Primum non nocere
Environment, health & equity
Both human health and the health systems we depend on are increasingly threatened by a range of environmental crises, including climate change.
Paradoxically, healthcare provision itself is a significant driver of environmental pollution, and is responsible for 2-5% of global greenhouse gas, sulfur dioxide, nitrogen oxide, and particulate matter emissions.¹
Contrary to the 'first, do no harm' axiom, healthcare pollution is associated with a substantial health burden. In the United States, conservative estimates suggest that healthcare pollution is responsible for a health burden similar to that caused by preventable medical errors.²
— "The progression of climate change is such that physicians urgently need to mobilize, not only with regard to research and treatment, but also and perhaps especially in terms of political action."
Environmental impacts of healthcare as a percentage of total global impact
Figure note: chart reproduced from Lenzen et al., 2020 (Figure 1). Impact contributions from healthcare to seven environmental parameters are reported as a percentage of total global impact.
Suggested citation: Lenzen M, Malik A, Li M, Fry J, Weisz H, Pichler PP, Chaves LS, Capon A, Pencheon D. The environmental footprint of health care: a global assessment. The Lancet Planetary Health. 2020 Jul 1;4(7):e271-9.
Healthcare professionals have a critical role to play in both reducing the environmental impacts of their workplace and advocating for the rapid decarbonization of society as a whole.
Furthermore, because nations and communities that have contributed least to environmental pollution are expected to suffer most from its impacts, healthcare workers also have a duty to advocate for greater health and environmental equity.⁶
Per capita healthcare-related climate pollution
Figure note: data from Lenzen et al., 2020. Unit, metric tonnes of carbon dioxide equivalents per capita.
Suggested citation: HealthLCA (2020). Per capita healthcare-related climate pollution [Figure]. Published online at HealthLCA.com. Retrieved from: healthlca.com/per-capita-climate-impact-of-health-systems [Online resource].
Measuring healthcare pollution
— Healthcare sustainability science explores dimensions of resource consumption and environmental emissions associated with healthcare activities. This emerging field provides tools and metrics to quantify the unintended consequences of healthcare delivery and evaluate effective approaches that improve patient safety while protecting public health.
Sherman et al., 2020
Assessing the environmental impacts of healthcare is the first step toward creating sustainable health systems. By identifying high impact activities and pointing toward more environmentally-friendly alternatives, such assessments provide impetus for evidence-based policy change.
There are two main approaches to measuring the environmental impacts of healthcare activities: process-based life cycle assessment (LCA) and economic input-output analysis.
Life cycle assessment is an internationally-standardized approach for quantifying the environmental impacts associated with the entire lifecycle (e.g. production through disposal) of a given product, process, or service. Life cycle assessment takes a so-called 'bottom-up' approach, measuring the energy and materials entering and exiting a defined system along with their environmental impacts. This approach is both very precise and well-suited to studying environmental impacts at the product-level (e.g. medical equipment and pharmaceuticals).
Economic input-output analysis, also referred to as environmental input-output analysis or economic input-output life cycle assessment (EIO-LCA), examines the relationships between various sectors of the economy, using aggregate expenditure data to assign environmental impacts to the system of interest. This 'top-down' approach is well-suited to estimating the impacts of highly complex systems, such as a hospitals or entire health systems, where a process-based LCA approach is simply not feasible or possible.
—heating & ventilation
—disposal & recycling
HealthcareLCA brings together environmental assessments of health systems, hospitals, healthcare services, surgical procedures, medical equipment, and pharmaceuticals into an open-access database.
What is HealthcareLCA?
From individual pharmaceuticals to entire health systems, researchers around the world are working hard to assess the environmental impacts of different aspects of healthcare. HealthcareLCA serves as an up-to-date repository for this work, bringing together new and existing assessments into one centralized and publicly accessible database.
HealthcareLCA identifies existing healthcare-related life cycle assessments and input-output analyses, extracts important methodological data and results from these studies, and tabulates these data into an interactive database. We also create charts from the data housed within the database to help visualize and communicate important findings.
In support of a rapid and evidence-based transition toward more sustainable health systems, we provide open-access to all of our data and charts, meaning that anyone is free to use, adapt, and build upon our work, as long as they meet some basic conditions.
HealthcareLCA aims to provide a valuable resource to the health community. Some of the potential benefits of our platform include:
The creation of HealthLCA was not commissioned by any funding agency in the public, commercial, or not-for-profit sectors. Our website and database is maintained free-of-charge.
Our annual operating expenses, which include the costs associated with hosting this platform online, total $350 CAD.
This amount is generously covered by the Creating Sustainable Health Systems in a Climate Crisis project within the Healthy Populations Institute, a multi-faculty research institute at Dalhousie University in Nova Scotia, Canada. This project is run in collaboration with the Centre for Sustainable Health Systems in Ontario, Canada and the Centre for Sustainable Healthcare in the UK.
maintenance & support
The HealthcareLCA platform was conceptualized in late 2020 by Jono Drew.
The groundwork for the HealthcareLCA database was laid during 2020 when Jono Drew and colleagues within the Healthy Populations Institute at Dalhousie University in Nova Scotia, Canada undertook a systematic review of life cycle assesments within surgical services.
Jono then extended this work to encompass the wider healthcare sector, identifying existing healthcare-related environmental assessments through a combined process of citation networking and specific literature searches. From each relevant data source, key methodological data were extracted and tabulated within a database. Jono then built the online platform to host the database and created a series of interactive charts from the housed data to help communicate pertinent findings.
Jono began collaborating with Chantelle Rizan in mid-2021. Together, the pair continued to update, refine, and improve the HealthcareLCA database and platform, while developing systems to support its long-term sustainability.
In late 2022 the HealthcareLCA platform gained formal support from CASCADES, the Healthy Populations Institute, and Brighton and Sussex Medical School. CASCADES is a Canadian capacity-building initiative to address healthcare’s contribution to the climate crisis led by the Centre for Sustainable Health Systems (based within the University of Toronto's Dalla Lana School of Public Health) in partnership with the Healthy Populations Institute at Dalhousie University, the Planetary Healthcare Lab at the University of British Columbia, and the Canadian Coalition for Green Health Care. CASCADES is funded by Environment and Climate Change Canada’s Climate Action and Awareness Fund for Community-Based Climate Action Projects.
HealthcareLCA endeavors to be as comprehensive as possible. If you are aware of a potentially relevant study that is not already included in our database, or believe that you have found a transcription error, we would appreciate hearing from you.
The creation of HealthcareLCA was not commissioned by any funding agency in the public, commercial, or not-for-profit sectors.
HealthLCA relies on generous support from the health community. To ensure that our database remains freely available, we depend on annual or one-off donations from individuals or organisations. Our annual fundraising target is $350 CAD. This simply covers the cost of hosting our platform online.
If you are interested in joining the global movement of healthcare workers fighting for a healthy and sustainable planet, get involved with one of the many advocacy groups.
1. Reduce health care’s climate footprint now
2. The health sector must support a societal transition to clean, renewable energy
3. Chart the course for zero emissions health care by 2050
4. Make development assistance for health climate-smart
5. Establish and implement government action plans for climate-smart health care
6. Deepen research on health care and climate change
Dr. Jono Drew
Project Lead and Creator
Jono is a junior doctor at Dunedin Hospital in Aotearoa New Zealand. He holds an adjunct appointment in the Department of Surgery on the academic staff of the Faculty of Medicine at Dalhousie University. He is a also a Scholar with Dalhousie's Healthy Populations Institute, and has research ties to the Climate Health Aotearoa Research Stream at the University of Otago in New Zealand.
Dr. Chantelle Rizan
PhD BSc(Hons) MBBCh MRes MRCS(ENT)
Chantelle Rizan is a Clinical Lecturer in Sustainable Healthcare at Brighton and Sussex Medical School, UK. Her PhD thesis evaluated ways to mitigate the carbon footprint of products used in the surgical operating theatre. Chantelle seeks to translate her research into practice, as founding member of the Royal College of Surgeons of England Sustainability in Surgery working group, and as academic advisor for a national report on Net Zero Surgery in collaboration with UK Health and Climate Change Alliance.
Sage is currently a master’s student at Queen’s University’s School of Environmental Studies in Ontario, Canada. Before her time at Queen’s, Sage studied at Dalhousie University, where she explored LCAs in a food systems context. Between degrees, Sage worked with Dalhousie University and the Nova Scotia Health Authority, where her interest in healthcare-related LCA research first developed.
What does open-access mean?
The data and charts presented on the HealthcareLCA platform are held under a Creative Commons Attribution-ShareAlike 4.0 International license. This means that anyone can use, adapt, and build upon our work, as long as they meet some simple conditions:
We also ask users of our material to cite and provide links to relevant external data sources.
Occasionally we reproduce charts from other publications and clearly indicate where this has been done. In these instances, the copyright remains with the authors of the original chart and those interested in using the material should refer back to work's original license. HealthcareLCA should not be credited in these instances.
We provide open-access to all of our data and charts, meaning that anyone is free to use, adapt, and build upon our work, as long as they meet some basic conditions.