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Benedetto V, Ferrè F, Nuti S. Including environmental and social sustainability in the planning process of healthcare services: A case study of cancer screening programs in an inner area in Italy. Health Policy 2024; 144:105074. [PMID: 38652936 DOI: 10.1016/j.healthpol.2024.105074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/20/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
Healthcare systems plan their activities to achieve efficiency and effectiveness, without addressing environmental and social sustainability. This paper describes a new approach adopted in Italy to plan and deliver health prevention services in an inner area of the Tuscany region (in Italy) to guarantee proximity of care and environmental and social sustainability. The project examines the design and delivery of cancer screening programmes using a mobile screening unit to maximise social benefits while minimising environmental waste. A cost analysis was developed to estimate the difference in CO2 equivalent emissions, travel costs, and productivity losses, comparing the current screening programmes against the introduction of a comprehensive full-service mobile screening unit. The results indicate that the new service model reduces direct non-medical costs incurred by the population and improves environmental sustainability. This alternative can reduce, annually, over 95,000 euros in terms of travel costs and productivity losses, as well as 35 tons of CO2-equivalent travel emissions for a population of 59,000 inhabitants in a mountainous area with around 6000 people involved in the screening programme. The study supports the need to adopt a new planning methodology that considers environmental, social, and financial sustainability jointly in the provision of public health services in rural areas.
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Affiliation(s)
- Vera Benedetto
- Interdisciplinary Research Center for Health Science, Scuola Superiore Sant'Anna, Via Martiri della Libertà, 33, Pisa, PI 56127, Italy.
| | - Francesca Ferrè
- Management and Health Laboratory, Institute of Management-Department Embeds, Scuola Superiore Sant'Anna, Via Martiri della Libertà, 33, Pisa, PI 56127, Italy
| | - Sabina Nuti
- Interdisciplinary Research Center for Health Science, Scuola Superiore Sant'Anna, Via Martiri della Libertà, 33, Pisa, PI 56127, Italy
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Wilkinson A, Maslova E, Janson C, Xu Y, Haughney J, Quint JK, Budgen N, Menzies-Gow A, Bell J, Crooks MG. Environmental Sustainability in Respiratory Care: An Overview of the healthCARe-Based envirONmental Cost of Treatment (CARBON) Programme. Adv Ther 2022; 39:2270-2280. [PMID: 35279810 PMCID: PMC9056443 DOI: 10.1007/s12325-022-02076-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/04/2022] [Indexed: 12/01/2022]
Abstract
Introduction Faced with the challenges of climate change, countries are seeking to decarbonise their economies. A greater understanding of what comprises the carbon footprint of care in healthcare systems will identify potential strategies for reduction of greenhouse gas (GHG) emissions. In respiratory care, the focus has been on preventer inhalers, thereby omitting contributions from other aspects such as healthcare resource utilisation (HCRU) and reliever inhaler use. The healthCARe-Based envirONmental cost of treatment (CARBON) programme aims to provide a broader understanding of the carbon footprint associated with respiratory care. Methods CARBON will quantify the carbon footprint of medications and HCRU among approximately 2.5 million patients with respiratory diseases from seven ongoing studies spanning more than 40 countries. Across studies, to obtain the carbon footprint of all inhaled, oral, and injectable medications, SimaPro life cycle assessment software modelling resource and energy consumption data, in addition to Ecoinvent® data sets and certified published studies, will be used. The carbon footprint of HCRU in the United Kingdom will be estimated by applying the methodology and data obtained from the Sustainable Healthcare Coalition Care Pathway Guidance. Planned Outcomes In asthma, CARBON studies will quantify GHG emissions associated with well-controlled versus not well-controlled asthma, the contribution of short-acting β2-agonist (SABA) reliever inhalers (and their potential overuse) to the carbon footprint of care, and how implementation of treatment guidelines can drive improved outcomes and footprint reduction. In chronic obstructive pulmonary disease (COPD), CARBON studies will assess the impact of exacerbation history on GHG emissions associated with HCRU and SABA use in subsequent years and estimate the carbon footprint associated with all aspects of COPD care. Conclusion CARBON aims to show that the principle of evidence-led care focused on improvement of clinical outcomes has the potential to benefit patients and the environment.
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Affiliation(s)
- Alex Wilkinson
- Respiratory Department, Lister Hospital, East and North Hertfordshire NHS Trust, Coreys Mill Lane, Stevenage, Hertfordshire, SG1 4AB, UK.
| | | | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | | | | | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
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Affiliation(s)
- Renee N Salas
- Harvard Global Health Institute, Cambridge, MA, USA
- Center for Climate, Health, and the Global Environment, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Edward Maibach
- Center for Climate Change Communication, George Mason University, Fairfax, VA, USA
| | - David Pencheon
- Medical and Health School, University of Exeter, Exeter, UK
| | - Nick Watts
- Lancet Countdown: Tracking Progress on Health and Climate Change, London, UK
| | - Howard Frumkin
- University of Washington School of Public Health, Seattle, WA, USA
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Life cycle assessment as decision support tool for environmental management in hospitals: A literature review. Health Care Manage Rev 2019; 46:12-24. [PMID: 31116121 DOI: 10.1097/hmr.0000000000000248] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Life cycle assessment (LCA) is an environmental accounting tool aimed at determining environmental impacts of products, processes, or organizational activities over the entire life cycle. Although this technique already provides decision-makers in other sectors with valuable information, its application in the health care setting has not yet been examined. PURPOSE The aim of this study was to provide a comprehensive overview of scientific research on the application of LCA in hospitals and its contribution to management decision-making. METHOD We perform a systematic literature review by searching a range of databases with synonyms of "LCA" in combination with the term "hospital" in order to identify peer-reviewed studies. The final sample of 43 studies were then subjected to a content analysis. RESULTS We categorize existing research and show that single and multi-indicator LCA approaches are used to examine several products and processes in hospitals. The various approaches are favored by different scientific communities. Whereas researchers from environmental sciences perform complex multi-indicator LCA studies, researchers from health care sciences focus on footprints. The studies compare alternatives and identify environmental impacts and harmful hotspots. PRACTICE IMPLICATIONS LCA results can support health care managers' traditional decision-making by providing environmental information. With this additional information regarding the environmental impacts of products and processes, managers can implement organizational changes to improve their environmental performance. Furthermore, they can influence upstream and downstream activities. However, we recommend more transdisciplinary cooperation for LCA studies and to place more focus on actionable recommendations when publishing the results.
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Frumkin H. The US Health Care Sector's Carbon Footprint: Stomping or Treading Lightly? Am J Public Health 2017; 108:S56-S57. [PMID: 29072935 DOI: 10.2105/ajph.2017.304160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Howard Frumkin
- Howard Frumkin is with the Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle
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Richardson J, Allum P, Grose J. Changing undergraduate paramedic students' attitudes towards sustainability and climate change. ACTA ACUST UNITED AC 2016. [DOI: 10.12968/jpar.2016.8.3.130] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Janet Richardson
- Professor of health service research, Faculty of Health and Human Sciences, Plymouth University
| | - Peter Allum
- Paramedic lecturer, Peninsula Allied Health Centre, School of Health Professions, Faculty of Health and Human Science, Plymouth University
| | - Jane Grose
- Post-doctoral senior research fellow in sustainability and health, Faculty of Health and Human Sciences, Plymouth University
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Woods DL, McAndrew T, Nevadunsky N, Hou JY, Goldberg G, Yi-Shin Kuo D, Isani S. Carbon footprint of robotically-assisted laparoscopy, laparoscopy and laparotomy: a comparison. Int J Med Robot 2015; 11:406-12. [DOI: 10.1002/rcs.1640] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 12/16/2014] [Accepted: 12/18/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Demetrius L. Woods
- Emory University School of Medicine; Department of Obstetrics and Gynecology; Emory Midtown Hospital Atlanta GA 30308 USA
| | - Thomas McAndrew
- Albert Einstein College of Medicine; Division of Gynecologic Oncology, Montefiore Medical Center, Department of Obstetrics and Gynecology and Women's Health; Bronx NY USA
| | - Nicole Nevadunsky
- Albert Einstein College of Medicine; Division of Gynecologic Oncology, Montefiore Medical Center, Department of Obstetrics and Gynecology and Women's Health; Bronx NY USA
| | - June Y. Hou
- Albert Einstein College of Medicine; Division of Gynecologic Oncology, Montefiore Medical Center, Department of Obstetrics and Gynecology and Women's Health; Bronx NY USA
| | - Gary Goldberg
- Albert Einstein College of Medicine; Division of Gynecologic Oncology, Montefiore Medical Center, Department of Obstetrics and Gynecology and Women's Health; Bronx NY USA
| | - Dennis Yi-Shin Kuo
- Albert Einstein College of Medicine; Division of Gynecologic Oncology, Montefiore Medical Center, Department of Obstetrics and Gynecology and Women's Health; Bronx NY USA
| | - Sara Isani
- Robert Wood Johnson Medical School; Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science; New Brunswick NJ USA
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Brown LH, Blanchard IE. Sustainable emergency medical service systems: how much energy do we need? Am J Emerg Med 2014; 33:190-6. [PMID: 25488338 DOI: 10.1016/j.ajem.2014.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/06/2014] [Accepted: 11/07/2014] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Modern emergency medical service (EMS) systems are vulnerable to both rising energy prices and potential energy shortages. Ensuring the sustainability of EMS systems requires an empirical understanding of the total energy requirements of EMS operations. This study was undertaken to determine the life cycle energy requirements of US EMS systems. METHODS Input-output-based energy requirement multipliers for the US economy were applied to the annual budgets for a random sample of 19 metropolitan or county-wide EMS systems. Calculated per capita energy requirements of the EMS systems were used to estimate nationwide EMS energy requirements, and the leading energy sinks of the EMS supply chain were determined. RESULTS Total US EMS-related energy requirements are estimated at 30 to 60 petajoules (10(15) J) annually. Direct ("scope 1") energy consumption, primarily in the form of vehicle fuels but also in the form of natural gas and heating oil, accounts for 49% of all EMS-related energy requirements. The energy supply chain-including system electricity consumption ("scope 2") as well as the upstream ("scope 3") energy required to generate and distribute liquid fuels and natural gas-accounts for 18% of EMS energy requirements. Scope 3 energy consumption in the materials supply chain accounts for 33% of EMS energy requirements. Vehicle purchases, leases, maintenance, and repair are the most energy-intense components of the non-energy EMS supply chain (23%), followed by medical supplies and equipment (21%). CONCLUSION Although less energy intense than other aspects of the US healthcare system, ground EMS systems require substantial amounts of energy each year.
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Affiliation(s)
- Lawrence H Brown
- Mt. Isa Centre for Rural and Remote Health, Faculty of Medicine, Health and Molecular Sciences, James Cook University, Townsville, QLD, Australia.
| | - Ian E Blanchard
- Alberta Health Services Emergency Medical Services, Calgary, Alberta, Canada; University of Calgary, Department of Community Health Sciences, Alberta, Canada
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Brown LH, Buettner PG, Canyon DV. The energy burden and environmental impact of health services. Am J Public Health 2012; 102:e76-82. [PMID: 23078475 DOI: 10.2105/ajph.2012.300776] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We reviewed the English-language literature on the energy burden and environmental impact of health services. METHODS We searched all years of the PubMed, CINAHL, and ScienceDirect databases for publications reporting energy consumption, greenhouse gas emissions, or the environmental impact of health-related activities. We extracted and tabulated data to enable cross-comparisons among different activities and services; where possible, we calculated per patient or per event emissions. RESULTS We identified 38 relevant publications. Per patient or per event, health-related energy consumption and greenhouse gas emissions are quite modest; in the aggregate, however, they are considerable. In England and the United States, health-related emissions account for 3% and 8% of total national emissions, respectively. CONCLUSIONS Although reducing health-related energy consumption and emissions alone will not resolve all of the problems of energy scarcity and climate change, it could make a meaningful contribution.
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Affiliation(s)
- Lawrence H Brown
- Anton Breinl Centre for Public Health and Tropical Medicine, James Cook University, Townsville, QLD, Australia.
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Brown LH, Canyon DV, Buettner PG, Crawford JM, Judd J. The carbon footprint of Australian ambulance operations. Emerg Med Australas 2012; 24:657-62. [DOI: 10.1111/j.1742-6723.2012.01591.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Lawrence H Brown
- Anton Breinl Centre for Public Health and Tropical Medicine; James Cook University; Townsville; Queensland; Australia
| | | | - Petra G Buettner
- Anton Breinl Centre for Public Health and Tropical Medicine; James Cook University; Townsville; Queensland; Australia
| | - J Mac Crawford
- Ohio State University College of Public Health; Columbus; Ohio; USA
| | - Jenni Judd
- Anton Breinl Centre for Public Health and Tropical Medicine; James Cook University; Townsville; Queensland; Australia
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Hess J, Bednarz D, Bae J, Pierce J. Petroleum and health care: evaluating and managing health care's vulnerability to petroleum supply shifts. Am J Public Health 2011; 101:1568-79. [PMID: 21778473 DOI: 10.2105/ajph.2011.300233] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Petroleum is used widely in health care-primarily as a transport fuel and feedstock for pharmaceuticals, plastics, and medical supplies-and few substitutes for it are available. This dependence theoretically makes health care vulnerable to petroleum supply shifts, but this vulnerability has not been empirically assessed. We quantify key aspects of petroleum use in health care and explore historical associations between petroleum supply shocks and health care prices. These analyses confirm that petroleum products are intrinsic to modern health care and that petroleum supply shifts can affect health care prices. In anticipation of future supply contractions lasting longer than previous shifts and potentially disrupting health care delivery, we propose an adaptive management approach and outline its application to the example of emergency medical services.
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Affiliation(s)
- Jeremy Hess
- Department of Emergency Medicine, School of Medicine, Emory University, Atlanta, GA 30303, USA.
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