 2020. DOI: https://doi.org/10.5694/mja2.50583
MCALISTER, S. et al. The carbon footprint of hospital diagnostic imaging in Australia The Lancet Regional Health-Western Pacific, vol.3, n.24, 2022. DOI: https://doi.org/10.1016/j.lanwpc.2022.100459
MCALISTER, S. et al. The Carbon Footprint of Peritoneal Dialysis in Australia. Journal of the American Society of Nephrology, vol.35, n.8, 2024. DOI: https://doi.org/10.1681/ASN.0000000000000361
MCGAIN, F. et al. The carbon footprint of treating patients with septic shock in the intensive care unit. Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine, vol.20, n.4, 2018. DOI: https://doi.org/10.1016/S1441-2772(23)00970-5
MCGAIN. F. et al. Carbon footprint of general, regional, and combined anesthesia for total knee replacements. Anesthesiology, vol.135, n.6, 2021. DOI: https://doi.org/10.1097/ALN.0000000000003967
MCMICHAEL, A.J.; LINDGREN, E. Climate change: present and future risks to health, and necessary responses. Journal of Internal Medicine, vol.270, n.5, 2011. DOI: https://doi.org/10.1111/j.1365-2796.2011.02415.x
MICHTENBERG, A. et al. Health care during electricity failure: the hidden costs. PLoS One, vol.15, n.11, 2020. DOI: https://doi.org/10.1371/journal.pone.0235760
MORRIS, D.S. et al. The carbon footprint of cataract surgery. Eye (Lond), vol.27, n.4, 2013. DOI: https://doi.org/10.1038/eye.2013.9
NANSAI, K. et al. Carbon footprint of Japanese health care services from 2011 to 2015. Resources, Conservation and Recycling, vol.152, 2020. DOI: https://doi.org/10.1016/j.resconrec.2019.104525
NATIONAL HEALTH SERVICE. Delivering a ‘net zero’. London: NHS, 2020.
NATIONAL HEALTH SERVICE. England carbon emissions carbon footprinting report. London: NHS, 2009.
NATIONAL HEALTH SERVICE. Reducing the use of natural resources in health and social care. 2018 report. Cambridge: NHS, 2018.
NICOLET, J. et al. What is the carbon footprint of primary care practices? A retrospective life-cycle analysis in Switzerland. Environmental Health, vol.21, n.1, 2022. DOI: https://doi.org/10.1186/s12940-021-00814-y
ORGANISATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT. Securing Medical Supply Chains in a Post-Pandemic World. OECD Health Policy Studies. Paris: OECD, 2024.
ORGANISATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT. Decarbonising Health Systems Across OECD Countries. OECD Health Policy Studies. Paris: OECD, 2025.
OU, Z.; SEPPÄNEN, A.V. The role of the health sector in tackling climate change: A narrative review. Health Policy, vol.143, n.10363, 2024. DOI: https://doi.org/10.1016/j.healthpol.2024.105053
PACHECO, M.R.P.S.; MARCONDES HELENE, M.E. Atmosfera, fluxos de carbono e fertilização por CO2. Estudos Avançados, vol.4, n.9,1990. DOI: https://doi.org/10.1590/S0103-40141990000200010
PARKER, G.; MILLER, F.A. Tackling Pharmaceutical Pollution Along the Product Lifecycle: Roles and Responsibilities for Producers, Regulators and Prescribers. Pharmacy, vol.12, n.6, 2024. DOI: https://doi.org/10.3390/pharmacy12060173
PICHLER, P.P. et al. International comparison of health care carbon footprints. Environmental Research Letters, vol.14, n.6, 2019. DOI: https://doi.org/10.1088/1748-9326/ab19e1
PINTO, T.P. et al. Panorama das Emissões de Metano e Implicações do Uso de Diferentes Métricas. Boletim Informativo da FGV, n.4, 2022.
POWER, N.E., et al. Environmental impact of minimally invasive surgery in the United States: an estimate of the carbon dioxide footprint. Journal of Endourology, vol.26, n.12, 2012. DOI: https://doi.org/10.1089/end.2012.0298
PRASAD, P.A. et al. Environmental footprint of regular and intensive inpatient care in a large US hospital. The International Journal of Life Cycle Assessment, vol.27, n.1, 2022. DOI: https://doi.org/10.1007/s11367-021-01998-8
RASHEED, F.N. et al. Decarbonising healthcare in low and middle income countries: potential pathways to net zero emissions. BMJ, vol.9, 2021. DOI: https://doi.org/10.1136/bmj.n1284
RIZAN, C. et al. The carbon footprint of surgical operations: a systematic review. Annals of Surgery, vol.272, n.6, 2020. DOI: https://doi.org/10.1097/SLA.0000000000003951
ROMANELLO, M. et al. The 2023 report of the Lancet countdown on health and climate change: the imperative for a health-centred response in a world facing irreversible harms. Lancet, vol.402, n.10419, 2023.
SEGLENIEKS, R. et al. Discrepancy between procurement and clinical use of nitrous oxide: waste not, want not. British Journal of Anaesthesia, vol.128, n.1, 2022 DOI: https://doi.org/10.1016/j.bja.2021.10.021
SHARMA, R. et al. The impact of incinerators on human health and environment. Reviews on environmental health, vol.28, n.1, 2013. DOI: https://doi.org/10.1515/reveh-2012-0035
SHOHAM, M.A. et al. The environmental impact of surgery: a systematic review. Surgery, vol.172, n.3, 2022. DOI: https://doi.org/10.1016/j.surg.2022.04.010
SIAU, K.; HAYEE, B.H.; GAYAM, S. Endoscopy’s current carbon footprint. Techniques and Innovations in Gastrointestinal Endoscopy, vol.23, n.4, 2021. DOI: https://doi.org/10.1016/j.tige.2021.06.005
SPECK, C.L.; MAGER, N.A.D.; MAGER, J.N. Pharmacists’ perception of climate change and its impact on health, Journal of the American Pharmacists Association, vol.63, n.4, 2023. DOI: https://doi.org/10.1016/j.japh.2023.04.004
TENNISON, I. et al. Health care's response to climate change: a carbon footprint assessment of the NHS in England. The Lancet Planetary Health, vol.5, n.2, 2021. DOI: https://doi.org/10.1016/S2542-5196(20)30271-0
THIEL, C.L. et al. Environmental impacts of surgical procedures: life cycle assessment of hysterectomy in the United States. Environmental science & technology, vol.49, n.3, 2015. DOI: https://doi.org/10.1021/es504719g
TOMSON, C. Reducing the carbon footprint of hospital based care. Future Healthcare Journal, vol.2, n.1, 2015. DOI: https://doi.org/10.7861/futurehosp.2-1-57
WATTS, N.; MOONESINGHE, E.; FOREMAN, C. Putting anaesthetic emissions to bed: commitment on desflurane, 2023 Disponível em: <https://www.england.nhs.uk/blog/putting-anaesthetic-emissions-to-bed> Acesso em: 03/2/2025.
WORLD ECONOMIC FORUM. Quantifying the impact of climate change on human health. Insight Report January 2024. Geneva: WEF, 2024.
WORLD HEALTH ORGANIZATION. COP26 Special Report on Climate Change and Health: the health argument for climate action. Geneva: WHO, 2021.
WORLD RESOUCES INSTITUTE. World Resources Report 2010-2011: decision making in a changing climate. Washington: WRI, 2011.
YASNY, J.S.; WHITE, J. Environmental Implications of Anesthetic Gases. Anesthesia progress, vol.59, n.4, 2012. DOI: https://doi.org/10.2344/0003-3006-59.4.154
YUSUF, H. et al. Travel-associated carbon emissions of patients receiving cancer treatment from an urban safety net hospital. Future Healthcare Journal, vol.11, n.4, 2024. DOI: https://doi.org/10.1016/j.fhj.2024.100174
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c). Conjuncture Bulletin (BOCA)
This work is licensed under a Creative Commons Attribution 4.0 International License.
